Medicare coverage for weight loss drugs has been available only since July, and it is already reshaping who gets access to these medications. According to Eli Lilly CEO Dave Ricks, about 700,000 seniors have started GLP-1 treatment since coverage began, and roughly 70% of them are taking a Lilly product.
Ricks described the early rollout as very encouraging and said the growth in the overall GLP-1 market is in line with what the company had hoped for. His numbers are among the first clear signs of how much Medicare coverage is expanding access, and of which drugmaker is winning over new patients in the ongoing race between Lilly and its main rival, Novo Nordisk.
How the Coverage Works
Seniors are getting these drugs through a temporary program called Bridge. Eligible Medicare beneficiaries can obtain weight loss medications for a $50 monthly co-pay. Medicare serves people age 65 and older, along with people with certain disabilities, and covers about 66 million Americans in total.
Through Bridge, beneficiaries can choose from four options: Lilly’s Zepbound injection, Lilly’s new obesity pill Foundayo, and Novo’s Wegovy in both pill and injection form.
Injections Still Lead, but Pills Are Gaining
So far, Zepbound appears to be the biggest beneficiary of Medicare coverage. Ricks said physicians are still prioritizing patients with the most weight to lose and the most health complications, and that is where Zepbound has been doing much of the work.
Foundayo fills a different role. Ricks sees the pill as a fit for patients who want a more convenient option and have a more modest goal, perhaps 25 to 30 pounds. Although Foundayo launched in April, a few months after Novo’s competing pill, Ricks said it now accounts for about one third of new patients starting an oral GLP-1.
A Smooth Rollout So Far
Big program launches often come with headaches, but Ricks said he has heard of few logistical problems. He credited the Centers for Medicare & Medicaid Services with a well run rollout, including educating physicians and coordinating with drug manufacturers and the insurance system.
What This Means Going Forward
The early numbers show just how much pent up demand existed among seniors for these medications once cost was no longer the main barrier. For Medicare beneficiaries, a $50 monthly co-pay puts treatment within reach for many who could not afford it before. For the broader health care system, the pace of adoption raises real questions about long term cost, since Bridge is a temporary program and its future structure will matter a great deal.
For employers and individuals watching this space, the Medicare experience is worth following closely. How GLP-1 coverage performs among seniors will likely influence how commercial insurance plans approach these drugs in the years ahead.