Massive Changes Coming to Medicare for GLP-1 Users w/ Joseph Zucchi, PA-C

14 million seniors may qualify for $50/month Wegovy and Zepbound starting July 1, 2026. Here's exactly how the Medicare GLP-1 Bridge Program works and why the BMI threshold is lower than most people think.

Ana Reisdorf, MS, RD sits down with Joe Zucchi, PA-C, a physician associate and obesity medicine specialist on the board of the New England Obesity Society, to break down the new Medicare GLP-1 Bridge Program launching July 1, 2026. They cover who qualifies, which medications are included, the prior authorization process, what happens after the program expires in 2027, and the senior-specific nutrition risks to watch out for.

IN THIS EPISODE
- The three eligibility categories — including the BMI 27+ pre-diabetes pathway that may qualify millions
- Which medications are covered: Wegovy injections, Wegovy pill, Zepbound QuickPen, and Foundayo
- How to work with your provider on the prior authorization and what documentation actually matters
- What happens after December 31, 2027 — and how the Balance Model is different
- Senior-specific risks: muscle loss, sarcopenia, and how to avoid Medicare GLP-1 scams

ABOUT THE GUEST
Joseph Zucchi, PA-C is the Clinical Supervisor and Physician Associate at Transition Medical Weight Loss in Salem, New Hampshire, where he leads a multidisciplinary obesity medicine program. Under his clinical leadership, the practice has helped patients lose more than 50,000 pounds and has been named Best Weight Loss Center in New Hampshire for three consecutive years. Joe is a board member of the New England Obesity Society and has been featured in The Wall Street Journal, The New York Times, Bloomberg, Healthline, and the Boston Globe. Through his clinical work, teaching, writing, and advocacy, he is committed to advancing evidence-based obesity care and improving long-term health outcomes.

CONNECT WITH JOE
Practice: Transition Medical Weight Loss (Salem, NH) — https://TransitionSalem.com
LinkedIn: https://www.linkedin.com/in/josephzucchi/

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RESOURCES
Medicare GLP-1 Bridge Program info: https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge

CHAPTERS
00:00  The BMI 27 surprise
01:25  Meet Joe Zucchi, PA-C
02:51  What the Medicare Bridge Program is
06:14  Who qualifies: the three eligibility categories
09:07  The prior authorization process
14:32  Which medications are covered
19:50  What if you're denied
21:55  What happens after December 2027
25:18  Is this just a political promise
28:35  Senior concerns and scam warnings

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*The content of this show is for informational purposes only and does not constitute medical advice. The goal of this show is to provide various points of view about GLP-1 Medications. The personal and professional opinion of the guests and their content does not necessarily reflect the opinion of Ana Reisdorf or GLP-1 Hub.

Transcript

SPEAKER_00 0:00

And then the third category is actually potentially the most exciting is a patient uh with a BMI over 27, so overweight, with one of these comorbidities, the first of which is prediabetes. And so if a patient has, yeah, if they have a BMI of 27 or higher and prediabetes, that is a qualification that is probably gonna uh make a lot of people eligible.

SPEAKER_01 0:20

There's a major shift coming for GLP1 access, the new Medicare GLP1 Bridge program. Starting July 1st, 2026, eligible Medicare beneficiaries may be able to access certain obesity medications, including Lagovi and Zbound, for $50 a month through certain participating plans. Welcome to the GLP One Hub Podcast. I'm Anna Reisdorf, Master Dietician and GLP1 user. Access has been an ongoing issue for GLP1 meds, but this is starting to change with this new program. And to break it all down, I'm joined by Joe Zucchi, Physician's Assistant and Obesity Medicine Specialist. We're going to talk today about what this program means, who it may help, what patients should know before assuming they're covered. And as always, if you're enjoying this episode, make sure you leave a review on Apple or Spotify. And if you're watching on YouTube, let me know what you think and if you're going to be applying to the Bridge program as well. Now let's get on to the episode. Welcome to the GLP One Hub Podcast. I want to welcome back a guest. Joseph Zuki is here today to talk about something very exciting coming July 1st. And this episode will publish on June 1st. So we'll have about a month. So, Joseph, can you just introduce yourself and remind the people who you are and what you do and why you're here to talk about this?

