The Medicare GLP-1 Discount Has One Big Catch: Some Sick Patients Don’t Qualify

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. 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, New Jersey, 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 Bridge program’s $50 monthly price. The notification didn’t say why he was rejected. He thinks that if he didn’t have that diagnosis, he would qualify due to his weight. “I’m obese, morbidly obese, BMI 42. I had quadruple heart bypass surgery. I’m at risk for stroke. I’m prediabetic. And yet I can’t get it. I’m livid,” he said. A Temporary Patch for a Long-Standing Gap About 1 in 5 American adults have taken a GLP-1 medication, and most of them, including those with health insurance, say the drugs are difficult to afford. Fed...