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2026年6月29日 / 美国东部时间下午3:39 / 哥伦比亚广播公司新闻
从7月1日起，部分医疗保险参保患者将首次能够通过一项旨在提高这类药物可负担性的新计划，以每月50美元的自付费用获取GLP-1类减肥药物。
这项被称为“医疗保险GLP-1过渡计划”的试点项目，扩大了礼来公司和诺和诺德公司生产的减肥药的覆盖范围，其中包括司美格鲁肽注射剂（Wegovy）、替尔泊肽注射剂（Zepbound）以及口服版司美格鲁肽（Foundayo）。
“医疗保险目前并未修改法律，”医疗保健研究非营利组织KFF负责医疗保险政策的副总裁兼主任朱丽叶·库班斯基说道，“它只是利用了法律中的特定条款，赋予联邦政府设立临时项目的权力。”
该项目标志着医疗保险首次为仅用于肥胖症治疗的药物提供报销，不再将覆盖范围限定在因糖尿病或心血管疾病等病症使用GLP-1类药物的人群。近几个月来，制药商已经降低了自付费用，但许多患者每月仍需支付约350美元。
过渡计划下的GLP-1药物覆盖期限为2026年7月1日至2027年12月31日。库班斯基表示，在这18个月的试点结束后，除非医疗保险和医疗补助服务中心（CMS）延长该项目，或是国会修改法律，否则患者可能会失去医疗保险对用于减肥的GLP-1类药物的报销资格。她还提到，制药商也有可能将目前的直接面向消费者的定价调整至与50美元自付费用持平。
“短期内我们有这项临时计划，但截至2027年底之后的发展方向目前尚不明确。”她说道。
谁有资格参与？
拥有D部分医保且参保了合格计划的医疗保险受益人，可通过过渡计划获得报销。
要符合资格，患者的医生必须提交预先审批申请，证明患者开具GLP-1类药物是用于减肥。预先审批是指确保药房能够配药的流程。
医生还必须证明患者在首次开始使用GLP-1类药物时，符合与体重指数（BMI）和健康状况相关的特定临床标准，需满足以下任一条件：
- 体重指数至少为35
- 体重指数至少为30，且有心力衰竭、难治性高血压或慢性肾病病史
- 体重指数至少为27，且患有前驱糖尿病、既往心脏病发作或中风，或有症状性外周动脉疾病
库班斯基指出，如果患者已经因2型糖尿病、睡眠呼吸暂停等病症持有医疗保险D部分覆盖的GLP-1类药物处方，则无法通过过渡计划获得报销。
“对于那些认为自己可能符合用药资格，或是想了解自己是否符合资格的患者来说，第一步最好是咨询自己的主治医生，他们可以提供帮助。”库班斯基说道。
医疗保险将覆盖哪些药物？
礼来公司的每日口服减肥药Foundayo、每周一次的注射型减肥药Zepbound KwikPen，以及诺和诺德的注射型和口服版减肥药物Wegovy均在覆盖范围内。
我需要支付多少钱？
符合资格要求的医疗保险参保者，获取GLP-1类药物只需支付每月50美元的自付费用。但有几点需要注意：由于该项目在医疗保险D部分的覆盖范围之外提供，这笔自付费用不计入患者的免赔额或年度自付费用上限。
“好消息是，患者无需先满足免赔额要求，就能以50美元的自付费用参与该计划，”库班斯基说道，“但另一方面，这50美元的自付费用也不会计入2100美元的年度自付费用上限。”
此外，患者不得使用优惠券或折扣进一步降低药价。
Medicare to cover GLP-1 drugs for weight loss for the first time starting July 1. Here’s what to know.
June 29, 2026 / 3:39 PM EDT / CBS News
Some Medicare patients will be able to access to GLP-1 medication for weight loss for the first time starting July 1, paying a $50 monthly copay through a new program designed to make the drugs more affordable.
Called Medicare GLP-1 Bridge, the pilot program expands access to weight-loss drugs made by Eli Lilly and Novo Nordisk, including Zepbound, Foundayo and Wegovy.
“Medicare is not changing the law right now,” said Juliette Cubanski, vice president and director of Medicare policy at the health care research nonprofit KFF. “What it’s doing is taking advantage of a specific section of the law that gives the federal government the ability to stand up a temporary program.”
The program marks the first time Medicare will help pay for drugs prescribed solely for obesity, rather than limiting coverage to people taking GLP-1s for conditions such as diabetes or cardiovascular disease. Drugmakers have lowered out-of-pocket costs in recent months, but many patients still pay about $350 a month.
GLP-1 coverage through the bridge program will run between July 1, 2026, and December 31, 2027. After that 18-month trial, patients could lose access to Medicare coverage for GLP-1s used for weight loss unless the Centers for Medicare & Medicaid Services issues an extension or Congress changes the law, according to Cubanski. It’s possible drug manufacturers could also lower their current direct-to-consumer pricing to match the $50 copay, she said.
“In the short term, we have this temporary program, and then no clear path forward yet as to what will happen at the end of 2027,” she said.
Who is eligible?
Medicare beneficiaries with Part D coverage enrolled in an eligible plan can get coverage through the Bridge program.
To qualify, a patient’s provider must submit a prior authorization request showing that the patient is being prescribed a GLP-1 for weight loss. Prior authorization is a process that clears the way for a pharmacy to fill a prescription.
Providers must also demonstrate that their patient meets certain clinical criteria related to their body mass index (BMI) and health conditions when they first start taking a GLP-1. They must either have:
- BMI of at least 35
- BMI of at least 30 plus a history of heart failure, uncontrolled hypertension or chronic kidney disease
- BMI of at least 27 plus prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease.
Patients are not eligible for coverage through the Bridge program if they already have a GLP-1 prescription under Medicare Part D for certain conditions, such as Type 2 diabetes and sleep apnea, according to Cubanski.
“Certainly, for patients who may think that they’re eligible for these drugs or are interested in exploring whether they’re eligible, a good first step is to talk to their clinician who can help them,” Cubanski said.
What drugs will Medicare cover?
Eli Lilly’s Foundayo, a daily weight loss pill, as well as Zepbound KwikPen, a weekly weight loss injection, are covered, along with Novo Nordisk’s Wegovy weight loss medication in injection and pill form.
How much will I have to pay?
Medicare recipients who meet the eligibility requirements will have to pay a $50 monthly copay to access the GLP-1 drugs. However, there are a few things to keep in mind. Because the program is being offered outside Medicare Part D coverage, the copay doesn’t count toward a patient’s deductible or yearly out-of-pocket cap.
“The good news is they don’t have to meet their deductible in order to qualify for the $50 copay,” Cubanski said. “But on the other hand, the $50 copay doesn’t count towards their $2,100 out-of-pocket cap.”
In addition, patients aren’t allowed to apply coupons or discounts to lower the price further.
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