SPEAKER_00 1:44

Yeah, glad to be back. Always a great pleasure to speak with you. We're very excited to talk about the GLP1 uh coverage that's starting with this bridge program. So we'll get into that. But just for background, uh my name's Shozuki. I'm a PA clinical supervisor at Transition Medical Weight Loss in Salem, New Hampshire. I'm on the board of the New England OBC Society and work in OBC medicine my whole career. Very passionate about advocating for coverage and certainly focus on a kind of comprehensive approach to weight loss, but be it through lifestyle, nutrition, exercise, and of course medication. And always trying to keep up with the latest data and hopefully we can put together some nice content today to help people who are confused or want to learn more about this.

SPEAKER_01 2:20

Yeah, you're doing a great job. I like to follow your content over on LinkedIn. You always have like clear messages, which is nice for those of us who glaze over when we hear anything about insurance or Medicare.

SPEAKER_00 2:31

Sure. It's a lot of data coming out like every week lately. It seems like our field is just exploding with the new data, so it's exciting. I try to kind of simplify the data whenever I can.

SPEAKER_01 2:39

Yeah, awesome. Okay, so we're here to talk today about something called the Medicare Bridge Program. So can you explain what that is and why this is different from what's been going on with Medicare to date with the GLP ones?

SPEAKER_00 2:51

Sure, yeah. So just for background, so unfortunately, Medicare patients that traditionally not have coverage for obesity medications. This dates back to like the early 2000s when Part D plans kind of began. There was some terminology in the wording that they would not cover any medications used for anorexic purposes or weight loss purposes. And unfortunately, at that time, those are kind of dated thoughts. We now know obesity is a chronic disease. This is not about vanity, this is about health. There's a biological component to why obesity is such a challenge for patients. It's tied to over 200 comorbidities, and patients deserve treatment for obesity medications just like any other chronic disease. And so, unfortunately, because of the way that kind of the Part D plan wording is written, it's been kind of almost not able, not allowed to utilize coverage for obesity medications. That changed a little bit when some medications got approved for other indications. So WeGOV is approved to reduce the risk of heart disease in patients with a personal history of heart attack or stroke, and so it has a cardiovascular indication. WeGOV also has indication for MASH, which is a type of more advanced fatty liver disease. And then ZEPA is approved for obstructive sleep apnea, moderate, severe OSA in patients with obesity. And so those criteria actually have been getting covered for patients currently who have a Part D plan when the provider prescribes it and when they do a prior authorization and submit proof of those qualifications. But when used solely for weight loss, it has not been a covered entity. And so this bridge program will be a whole new option. So basically, the government has been working to negotiate some kind of price drops here with the manufacturers, um Ila Lilly, which makes Zeppan and Foundo, and Novo Norris, which makes Wigovi, and now the Wigovi tablet or the Wigovi pill. And so because of that, the prices have been negotiated on the back end CMS. The government will be spending around $245 or so for the medication per month. And now the patient will have a flat $50 copay. And this will all take effect starting July 1st. Um and we'll talk about who will be eligible, what the criteria will be, and those types of things. But this is exciting times, certainly for uh for the field of obesity medicine and more importantly for our patients.

SPEAKER_01 4:56

Yeah, I think it's I think it's really great that the people on Medicare can get it. You know, it's been tough for older adults specifically to afford it to date if they're they don't have insurance or whatever or whatever they're getting. So I think it I think it's awesome that and then I th I hope that when the government starts negotiating things that prices come down for the rest of us too.

SPEAKER_00 5:16

Yeah, I mean I hope the same thing. You know, uh unfortunately commercial coverage of these medications has been going downhill, and a lot of plans have been dropping coverage due to cost and just the demand is kind of outseed their their budget. And so hopefully, you know, if this bridge program shows success and eventually this can trickle down into commercial coverage, we hope and pray. The um, you know, the way these programs work is kind of a demonstration to showcase how this can be beneficial. And yes, these medications are expensive, but we also need to keep in mind they are often helping patients on their health journey and going to hopefully save on cost long term. Down the road, it may take some time to showcase this, but five, ten years down the road, you hope patients are gonna have less heart attacks, less strokes, less diabetes, less joint replacements, less sleep apnea, less comorbidities, less mortality. So there is a huge benefit to these medications, and hopefully with better pricing, better coverage, we can showcase that where patients who would benefit from them are able to get it at a fair price.

