Starting July 1, Medicare beneficiaries will have access to weight-loss drugs for the first time. There are some unique factors they should consider.
A temporary Medicare program is giving older adults who are trying to lose weight access to certain GLP-1s for $50 a month.
Many older adults in the U.S. will soon have access to GLP-1s for weight loss for the first time.
As part of a new Medicare program, people with Medicare Part D who meet the criteria can pay $50 per month for one of several weight-loss drugs: Novo Nordisk's (NVO) (DK:NOVO.B) Wegovy pill or injection or Eli Lilly's $(LLY)$ Foundayo pill or Zepbound KwikPen. About 3 million people are expected to qualify for the pilot program, according to Evercore ISI analysts.
However, doctors say there are several unique clinical factors that older adults should consider before starting one of the popular medications for weight loss. In addition, the Medicare program is temporary and is somewhat hard to navigate.
Unlike younger adults who may want to lose weight in order to look better or to get ahead of obesity-related conditions that could lead to decades of poor health, older people often have different priorities.
They may want to have more energy for their grandchildren or to be more physically active - or they may still be looking to prevent later-in-life health complications. Having more energy was the top reason older adults gave for wanting to take a GLP-1, while younger users said they want to feel confident, according to an intake survey conducted by the MeAgain GLP-1 tracker app.
"We focus on the number of pounds lost, and that, in particular for older adults, is not the way we need to think about things," said John Batsis, a geriatrician and obesity specialist at the University of North Carolina School of Medicine. "We need to think about: How do we improve health? How do we improve physical function?"
Higher rates of side effects
GLP-1s can present difficulties for older adults, who tend to experience higher rates of troublesome side effects like constipation, according to Alissa Chen, a primary-care doctor and obesity specialist at Yale Medicine, citing a recent Portuguese study that examined use of Novo Nordisk's semaglutide and the older GLP-1 liraglutide in older adults. These side effects can lead patients to stop treatment. When working with older adults, Batsis said he increases the dose far more slowly than is recommended on the drug's label to try to limit any side effects.
Before handing out a prescription, both doctors say they want to know as much as possible about each patient's digestion; the medications they already take; their exercise habits, including any resistance training; and the quality of their diet, particularly how much protein they eat. Since GLP-1 drugs work by mimicking the feeling of fullness, older patients can be at risk for malnutrition at a much more sensitive time of life.
They also have to figure out how to combat the muscle loss that is common with these drugs. For most people, muscle mass declines between 1% and 2% a year after age 35, and 3% a year after age 60, according to Harvard Medical School. For Americans with sarcopenic obesity, which is characterized by extra weight and reduced muscle mass in people mostly older than 65, frailty is a major concern.
"A loss of muscle mass in these patients could worsen physical function and result in a bad event like a fall," Chen said in an email. "I'm generally very cautious about starting a GLP-1 in my older adult patients who have functional impairments, like needing a walker to ambulate or needing assistance with transferring from a bed to a chair."
Until now, the only way that Medicare beneficiaries could get weight-loss medications was to pay in cash, because of a 2003 law that prevents Medicare from paying for prescription drugs for weight loss or gain. In recent years, some seniors have been prescribed covered GLP-1s for obesity-adjacent conditions like Type 2 diabetes and sleep apnea or to reduce the risk of stroke, heart attack and cardiovascular death, rather than for weight loss alone.
The Medicare GLP-1 Bridge program sidesteps those restrictions, allowing people with Part D coverage, if they qualify, to pay $50 a month for one of the selected drugs. The program starts July 1. CVS Health $(CVS)$ and Walmart $(WMT)$, including Sam's Club, both said this week that their clinicians will help Medicare beneficiaries figure out how to access the program. CVS has even launched a virtual weight-loss visit for $49.
That's because there are a few rules that make the program far more complex than it sounds. Each patient has to go through a prior-authorization process, and the $50 monthly copays fall outside Part D coverage, meaning they don't count toward a beneficiary's out-of-pocket costs.
More important, in order to qualify, Medicare patients must have a higher body mass index than the rest of the U.S. population needs to have in order to take these drugs. Older adults need to have a BMI of at least 35 (rather than 30 for the general population), or 27 (rather than 25) with a comorbidity like prediabetes or uncontrolled hypertension. The program is also temporary: It is set to expire at the end of 2027 after health insurers largely pushed back on their participation.
That's worrisome to physicians who treat these patients.
"If it's not renewed, you're going to have all these patients on these meds, and then they're going to stop them," Batsis said. "Not only will weight come back, comorbidities will come back, and we know from lifestyle studies ... when you gain it back, you're gaining more fat than muscle."
-Jaimy Lee
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(END) Dow Jones Newswires
June 24, 2026 11:35 ET (15:35 GMT)
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