Part 1 of this story looked at changes to the BRIDGE and BALANCE programs, CMS initiatives that were developed to give Medicare and Medicaid beneficiaries access to GLP-1 treatment for obesity. CMS paused the BALANCE program on April 20, citing lack of insurer participation. The agency is instead extending its Medicare GLP-1 Bridge pilot program to the end of 2027.
Bridge was originally slated to run from July 1 to Dec. 31, 2026 To qualify for coverage of eligible GLP-1 drugs, Medicare beneficiaries must meet certain prior authorization criteria and be enrolled in a standalone prescription drug plan (PDP) or Medicare Advantage (MA) coordinated care plan in 2026.
A medical provider submits a prior authorization request and a prescription for an eligible GLP-1 drug for a use covered under the demonstration. Eligible beneficiaries will be charged a $50 monthly copay. This is a significant cost savings compared to the over-the counter price, as we previously reported.
While the pilot offers notable cost savings, it’s important for patients — especially older patients — to understand that GLP-1s can come with significant side effects, according to John A. Batsis, M.D., a geriatrician and associate professor of medicine at the University of North Carolina, Chapel Hill. Older adults have different physiology and “we know from those on GLP-1s for diabetes that when you’re on these drugs, you lose fat, but you also lose muscle and bone,” he said. Sometimes the consequences don’t show up until years later.
Loss of muscle mass and strength is associated with increased risk of adverse events, hospitalizations, disability, long-term, institutionalization, and mortality in older people, Batsis said. “So we have to think about what other research has been done, and apply it to the GLP-1s,”
Why This Matters
Reporters should do their due diligence and ask physicians how they’re educating older patients about the pros and cons of these drugs, what criteria they’re applying to older candidates and how they’re being monitored for potential adverse effects. Once the program launches, check back and see if there’s been an uptick in appointment requests or referrals.
Obesity and weight issues present differently in older adults than in younger patients, according to Reshmi I. Srinath, M.D., an associate professor of Medicine in the Division of Endocrinology, Diabetes and Bone Disease, and director of the Mount Sinai Weight and Metabolism Management Program in New York. Older patients with diabetes and heart conditions also can experience cognitive changes, all factors that make treatment with these medications for obesity an important step forward, by addressing these underlying chronic conditions. she added. About 30% to 40% of patients in the Mount Sinai obesity clinic are over age 65.
Both physicians agreed that GLP-1s for obesity in older adults should be considered only after those patients attempt to make lifestyle changes. “As we get older, we lose muscle mass,” Srinath commented. “Metabolism slows, and much of the weight gain that occurs is due to slower metabolism and inactivity, versus more of a mechanism where patients are overeating and gaining weight because of just dietary excess.”
Most GLP-1s target appetite, a factor that may not be significant for older adults, Srinath explained. “What’s the criteria for making them a candidate for this change?” she asked. “Because if it’s not appetite or dietary related, will they work the same?” Srinath asked.
There isn’t enough data in the GLP-1 sphere yet, Batsis noted, due in part to trials not including a significant proportion of older adults in data collection.
White some studies show that side effects are similar in younger versus older adults, Batsis said his own data review found that adverse effects are higher in older adults, which may be due to dose escalation. There are also side effects like nausea, constipation or GI issues, which are exacerbated by aging.
Despite broadened GLP-1 availability for those over 65, “these meds may not be for everybody,” Batsis said.
