A new KFF analysis finds that 3.8 million Medicare beneficiaries met the criteria to be eligible for the new Medicare GLP-1 Bridge, based on claims data from 2023.
The temporary 18-month program, launching on July 1 and running through December 2027, will provide coverage of three GLP-1s (Wegovy, Zepbound, and Foundayo) used for weight reduction and weight management to eligible beneficiaries who are enrolled in Medicare Part D.
The total cost to the federal government of the program will depend in part on what share of eligible beneficiaries participate, how quickly they take up coverage, and how many prescriptions each participating beneficiary fills during the 18-month period.
Based on the estimated 3.8 million Part D enrollees eligible, if 10% to 25% participate in Bridge beginning in July 2026 and fill a prescription each month for the duration of the program, the cost to Medicare would be $1.3 billion to $3.3 billion (at a net monthly cost of $245 minus the $50 beneficiary copay). If participation instead ranged from 50% to 75%, the cost to Medicare would be between $6.7 billion and $10 billion.
The clinical criteria for determining a Part D enrollee’s eligibility for Bridge include having a BMI of 35 or more; or having a BMI of 27 or more along with certain comorbid conditions. In addition, eligibility is limited to Part D enrollees who don’t have conditions treated by GLP-1 drugs that are currently covered under Part D, such as type 2 diabetes, and who have not filled a GLP-1 prescription in their Part D plan in 2026.
Although more than 13 million Medicare beneficiaries met the BMI thresholds for obesity or overweight based on diagnosis data in 2023, the analysis shows that a smaller group --9.7 million beneficiaries -- were enrolled in Part D and met the clinical criteria for the Medicare-GLP-1 Bridge, and an even smaller subset -- 3.8 million – met all of the eligibility criteria. That is because the potentially eligible population for Bridge is not as broad as if the program were targeted to all Medicare beneficiaries with obesity or overweight.
