As you might know, Medicare plans cover many GLP-1 medications for diabetes but currently do not cover them for treating weight control issues. Starting this July, Medicare will provide coverage for subscribers who are most overweight but could also have conditions like pre-diabetes or uncontrolled hypertension. Those who qualify will pay $50/month for any dosage amount of many of the GLP-1 drugs like Foundayo, Zepbound and Wegovy (injectable or tablet form).
The program will be completely outside of your current Medicare Advantage or Part D prescription plan. Your doctor will have to submit a prior authorization form, and it will be processed by insurance carrier Humana. If the authorization is approved, it can be filled at any pharmacy.
There are 2 important caveats:
1. Since the benefit is outside of your existing coverage, your plan’s deductible and $2100 annual maximum out-of-pocket limit do not apply. In other words, you could be out-of-pocket the new $50/month copay plus up to another $2100 if you have other expensive drugs.
2. The new benefit is temporary and might or might not be renewed after 2027. Due to the projected cost to Medicare, the benefit could end as of 1/01/2028.
You will probably start seeing lots of information on this new benefit. If you have questions, feel free to call us and we will try to answer them. Details are still rather undefined.