Medicare's pilot GLP-1 discount program has a catch. Some sick patients don't qualify
A Medicare pilot program offering discounted GLP-1 weight loss drugs is excluding some patients due to specific pre-existing conditions. Many patients, including those with severe health risks, are finding themselves ineligible for the $50 monthly price.
Why it matters
The exclusion criteria highlight gaps in healthcare access for high-risk patients seeking treatment for obesity-related conditions.
In January, Jeff La Marca got a prescription for the popular weight loss drug Zepbound. But he couldn't afford the $750 monthly price tag.
This story was produced in partnership with KFF Health News .
Then Medicare launched an 18-month pilot program that offers GLP-1 medications to some enrollees for only $50 a month. La Marca thought he might finally be able to afford the drug.
"I thought, 'Thank God, there's a path,'" said La Marca, who lives in Basking Ridge, N.J., and has tried numerous diets and exercise regimes.
But the 68-year-old's celebration was short-lived.
His application to the pilot program was denied.
La Marca has severe obstructive sleep apnea, one of several diagnoses that exclude patients from the Medicare GLP-1 Bridge program's $50 monthly price.
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