Senior GLP-1 use surges 21% following Bridge launch

Medicare's experiment to increase seniors' access to affordable GLP-1 medications continued to attract more beneficiaries in its first three months, according to a new analysis from the healthcare analytics firm Truveta. 

GLP-1 prescribing among adults 65 years and older increased by nearly 21% between June and September, marking the month right before Medicare launched the GLP-1 Bridge program through its initial months. 

The CMS launched the program on July 1 to give more beneficiaries access to GLP-1s, including brand-name Wegovy, Zepbound and Foundayo, for weight management. Eligible beneficiaries pay just $50 a month for the prescriptions, a significant reduction from the hundreds of dollars people typically pay for the drugs. 

The program drew about 600,000 sign-ups by Aug. 31, according to CMS Administrator Dr. Mehmet Oz, supporting a previous Truveta analysis of GLP-1 prescribing data, which recorded the largest month-to-month increase among seniors in the last seven years. 

Prescribing is still up, according to the updated data, with 21% more first-time GLP-1 users among those 65 years and older. 

GLP-1 prescribing rates among seniors also outpaced those among younger age groups, with the younger groups remaining relatively stable this summer. However, the analysis found very modest decreases in prescribing rates among those aged 18-34 (-2.6%) and 35-49 (-1.2%). 

This may reflect shifting coverage policies among employer-sponsored health plans, which have pulled back on coverage of GLP-1s specifically for weight loss due to cost concerns. 

Meanwhile, Truveta researchers said the growth among seniors likely points to pent-up demand, especially among those who previously couldn't afford the drugs or access them at all due to Medicare coverage restrictions on weight management. 

GLP-1 prescribing saw a boom following implementation of the Bridge program but had started to stabilize heading into the fall. 

Researchers noted several limitations to their analysis, including not identifying which patients specifically qualified for the Bridge program, which has strict eligibility criteria based on body mass index and health conditions. 

Still, the increases in GLP-1 prescribing among adults who are Medicare age coincided with the launch of the program. 

These numbers may not last, though, as the Bridge program is slated to end in 2027. The CMS designed the program as a stepping stone to its upcoming BALANCE Model, which stands for Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth. BALANCE is a five-year pilot program that will integrate weight-loss GLP-1s into standard Part D plans, as well as Medicaid. 

The Bridge program stands outside of Medicare Part D, allowing the CMS to circumvent strict coverage rules, like the federal ban on Medicare covering any weight management drugs. But it also protects insurance plans from the premium shock of expanding coverage of GLP-1s to weight management. 

Integrating weight-loss drugs into Part D would make millions of seniors eligible for these expensive drugs, creating massive volatility for payers that sponsor Part D plans. This has discouraged major payers from joining BALANCE, leading the CMS to cancel the Medicare portion of the model. The agency then expanded the Bridge to 18 months from 6 months. 

The Bridge program will serve as a test for seniors' appetite for weight-loss drugs and how that will affect plan costs. The CMS plans to use this data to potentially reframe BALANCE and convince Part D plan sponsors to participate in the future. 

Jacqueline LaPointe is an Executive Editor at Xtelligent Healthcare Media, covering revenue cycle management, healthcare payers, health policy, and health IT since 2016.