SPEAKER_01 6:08

Sure, sure. Okay, so who is gonna qualify? Because it's not everybody on Medicare that can just get it.

SPEAKER_00 6:14

Yes. So basically, starting July 1st, this will be, and there's a pretty good website for the CMS that kind of goes through some FAQs on there as well. But just to generalize it, anyone with a BMI over 35, no comorbidities necessary, would be the first qualification. That's a nice clean cut kind of one. And keep in mind, these qualifications that I mentioned, not only are they for patients who are new to therapy, and those would be, you know, their BMI as of today, but it's also patients who perhaps are on the medications now, maybe they've been paying for it for months or years. We can also potentially or should be able to get them covered if their initial statistics met these criteria as well. And so if a patient previously, yeah, if they had a previous BMI of 38, now it's 28 because of the medication, they still qualify because prior to medication it was 38. So just keep that in mind as the criteria as we talk about. So first is 35 or higher. The second criteria is a BMI of 30 or higher with a few different chop choices here. One is if the patient has heart failure with preserved ejection fraction. Second is uncontrolled hypertension after having at least two medications for hypertension on board. And third is patients with chronic kidney disease at least stage 3A. And so that's kind of the second category of potential coverage. And then the third category is actually potentially the most exciting is a patient uh with a BMI over 27, so overweight, with one of these comorbidities, the first of which is prediabetes. And so if a patient has, yeah, if they have a BMI of 27 or higher and prediabetes, that is a qualification that is probably gonna uh make a lot of people eligible. And so prediabetes typically would be a glucose over 100. Diabetes has a glucose over 126, so anywhere over that 100 marker that would maybe be a qualification. And also, usually an A1C between 5.8 and 6.4 is considered prediabetes as well. And so we have that criteria. So 27 plus prediabetes, also 27 plus previous history of heart attack or stroke is another qualification. And then lastly, we also have 27 or higher with peripheral artery disease as a third qualification in that subset. So we have lots of different categories there, and hopefully a lot of patients will be able to find eligibility through those working with your provider to showcase either prior eligibility or current eligibility based on those parameters.

SPEAKER_01 8:31

That is really great because, like I said, that's probably like 60% of the people over 60%.

SPEAKER_00 8:39

I've seen some stats, like literally 14 million people will be eligible. I mean, it's a significant amount of the population that will be eligible with these criteria.

SPEAKER_01 8:46

I'm gonna get so many podcast listeners, man. It's so exciting. I've worked out some good content.

SPEAKER_00 8:51

Exactly. No, it's exciting to have a new tool at a better cost for patients, especially seniors who deserve that.

SPEAKER_01 8:57

Absolutely, absolutely. Okay, so you're a senior, let's say you've been paying for it or whatever you've been doing, you've been on it, so now you want to get on this. So, what do you do?

SPEAKER_00 9:07

Sure. Well, a couple uh caveats here. First is it does require the senior to have Medicare Part D coverage. It can't just be part A, Part B, it has to be part D. Um, so that's often you know an opt-in type of a plan, or a Medicare Advantage plan will also be eligible for this as well, as long as it carries some pharmacy benefits as part of that. And so there's again more details online, but uh, we want to make sure we have a Part D plan or a Medicare Advantage plan that has pharmacy benefits. Those patients should be eligible. Now note this bridge program, everyone who meets those qualifications is eligible. This is different than the balance model that we'll talk about that will take effect in 2028. The balance model will require opt-in from the individual Part D plans, and that could differ from plan to plan. But this bridge program is run by the government and it is available to everyone. They don't have to have their particular plan opt-in. So just keep that in mind. Also, most patients are going to be typically above 65 that are on Medicare, but there are some patients that perhaps have disability and are below 65. They also should qualify because it says 18 and older with these qualifications. Medicare patients that are under 65 may also have coverage too. And so that's kind of that there. But to get things started, you definitely want to have a meeting with your provider. This needs to be prescribed. Of course, this is a prescription medication, and then it will require a prior authorization. And so basically, that is a form that we fill out, typically either virtually or can be done as a fax, that is submitted to the insurance. Or in this case, Humana is the one that is managing this with the government. Even though you don't may not have Humana as your Part D plan or your insurance plan, they will be handling the kind of prior authorizations here. And providers will need to submit documentation to prove that the patient hits the qualification as we discussed, perhaps showcasing BMI and comorbidities. And then from there, also usually we have to make note the patient is also receiving lifestyle changes and nutrition and exercise guidance alongside the medication because that is an important component that's on the label of these medications to be used in conjunction with these uh exercise and nutrition changes. Um, and then from there, once the prior authorization is hopefully approved, then the prescriber can can prescribe it to any pharmacy. And the patient would go there and pick up the prescription and should only pay a $50 copay. Also keep in mind this does not apply to out-of-pocket maxes. It is separate from your Part D plan. And so it doesn't apply at all to that. This is its own thing. And just keep that in mind when you're thinking about the copay.

