A temporary pilot program in Medicare will begin July 1. This program will allow individuals to get GLP-1, as weight loss drug, and similar weight loss medicines Wegovy, Foundayo, and Zepbound for a co-pay of $50.

Until this point, Medicare was prohibited from providing weight loss medication.

To be eligible, an individual should have Medicare part D insurance or Medicare Advantage and must have criteria. A prior authorization request is required. One of the interesting features is that meeting the body mass index (BMI) guidelines may not be required. If someone in the past has met the BMI guidelines, they are eligible.

The first group are those with a BMI of 35 or more. An index of 35 would be someone who is 5 foot, 10 inches tall, and weigh around 240 pounds.

The second group are those with a BMI over 30, who also have a single risk factor such as diabetes, heart, disease, hypertension, kidney disease. For someone around 5’10” tall, the 30 BMI weight would be 210 pounds.

The third group are those with a BMI over 27 who have more than one risk factor. For someone who is 5’10” tall, this would be a weight of around 190 pounds.

On Jan. 1, 2027, Medicare will also have a negotiated price for weight-loss meds, but it is unclear at this point what the costs will be.

–Ron Asher, North Platte

Body Mass Index is a calculation that uses a person’s height and weight to estimate body fat and categorize weight status as underweight, healthy weight, overweight, or obese. A healthy BMI range for adults is typically between 18.5 and 24.9, according to the American Heart Association. – Editor

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