health
The Medicare GLP-1 discount is here, so why are some sick people excluded?
In January, Jeff La Marca got a prescription for the popular weight loss drug Zepbound. But he couldn’t afford the $750 monthly price tag.
TL;DR
- Medicare launched an 18-month pilot program offering GLP-1 medications for weight loss at $50 per month.
- The program excludes individuals with specific medical conditions, such as Type 2 diabetes or obstructive sleep apnea, even if they have a high BMI.
- Those excluded are directed back to their Medicare Part D plans, which can result in monthly copays of hundreds of dollars.
- Jeff La Marca, a Medicare enrollee with severe sleep apnea and obesity, was denied access to the discount program.
- Federal law previously barred Medicare from covering drugs solely for weight loss, making the pilot program a notable development.
- The exclusion is based on whether the GLP-1 is used solely for weight loss versus treating an approved medical condition.
- Critics argue the program leaves behind patients with the greatest medical need.
- The cost to Medicare of the program is estimated to be billions of dollars depending on enrollment.