SPEAKER_01 11:31

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SPEAKER_00 13:30

Sure. If somebody was a previous patient of a commercial plan in the past and they had a prior authorization effect, that prior auth is only with that particular insurance plan. Certainly, if they're on Medicare now and they're paying out of pocket and maybe they're doing it through LilyDirect or NovoCare, they are gonna they don't even have a prior auth in place. They're gonna need a new one. So everyone will need a new prior authorization starting on July 1st and onward once it's available for us to even submit the prior authorization.

SPEAKER_01 13:55

You guys have help doing this? Because I feel like you're getting an influx and you're gonna be a little overwhelmed.

SPEAKER_00 13:58

Yeah, I will say, you know, please be patient with your providers because um, you know, there are many patients that will be certainly excited about this, and some providers may have hundreds or thousands of patients on Medicare and July 1st, prior authors are not easy. They're a long process of form filling and data entry and also uploading documentation. And so it may take you know some time for providers at different offices to be able to get this paperwork going. But and we'll see how long the turnaround time is from uh you know Humana. Um, but it is again, it's exciting. Just it's gonna be a little bit of a learning curve for everyone.

SPEAKER_01 14:29

Yeah, I think the process I feel bad for you guys. Prior authorizations are a lot. They are I know, and then the back and forth. Anyway, so it says that there's gonna be $50 a month, and some it's gonna apply only to the Zetbound quick pen or multi-dose pen, so not the vial. One of my pay one of my audience members is very concerned about that.

SPEAKER_00 14:50

Yeah, so it looks like the the list of medications that are approved through this GLP1 bridge program for obesity are basically we go v injections, all dosages. I did see the 7.2 is on that list, the newest indication, the newest dose. We go V HD. Uh, we go V tablets as well, and so both of those, and then we have, of course, Zetbound, which is covered. But as you mentioned, it is the quick pen is being utilized for this. Z-bound uh typically comes in three versions. We have the auto injector pens that traditionally has been through the insurance at the pharmacy. Then you have vials and quick pens, which have typically been the cash pay model for patients through LilyDirect, or now quick pens are also available in the pharmacy. And that's possibly part of the reason why. I think honestly, vials will probably likely be kind of slowly going away because it is a bit redundant and the quick pen somewhat simplifies it for patients. I know some people love the vials, I get it, but the quick pen for many patients who are a little afraid of needles simplifies it to an auto injector to some extent. One pen has enough medication in there for the month supply. And so there's, you know, four injections worth in that pen. They just twist on a new needle tip each time. And the quick pens are currently the cash pay price, which is equal to of the vials through LilyDirect. But quick pens are also available in the pharmacy right now at the cash price, the discounted cash price with the coupon. But because it's already in pharmacies and it's kind of you know read ready production is there, once this uh bridge program begins, quick pens will make good sense to be in the pharmacies because they're already in stock in that sense. And so I think that's the reason.

SPEAKER_01 16:25

Some people like the vial because they can like if they've been on it for a while, they can adjust the dose a little bit.

SPEAKER_00 16:31

Sure.

SPEAKER_01 16:32

That quick pen doesn't allow that.

SPEAKER_00 16:34

So the quick pen does so you count uh technically if you turn the dial, there is clicking, and if you click it all the way to the 60th click, that is a full dose, which says the number one on there. It doesn't tell you how much is in each click, but technically, if somebody wanted to, there is a way that you can, you know, work with your provider. It's a bit off label, but you could count clicks and figure out dosages if somebody needed less for some reason. There are ways to do that. So the quick pen is still flexible in that sense, but for most patients, it's advised that this quick pen is to be used for four injections over the course of one month.

