Anti-Obesity Medications and the Medicare GLP-1 Bridge Program

What I Want Patients to Know

By Lee Schnee, M.D.
Holton Family Medicine / Weight Management

Beginning July 1, 2026, a new Medicare GLP-1 Bridge Program is expected to expand access for many Medicare Part D enrollees to some of the latest medications used to treat obesity.

This is an exciting time in medicine. We now have safe and effective treatment options for a disease that causes significant physical and emotional distress for many people. Unfortunately, there is also a lot of misunderstanding, misinformation, and disinformation about these medications.

My goal is to help patients better understand why these medications may be considered, how they work, what risks should be discussed, and who may qualify for the new Medicare program.

Obesity Is Not Simply a Matter of Willpower

It is important to understand why we are looking at medications to help treat obesity.

Many people assume that people suffering from obesity do so because of poor life choices or lack of willpower. This simply is not true.

We now recognize that maintaining body weight involves a complex set of physical processes. This is similar to the way the body regulates blood pressure, blood sugar, sodium levels, and many other important functions.

When blood pressure regulation is not working correctly, we call that hypertension. When blood sugar regulation is not working correctly, we call that diabetes. In the same way, when weight regulation is not working correctly, obesity is a disease.

Like other chronic diseases, obesity often requires comprehensive, long-term, person-centered care. That care may include nutritional therapy, physical activity changes, behavioral modifications, and medications. All of these can be valid and important parts of a treatment plan.

Why GLP-1 Medications Are Getting So Much Attention

Recently, much of the attention in obesity medicine has focused on medications commonly called GLP-1s.

There is good reason for this. These medications are the most effective medications developed to date for obesity treatment.

However, GLP-1 medications are not the only option. There are still other good medication options if someone cannot afford GLP-1s or cannot tolerate them.

Because the new Medicare program is focused on GLP-1 medications, that will be the focus of this article.

GLP-1 medications are also not as new as many people think. The first medication in this class came out in 2005 (for diabetes), with the first approved for weight loss in 2014, meaning we have over 20 years of data for this group of medications.

Understanding the Medication Names

One area that can be confusing is the names of these medications.

The same medication may have different brand names depending on whether it is being used for diabetes or obesity.

For example:

• Ozempic is the brand name for semaglutide when used for diabetes.
• Wegovy is also semaglutide, but it is used to treat obesity and a few other indications.
• Mounjaro is the brand name for tirzepatide when used for diabetes.
• Zepbound is also tirzepatide, but it is used for obesity and sleep apnea.
• Foundayo, or orforglipron, is a different molecule altogether.

Your provider can help explain the differences and determine whether any of these medications may be appropriate for you.

How GLP-1 Medications Work

From the standpoint of obesity treatment, GLP-1 medications mainly work as strong appetite suppressants.

They can help reduce appetite, help people feel full sooner, and help the feeling of fullness last longer after a meal. They may also affect reward pathways in the brain, making high-fat and high-sugar foods feel less rewarding.

Possible Side Effects and Risks

Like any medication, GLP-1 medications can have side effects.

Many people have no side effects. When side effects do occur, they are often mild and may improve over time. However, some people can have more severe side effects. In general, about 6–10% of people stop these medications because of side effects.

The most common side effects involve the gastrointestinal system. These may include nausea, vomiting, constipation, diarrhea, belching, and abdominal pain.

The most common side effect I see is nausea. Even then, it is often mild and often improves over time.

Other possible side effects can include injection site reactions, fatigue, dizziness, low blood sugar, especially in some patients with diabetes, and muscle loss. Muscle loss is something that should be monitored and can often be helped by good protein intake and resistance training.

There are also larger concerns that should be discussed before starting medication. These include potential risks related to the gallbladder, pancreatitis, gastroparesis, and one type of thyroid cancer called medullary thyroid cancer. The thyroid cancer concern was found in rats and mice given GLP-1 medications, but there are biological reasons to believe this may not translate to humans, and studies involving humans have generally been inconclusive.

This is why it is important to talk with a medical provider before starting these medications. Your provider can review your medical history, current medications, risks, and goals.

Some side effects have also been sensationalized on social media. For example, “Ozempic face” is caused by the rapid weight loss that can occur with the medication. It has not been shown to be a direct effect of the medication itself. Hair loss can also happen with weight loss in general. In the vast majority of cases, once weight stabilizes, the hair loss stops.

Benefits I Have Seen in Patients

Despite potential side effects, these medications work very well for many people and have been shown to have positive health benefits in many different areas.

In my own patients, I have seen reduction in weight and incredible improvement in diabetes control. I have also seen improvement in joint pain, mood, and sleep, even before significant weight loss has occurred.

Many patients have also described a major reduction in “food noise.” For some, this means they feel free from constantly thinking about food for the first time they can remember.

These medications also have anti-inflammatory effects that we are just beginning to study and understand. I believe more positive benefits of these medicines will be found over time.

Learn more about my complete obesity medicine program on our website HERE.

What Happens If Someone Stops Taking the Medication?

The most common question I get about these medications is what happens if or when someone stops taking them.

Because obesity is recognized as a chronic disease, these medications are intended for long-term use. Medically, there is not a need to stop the medication once weight goals have been achieved.

