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Starting today, some Medicare beneficiaries can get popular obesity medications for a relatively low copay. NPR pharmaceuticals correspondent Sydney Lupkin has more.
SYDNEY LUPKIN, BYLINE: A new program is kicking off to help Medicare beneficiaries access GLP-1 drugs for $50 a month. It includes Wegovy, Zepbound and Foundayo, Eli Lilly's new obesity pill, which can cost hundreds of dollars a month out of pocket. Here's Dr. Mehmet Oz. He leads the Centers for Medicare and Medicaid Services, which is funding access to the drugs.
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MEHMET OZ: The goal we have is very simple - to improve access, encourage better health outcomes and gather the data needed to inform future innovation.
LUPKIN: It's called the Bridge program. Dr. Dace Trence is the president of the American Association of Clinical Endocrinology. She says it will expand access to these drugs, but not everyone will qualify.
DACE TRENCE: There are some caveats. So it's not, like, 100%, I want to lose some weight, so I want to go on this medication. It's not quite the way it works.
LUPKIN: She says patients must have Medicare drug coverage through a Part D plan, and there are tiers of eligibility. If someone has a body mass index of over 35, they're covered. They're also covered if they have a BMI over 30 with another qualifying condition, like having had a previous heart attack or having uncontrolled high blood pressure despite taking at least two medications for it. And if they have a BMI between 27 and 30, there's another list of qualifying conditions. Here's Trence again.
TRENCE: I think the excitement that it would cover everyone in Medicare unfortunately has been dampened a bit by the fact it does not cover everybody in Medicare.
LUPKIN: If someone meets the eligibility criteria, they'll need more than just a prescription. They'll also need their doctors to fill out a form explaining why they qualify and get it approved by Medicare. It's called a prior authorization and could make the program clunky. Trence says she hopes things will get smoother with time.
The Bridge program is designed as a test, and it's temporary - only lasting until the end of 2027. The nonpartisan health policy research group KFF estimates that Medicare's coverage for these drugs could help nearly 4 million patients and cost taxpayers more than $1.3 billion.
Sydney Lupkin, NPR News.
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