SPEAKER_01 17:06

Okay. And if you're going through LilyDirect right now, can you continue? Can your doctor send the prior authorization and everything to there and pick it up?

SPEAKER_00 17:16

Good question, yes. More to come on that. I couldn't find any great information proving if LilyDirect will work with the bridge program, but I'm I'm confident that they probably will, just because the LiliDirect option works for both covered patients and non-covered patients right now. When patients have coverage, it typically routes through like Amazon pharmacy. And when they don't have coverage, it gets shipped to them directly. And so I feel like there's going to be an option for patients to get it still through LilyDirect or it may be shipped from a certain pharmacy in particular. But the pharmacy does not need to opt into the bridge program. There's specific numbers and data for the pharmacist to be able to submit the coverage and get the medication kind of approved. But the prior authorization is something that the provider is doing. LilyDirect is not involved in that. We submit the prior author directly to Humana. And then from there we can prescribe it to any pharmacy. And that could be CVS, Walmart, Walgreens, or it could be online pharmacies like Amazon. And I, you know, again, hope that perhaps a LilyDirect will also be an option. But you likely will still need a new prescription because it will be a quick pen, not the vial or the auto injector. The prescription has to be different for each of those different things. Sure. And so keep that in mind. And just thinking back, I know I mentioned earlier about WeGovi injections, we go be pills, and Zetbound, quick pens only, but also Foundeo, which is the newest FDA-approved pill for obesity made by Eli Lilly, that is also on this bridge program as well. So you have four options WeGovi, Wigovi pill, Zetbound, and Foundeo, all of them supposedly for a $50 copay.

SPEAKER_01 18:48

Okay. Unrelated side note, how are you feeling about the Foundeo?

SPEAKER_00 18:51

Yeah, it's exciting to have more options. You know, it's just like when the Weigobi pill came out. There are patients that prefer a pill versus injection. A lot of patients find the injection certainly very easy. But for those that prefer a pill version, it's nice to have now tools in our toolkit to offer patients that still has double digit efficacy. The Weigobi pill has perhaps a little bit higher efficacy in its trials, and it does carry the cardiovascular indication because semaglitide is a molecule that's been around a bit longer and has a good track record. But what's exciting about Foundio is or forglipron, which is the ingredient here, is the first ever non-peptide small molecule GLP1. It has very good bioavailability and very good absorption orally, and so it actually can be taken any time of day with or without food. And so there's more flexibility for patients who perhaps need that. And so again, tools in the toolkit, working with figuring out what's the right fit for a patient alongside your provider is the best way to go. But it is nice that we have you know successful medication options, both in pill version and of course successful injection options. Zbound and we go VHD will still carry the highest efficacy for patients that need more significant weight loss. But for those that maybe are a lower BMI or for those that prefer a pill, we have that option now.

SPEAKER_01 20:01

Yeah, yeah, awesome. So if can a patient technically be denied coverage if they meet those criteria? Because you know, sometimes the government loses your forms. They did that to my taxes. That's a check they owed me back.

SPEAKER_00 20:15

Yeah. I'd say nothing's perfect. There's always chances of issues. I mean, prior authorizations are a process. I mean, even with commercial insurances, it's a series of questions and documentation. And and sometimes, even though it seems like they should qualify, sometimes they don't. We want to always figure out why were they not qualified. Sometimes I have to go back and resubmit something or appeal it, and maybe they, you know, uh didn't really read it the right time the first time around. If somebody meets those criteria either now or prior to starting the medication and it's documented properly, they should qualify. So if they get a denial, definitely worth double checking and making sure, you know, if the provider just accidentally submitted that their BMI today is 27 and there's no history of their starting BMI, then sure they could get denied. So it's up to really to the provider and the team who does the priauthorization to make sure the documentation is adequate to showcase the CMS that this person is a good candidate based on the eligibility. And so certainly if somebody does not qualify because their BMI is is, you know, not in those ranges or doesn't have the comorbidities, then unfortunately there is, you know, no pathway to getting it covered. But if you do meet those criteria, I would hope that you'll get it approved. It just sometimes may take a little extra elbow grease.

SPEAKER_01 21:24

Right, right. That makes sense. So I think your your your bottom line here is be patient.

