Medicare offers pilot program that covers GLP-1 weight loss drugs

A recent Medicare change offers older Americans with obesity concerns a chance at affordable and possibly life-changing weight-loss drugs. The shift is particularly good news for rural Americans, who tend to be older and have higher obesity rates than their urban counterparts.

Beginning in July, Medicare beneficiaries "may be able to get a GLP-1 prescription for weight loss for $50 a month," reports Jackie Fortiér of KFF Health News. "It’s a notable shift for Medicare, which has long been barred from covering weight loss treatments."

Although weight-loss drugs, such as Zepbound and Wegovy, offer chronically overweight patients a way to lose weight that may cause other health issues, their prices have often put them out of reach for many Medicare patients. Fortiér explains, "They’re available in injection or pill form. Even with discounts, current cash prices typically range from $149 to $699 per month."

In an effort to address Medicare enrollees' obesity-driven health problems and budgetary restraints, the Centers for Medicare & Medicaid Services announced a "short-term pilot program known as the Medicare GLP-1 Bridge. It will run from July 1, 2026, through Dec. 31, 2027," Fortiér writes. "It’s meant to 'bridge' the gap before a longer-term program that might — or might not — begin in 2028."

The pilot program will cover most GLP-1 weight loss medicines, including the pill and injectable formulations of Wegovy, the KwikPen formulation of Zepbound, and the Foundayo pill, Fortiér reports.

Medicare enrollees should know that Medicare's GLP-1 Bridge is "not your typical Medicare benefit. Even though Part D enrollment is required, the Bridge program itself works differently," Fortiér explains. "Instead of going through your regular Part D plan, you will need prior authorization" which your doctor can send to CMS for processing. Physicians prescribing GLP-1 to Medicare patients don't have to be, or become, registered Medicare providers.

Read all the requirements and rules for Medicare GLP-1 Bridge coverage here.

A little-known pharmaceutical company that made billions selling opioids 'escapes' billions in fines and IRS payments

Endo began in 1920 as "Intravenous Products of America." Its website does not mention opioids;
instead it highlights the company's "past successes and history of expertise." (Endo photo)

A lesser-known pharmaceutical company named Endo made billions of dollars during the U.S. prescription opioid crisis by marketing its flagship opioid, Opana ER, as safe and non-addictive.

Despite whistleblower suits from Endo employees, the U.S. Department of Justice failed to pursue Endo, even as it vigorously prosecuted Purdue Pharma for its part in the opioid crisis, report Bob Fernandez of ProPublica and Craig R. McCoy of The Philadelphia Inquirer. The DOJ's investigative delay and the company's clever bankruptcy exit strategy allowed Endo to "escape $1.5 billion in fines and forfeitures" it owed and billions more "officials said it owed the U.S. government."

When the DOJ finally moved to prosecute Endo for its part in the opioid crisis, the company was bankrupt. "In what amounted to a liability fire sale by the Justice Department, the company’s woes with the federal government would all be resolved by a $200 million payment," Fernandez and McCoy explain. "In sentencing Endo in federal court Judge Linda Parker wondered how the amount paid to the U.S. could be so low. Parker said, 'I just don’t understand how it went from $1 billion to $200 million.' Federal prosecutor Benjamin Cornfeld explained: Endo was broke."

While Endo's 2024 financial troubles were real, a deeper look at the DOJ's delay after winning a criminal case against Endo in 2014, revealed how in those intervening years allowed Endo "vastly expanded its narcotic-pill empire before executing a corporate escape plan," Fernandez and McCoy write. "The plan allowed Endo to restructure its debt to retain control of the company and hand out $95 million in executive bonuses before seeking protection in bankruptcy."

DOJ's settlement with Endo concluded some of the company's financial troubles and "also mostly erased claims of another $1.5 billion for false health care billing and Medicare costs generated by the opioid crisis." In addition, "Endo paid a tiny fraction — three pennies on the dollar — of the $7 billion that officials said it owed the U.S. government, including $4 billion in taxes," Fernandez and McCoy explain. "Hundreds of lawyers, paralegals and financial advisers litigated Endo’s bankruptcy, billing more than $350 million. . . . Individual opioid victims didn’t fare as well. They got just $40 million from Endo — a sum that works out to about $1,000 per victim."