Pilot program to provide cheaper GLP-1 via Medicare stokes shortage fears

Kathryn, a retiree who worked in healthcare, has throughout her life experienced “cyclical weight-loss, weight-gain”.“Every time that that has happened, it’s been a little bit greater of the loss and the gain, which is really unhealthy,” said the 66-year-old who lives in Denver, Colorado, and requested that only her first name be used. At her heaviest, the 5ft 1in-woman weighed 220lbs.But like millions of people who struggled with obesity, Kathryn started taking a GLP-1 drug about two years ago and was able to break that cycle. She now weighs 133lbs.“My blood pressure is great; my cholesterol is great. I feel really good,” she said.But that health improvement comes at a high cost. Using Zepbound, an injectable GLP-1 which costs $450 each month, means Kathryn has not been able to afford to travel like she hoped in retirement. Lately, she has been stretching out the dosages, so that she can make each order last longer than a month.Luckily, some financial freedom may be on the horizon. On 1 July, the Centers for Medicare & Medicaid Services (CMS) will launch a pilot program that will allow some adults ages 65 and above to only pay $50 each month for a GLP-1 drug.Doctors who treat obesity say the initiative, GLP-1-bridge" class="entity-link entity-topic" data-entity-id="156264" data-entity-type="topic">Medicare GLP-1 Bridge, could help millions of older adults who, like Kathryn, struggle to pay for the drugs – or could not afford to even start taking them – but said that questions remain about the federal government’s administration of the program. Additionally, it’s only slated to be a temporary offering.“It’s a huge social and healthcare experiment to have this volume of people that are going to rely on the CMS website working; the pharmacy side working and the health system side all being able to process these prior authorizations in an efficient, effective way,” said Dr Annie Moore, an internist at CU Health in Denver. “This has never happened. I just don’t quite know how smooth it’s going to be.”In fall 2025, about 5 million US adults ages 65 and above – the population that is covered by Medicare – were taking a GLP-1 drug for weight loss or a chronic condition such as diabetes, according to a KFF Health survey.“They are super popular for a reason: they work really well,” said Dr Christopher Weber, an internist in Milwaukee who only sees patients struggling with obesity.Still, seniors were also much likelier than younger adults to stop using the drugs, in part because of the cost, KFF Health News reported.The GLP-1 Bridge program will cover three drugs, Foundayo, Wegovy and Zepbound, and be available to people who have Medicare Part D, an optional extra coverage to lower the cost of prescriptions. They also can’t have type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease because those conditions could already be covered by their drug plan and must have one of three conditions, including a body mass index of 35 or higher.If millions more people want to start taking a GLP-1, “the clinics are going to be busy”, Weber said. “It’s a process for these prior authorizations, so just keeping up with that demand and the administrative overhead is going to be a challenge.”Despite the new change, Moore estimates it could take three to four months before patients can get GLP-1 drugs for $50.“I think there is going to be a lot of frustration, particularly in our patients that are already paying cash because they know the benefits” of a GLP-1, Moore said, before adding that because many older adults have very limited income, “we still have a concern that some people will find $600 per year too expensive”.The Bridge program is slated to run until the end of 2027, prompting providers to raise concerns about what will happen if the government does not extend it as people typically regain the weight they lost after stopping a GLP-1.“It’s a temporary program; obesity is not a temporary problem,” said Dorothea Vafiadis, senior strategist for healthy aging at the National Council on Aging. When considering 2028, “people are scratching their heads, saying: ‘What will I do then?’”In the meantime, physicians such as Moore and Weber hope the program will allow more patients to start taking a GLP-1. Weber said that he talks with at least five patients each day who could benefit from such a drug but said they cannot afford it.Carmin, who also lives in Denver, said she was teased about her weight as a child and has had six 150-lb weight swings in her life. She had been interested in trying a GLP-1 but opted not to because she is saving for retirement. Now, she hopes to use the Bridge program.“The dream scenario for me is that by Christmas or next spring,” said Carmin, who works in healthcare, “I can get back into clothes I was wearing two years ago.”