SPEAKER_00 21:29

Be patient. Have your documentation. Again, in my practice, I see patients very frequently. We have a very good touch point relationship, and uh, other practices may only see a patient once a year. And so you may need to do a little bit more hand holding and let the provider know here's the data. Here's remember my starting weight was this. This is before I started this medication. Any documentation that you can provide to them may help them when they submit the prior authorization because uh it is up to them to make sure that the right data is provided when these prior authorizations are submitted.

SPEAKER_01 21:55

Right, definitely. So, right now the program is guaranteed through December 2027. Which is like a year and a half. So what happens after that?

SPEAKER_00 22:04

Yeah, great questions. Basically, this bridge program is somewhat a demonstration, really optimistic demonstration. This will prove that we can hopefully continue coverage. Um the hope here is that this bridge program will continue into the balance models. Uh originally the bridge program was actually a shorter period of time, and the hope was that Part D plans were going to opt in, and but there were still some questions. And so they now have pushed back and extended the bridge program now until the end of 2027. Like you said, December 31st, 2027. Everyone, like we talked about, should qualify. Once we hit 2028, it will now be back onto the Part D plans to enroll in this balance model. And again, more data to come on this, but we're hopefully going to be showcasing the benefits of these medications during this bridge. And then the balance model will be a bit more opt-in by Part D plans. Hopefully, again, a high amount of enrollment there, but we we we can't guarantee anything, right? So certainly these medications, if there's a lot of people who are going to be excited and eligible for them, this will be an expense, but hopefully a worthwhile expense because of the health benefits for patients and the investment is you know long-term beneficial for sure, both in terms of cost and health. And so the balance model will be taking effect in 2028. More to come on that. So it is still up in the air, but the bridge program is this interim period of time where it is not through the Part D plans, it is through the government directly.

SPEAKER_01 23:27

Okay. And so when these medications first started like being used off label for weight loss, there was some shortages. Do you think that now with this like influx there could be shortages again?

SPEAKER_00 23:38

I would say very low chance, just because honestly, Novo and Lily have done a fantastic job of ramping up their supply. They have both stated multiple times that their supply is better than ever possible, and they have ramped up their manufacturing, likely in anticipation of this breach program because it's been in the process. You can also think of, you know, the Zetbound Quick Pen is one pen instead of four pens, so there's a little bit more of a less supply even necessary to make the plastic pens there. The pills on both Fondeo and WeGovi are very easy to manufacture in bulk because pills are more simple to make. WeGovy hasn't had any supply shortages since you know a few years ago. And I think since there's also technically four different medications that are going to be covered here, it's not like just one medication. There's going to be a blend of different options for patients. So I feel uh again, anything's possible, but I think that both companies are prepared for this and have their manufacturing supply in a good shape.

SPEAKER_01 24:28

Okay, yeah, because also the FDA is cracking down on compound. So I would think that some of those people that were on compound, if they have access, they would go. They might not do bridge, but they would start wanting, you know, sure.

SPEAKER_00 24:40

Yeah. It will be, I guess, a little bit tricky to see for those that were getting a compound of medication. And if the provider is trying to showcase their previous statistics in terms of uh qualification criteria like BMI, it'll be a little bit more hazy to see if they're gonna allow that because that person was not on a branded medication. Hard to say on that, but certainly hopeful that those patients will continue to get coverage. But those that were on compounds, you know, switching to these medications will likely hopefully be certainly more cost effective because it's um $50 copay. Um but also these are the brand name FDA approved medications. You know that that medication you are getting is been vetted for safety and efficacy and is what the trials were based on from the companies that created the molecule itself.

SPEAKER_01 25:18

Right, definitely. So there seems to be a little bit of uh just conspiracy theories going on about this whole thing. Sure. That it we have some midterms coming up, and the older population is a great voting block to uh try to sway them.

SPEAKER_00 25:31

Sure, sure.

SPEAKER_01 25:32

Towards your uh your point of view. So do some of my audience feels a little nervous that this is just a political promise and then it's gonna go away. What do you think about that?

