Medicare will start covering weight-loss drugs on July 1 for the first time. Millions of Medicare enrollees will gain their first-ever coverage for drugs for weight loss under a temporary pilot program that launches July 1.
Who is Eligible?
Only certain Medicare enrollees are eligible. Not only must they be enrolled in a Part D drug coverage plan, they have to meet specific health criteria when they started taking GLP-1 medications, even if it preceded the launch of the Bridge program.
Those with a body mass index, or BMI, of 35 or more qualify. Those with a BMI between 30 and 35 must also have one of the following: uncontrolled high blood pressure, prediabetes, a previous heart attack or stroke, blocked arteries in arms or legs with symptoms, chronic kidney disease at Stage 3a or higher, or diastolic heart failure.
What Medications Can Beneficiaries Receive, and How?
The pilot program covers Wegovy tablets and injections, Zepbound KwikPens and Foundayo tablets. It does not cover single-dose Zepbound vials or pens.
Eligible enrollees interested in Zepbound and Foundayo can also go to LillyDirect Pharmacy, the drugmaker’s direct-to-consumer website.
“For many, this will be the first time obesity treatment has been within reach,” Ilya Yuffa, president of Lilly USA and Global Customer Capabilities, said in a statement.
How Much Will Enrollees Have to Pay?
Eligible enrollees will pay $50 for a month’s supply. However, that copayment does not count toward their annual deductible or out-of-pocket maximum.
Original reporting: 40/29 / KHBS (NW Arkansas) — read the source article.
