A new Medicare pilot program offers GLP-1 weight loss drugs for $50 a month, but patients with certain pre-existing conditions are ineligible for the discount.

Medicare has launched an 18-month pilot program to provide GLP-1 medications for weight loss at a cost of $50 per month for eligible enrollees. However, patients with specific health conditions, such as moderate to severe obstructive sleep apnea or Type 2 diabetes, are excluded from the program. These individuals are instead directed to their standard Medicare Part D plans, which often require significantly higher monthly copays.

Program Eligibility and Exclusions

The pilot program, which began in July, covers Wegovy, Zepbound, and Foundayo. To qualify for the $50 price, patients must be enrolled in Medicare Part D and generally have a body mass index (BMI) of 35 or higher. Those with a BMI between 27 and 34 may qualify if they have conditions like prediabetes or cardiovascular disease. The program is specifically designed for those using the drugs solely for weight loss; patients with FDA-approved conditions for GLP-1 treatment are ineligible for the discount.

Financial Impact and Patient Access

The cost to the federal government for the pilot depends on enrollment numbers, with estimates suggesting costs could range from $3.3 billion to $10 billion depending on participation rates. While CMS reports that thousands of beneficiaries have accessed the drugs through the program, some patients face high out-of-pocket costs through their standard Part D plans. Physicians note that these patients often face complex prior authorization requirements and high copays, sometimes ranging from $200 to $600 per month.