SPEAKER_00 25:42

Yeah, I think that certainly we we can never have a crystal ball where we can guarantee that these things are there, but all of the data from both the government and as well from the manufacturers themselves is that Lily and Nova have, you know, published plenty of content now showcasing this is who's covered, this is what's gonna happen starting July 1st. And so there's a lot of you know background to this that shows proof that this should certainly be a real thing taking effect. And they've guaranteed, you know, that this will be covered until December 31st, 2027, and then we'll see again from there how things will go. Again, nothing is guaranteed in life. We never can be 100% sure, but I have very high confidence that this will take effect. There was a little bit of a moment when this the balance model was being pushed back that there was concern, but luckily the the government said let's extend the bridge program longer and keep this covered going so we can see, you know, hopefully showcase the benefits. So good. Hopefully for sure.

SPEAKER_01 26:34

Awesome. So you do you feel confident for now that I do.

SPEAKER_00 26:36

I do.

SPEAKER_01 26:37

We never know the future.

SPEAKER_00 26:38

So I will mention, you know, as great as it is to have this, this is just one piece of the puzzle, right? We still need to get obesity covered as a disease across the board. That is sad that we have to get to the point where we have to be, you know, unfortunately, half the time I'm talking with patients is about cost, coverage, and accessibility. And it should be focused on their health and which medication is the right fit for them alongside lifestyle. And it is sad that cost is such a hindrance now because the medications have had poor coverage. As great as this bridge program is, and I'm hopeful that it leads to commercial coverage down the road. Another thing that we always want to keep on pushing forward is something called TROA, the Treat and Reduce Obesity Act. And that is a hope to get obesity as a standard covered on the formularies, something that is no longer excluded from coverage on Medicare patients. It would have more wide-reaching kind of benefits for patients. It's a bipartisan bill that's being, you know, has more and more uh momentum behind it. So hopefully at some point we get to the point where this is not a question of coverage or not. It is covered like any other chronic disease. But again, we take what we can get, and this rich program is definitely a big step for patients and seniors who never had coverage for many forever.

SPEAKER_01 27:44

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SPEAKER_00 28:52

Yeah, I agree. It's I'm sure there will be a lot of creative things out there to try to get money from people. So work with your provider, make sure it's somebody that you trust. Hopefully, somebody you already have a relationship with now. Certainly, hopefully, it's a a provider who has experience in obesity medicine. If it is somebody new that you're working with, you want to be making sure you're going through this process properly. The provider should be submitting documentation to, you know, again, Humana and Medicare and getting this approved. And then you should be picking up the prescription itself at a regular pharmacy and you should be paying a $50 copay. And so if you are told anything over $50, or if you're being told that we're gonna, you know, sell this to you as some package, like definitely that sounds sketchy. So be very cautious. Uh, if for any scam emails, you want to talk with your provider directly and get any um information either from probably Eli Lilly's website, Novo Nordis' website, or from the government's website, because these medications uh they'll be providing updates to patients as well in terms of the process of how this will work. Even as providers, we're still learning where we'll be submitting the prior authorizations to and how that'll be done. Um but if anyone is trying to sell you anything, you know, again, your provider is the one who's going to be prescribing the medication, your provider is the one who's going to be writing the prior authorization. And so you can give them data and give them information to help them, but don't fall for any scams where somebody is trying to bribe you to pay for this medication up front or through some side pathway.

SPEAKER_01 30:10

Okay. Yeah, yeah. I think that's unfortunately it's a just an opportunity for scam.

SPEAKER_00 30:16

Yeah.

SPEAKER_01 30:17

So I have one last question for you because this is something that I'm personally concerned about. This is wonderful. I love access for all the people. But people over 65 have slightly different nutritional needs and you know, comorbidities and other things that I am worried about if they are not addressing some of the lifestyle and protein and multiv micronutrients and all the things that we discuss. So, yes, what is just like a closing idea for our seniors as they're excited to move along this journey for them to actually use this to be healthy and live longer and not develop, you know, scurvy?