It is also important to remember that medication is only one part of a treatment plan. If medication, nutritional changes, physical activity changes, or behavioral modifications are stopped, the underlying disease is still present, and weight is very likely to come back.

This is not unique to GLP-1 medications. It is the natural consequence of stopping treatment for a chronic disease.

Cost and Access Have Been Major Barriers

One of the biggest concerns with these medications has been, and continues to be, cost, insurance coverage, and access.

The new Medicare GLP-1 Bridge Program may significantly expand access for some Medicare patients.

In 2003, the Medicare Modernization Act made it illegal for Medicare to cover medications used solely for weight loss. Disappointingly, this has not changed.

What has changed is that the Medicare GLP-1 Bridge Program will allow some Medicare Part D beneficiaries and people with Medicare Advantage plans with drug coverage to access these medications at a lower cost if they meet specific criteria.

When the Medicare GLP-1 Bridge Program Starts

The program starts July 1, 2026, and runs through December 31, 2027.

At this time, it is not entirely clear what will happen with coverage after the program ends.

Medicare GLP-1 Bridge information from CMS

Who Does Not Qualify for the Bridge Program?

To qualify for the Medicare GLP-1 Bridge Program, a patient cannot already have a diagnosis that would qualify them for GLP-1 therapy otherwise.

These diagnoses include:

• Type 2 diabetes
• Moderate or severe obstructive sleep apnea
• Noncirrhotic metabolic dysfunction-associated steatohepatitis, also called MASH

Medicare Part D plans already cover GLP-1 medications for these indications. Individuals with any of these conditions do not qualify for the bridge program because they should already be able to access these medications through their plan.

Who May Qualify?

Eligibility criteria for the Medicare GLP-1 Bridge Program are more restrictive than the general FDA indications for these medications.

Eligibility is based on Body Mass Index, or BMI, and other health conditions.

A patient may qualify with:

BMI greater than 35

No other health condition is required.

BMI greater than 30 with one of the following:

• Uncontrolled hypertension, meaning blood pressure remains over 140/90 despite treatment with two blood pressure medications
• Chronic kidney disease
• Heart failure with preserved ejection fraction

BMI greater than 27 with one of the following:

• Prediabetes
• History of heart attack
• History of stroke
• Symptoms from peripheral arterial disease, also called PAD

Because eligibility is specific, patients should talk with their provider and Medicare drug plan to determine whether they qualify.

What Will the Medication Cost Through the Program?

If a person qualifies for the program, they can receive one of the covered GLP-1 medications for $50 per month.

The GLP-1 medications covered through this program include:

• Wegovy, either injection or pill form
• Zepbound KwikPen
• Foundayo

A New Opportunity for Many Patients

Obesity medicine has been revolutionized by medications that can complement lifestyle changes and make a lasting impact on the health of many people.

Now, through the Medicare GLP-1 Bridge Program, access to these medications may significantly increase for many people in our community.

If you are interested in these medications, I encourage you to reach out to your provider to see whether they may be appropriate for you.

You may also schedule an appointment with me at Holton Family Medicine. Together, we can develop a comprehensive plan to help you reach your goals.

To schedule an appointment with Dr. Lee Schnee at Holton Family Medicine, call 785-364-2126.

Please note: Coverage, eligibility, medication availability, and out-of-pocket costs may vary. Patients should speak with their healthcare provider and Medicare Part D plan or Medicare Advantage drug plan to confirm whether they qualify for the Medicare GLP-1 Bridge Program.

FAQ’s

What is the Medicare GLP-1 Bridge Program?

The Medicare GLP-1 Bridge Program is a temporary program beginning July 1, 2026. It may help eligible Medicare Part D beneficiaries and Medicare Advantage patients with drug coverage access certain GLP-1 medications at a lower monthly cost.

Why are GLP-1 medications used for obesity treatment?

GLP-1 medications can help reduce appetite, help people feel full sooner, and help fullness last longer after meals. For some patients, they may be part of a broader obesity treatment plan.

Is obesity considered a chronic disease?

Yes. Obesity is recognized as a chronic disease. It can involve complex physical processes that affect hunger, fullness, metabolism, and weight regulation.

Are GLP-1 medications right for everyone?

No. GLP-1 medications are not right for everyone. However, GLP-1 medications are not the only option. There are still other good medication options if someone cannot afford GLP-1s or cannot tolerate them.

Patients should talk with a medical provider about their health history, risks, current medications, and treatment goals.

What are common side effects of GLP-1 medications?

Common side effects may include nausea, vomiting, constipation, diarrhea, belching, and abdominal pain. Some people have no side effects, while others may not tolerate the medication well.

What happens if someone stops taking a GLP-1 medication?

Because obesity is recognized as a chronic disease, it is important to remember that medication is part of a treatment plan. If medication, nutritional changes, physical activity changes, or behavioral modifications are stopped, the underlying disease is still present, and weight is very likely to come back.

Who may qualify for the Medicare GLP-1 Bridge Program?

Eligibility is based on specific Medicare drug coverage requirements, BMI, and certain health conditions. Patients should talk with their provider and Medicare drug plan to determine whether they qualify.

How can I schedule an appointment with Dr. Lee Schnee?

To schedule an appointment with Dr. Lee Schnee at Holton Family Medicine, call 785-364-2126.