SPEAKER_00 30:55

Yeah, no, I agree. That's such a great point. Uh, you know, as amazing as these medications are, they always need to be done alongside the lifestyle. They're not in place of the lifestyle, they're not meant to be cop-outs or quick fixes. They're a tool. And they certainly will impact our appetite for the better in terms of reducing hunger and cravings, reducing food noise, all that good stuff. Certainly benefits on other things, cardiometabolic health, inflammation, blood sugar, awesome. But we also don't want to just start skipping meals. We don't want to become malnourished. The data from these trials on the medications have shown, you know, positive data in the sense that the majority of the weight loss comes off as fat mass, and a more of a smaller minority comes off as lean mass, but that will vary depending upon the person's lifestyle. If somebody is getting exercise and getting protein, then their risk of muscle loss is much lower. But if somebody is skipping meals, not getting adequate protein, um, then and then not getting activity in, like you mentioned, uh, that population is already at a higher risk of sarcopenia and osteoporosis, and we do not want patients to becoming frail. And so a small amount of muscle loss is not necessarily horrible. You have to keep in mind that lean mass loss also includes water weight. It's not just muscle tissue. And if a patient is losing weight, they may actually have better function of their body because they can be more mobile. So it's not a massive concern to see a little bit of muscle loss. But if somebody is um losing weight in a rapid pace or in an unhealthy pace, or if they're you know truly starving themselves, there is a high risk of many issues happening from uh, you know, acute kidney injury if somebody is dehydrated to lean mass loss to being more frail and so forth. So even low blood sugar. So I would say personally and for other providers, it's worth definitely titrating more gradual with patients that perhaps have more comorbidities or those that have a bit, you know, more frail because we do not want to race up to the top dose and have a higher risk of side effects, both in terms of GI side effects or just, you know, fatigue and things like that. We want to monitor patients closely and patients that are not perhaps in a comprehensive weight loss program, try to have, you know, a support system in place or reach out to a dietitian so you're getting that counseling on how should I be eating with this medication. Yes, the medications help us eat less, but the goal is not to just skip meals and go out the whole day without eating. We still want to think about spacing meals out throughout the day, plenty of protein, fruits and vegetables, fiber intake. We want to prevent constipation. We want to keep up with our water. That's really important. A dehydration can can lead to many different problems. And so I hope that providers are perhaps a bit more, you know, cautious of their dose escalation, going more slow, and patients are hopefully, you know, putting in the lifestyle changes alongside it to lead to better outcomes, better tolerability, and better long-term health.

SPEAKER_01 33:28

Yeah, definitely, definitely. I I think that that, you know, there it just needs to be a little bit more cautious. You know, when you're 20, you can do get away with more flexibility. Sure. You know, but as you get older and other things come on the picture, I think that that's that's constant. So thank you so much, Joseph. Where can people go to find out more about the bridge program, but also find out more about your work as well?

SPEAKER_00 33:50

Yeah, so if you just kind of type on a Google CMS Bridge program, there's a website right from the government, cms.gov, I believe, that has uh really great information. It's um provides lots of context on FAQs and more clarity, and I'm sure more will be coming on there as well. So that's a great resource. Again, there is some material that's also coming out from both manufacturers, Novornodas and Eli Lily, that should be providing more data for patients. So those will be great. Keep an eye out, but definitely follow, you know, uh proper sources when you're reading about this stuff versus just speculation. On top of that, personally, uh I work at Transition Medical Weight Loss. If any patients are in New Hampshire or Massachusetts, happy to help. We uh are transitionsalem.com. I also have a lot of posts on obesity medicine education for colleagues in the space on LinkedIn and post infographics and different content regarding new studies and trials and even put together a whole thing about the Medicare Bridge program as well. So uh looking forward to continue to help uh provide more education in this space too.

SPEAKER_01 34:43

Awesome. Well, thank you so much for coming on again and at the last minute and uh get the information out that people need. I really appreciate it.

SPEAKER_00 34:50

Of course, yeah, happy to be here. I hope this helps give you more information. We can always uh, you know, have more details to come, but I think this gives a lot of people at least a good found um foundation of knowledge and this new exciting uh path to come.

SPEAKER_01 35:00

Yeah, awesome. Thanks again, Joseph.

SPEAKER_00 35:02

Thank you.

SPEAKER_01 35:03

Thank you so much for listening to this episode of the GLP One Hub Podcast. I'm really grateful for Joseph for being such a great resource to our community and sharing with us everything that he knows about this new Medicare program. I'm sure that there will be plenty of other questions coming up in July as it rolls out, but at least we can get kind of a baseline to understand what's going on. And if you are planning on starting a GLP One or going to use the Bridge program to get access to GLP1 or just paying out of pocket, make sure you check out the GLP One Hub membership. You can find the information for that down in the show notes below, and that's where I provide support to help you along your journey with nutrition, exercise mindset, and all the things that you need to know to be successful along the way. And I'll see you in the next episode.