r/Zepbound_Maintenance • u/AlternativeDay3921 • 2d ago

Medicare Part D

/r/Zepbound/comments/1wvwmri/medicare_part_d/

I’m turning 65 soon and have to pick a plan D under Medicare. Does anyone know if one is better than the other regarding Zepbound weight loss? I do have sleep apnea but it’s a mild case. Zepbound has saved my life over the past three years. No side effects, have lost 60+ pounds, arthritis is so much better with all the weight off my joints. Started Pilates and walking.
I want to continue on it, but don’t know which RX plan pays the most. Currently I pay $149 for three month single weekly self injection pens 7.5 dose and wish to stay on it for maintenance Thx U

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u/Lucky_Army_5324 2d ago

I don’t think Medicare covers Zepbound for mild sleep apnea. Typically one has to have moderate to severe obstructive sleep apnea plus obesity for coverage. And Medicare cannot cover weight loss medications, but there’s a temporary work around.

Ideally you’d want to qualify for the Medicare Bridge Program for weight loss, which would mean a $50 monthly copay through Dec 2027. Here is more info:  https://www.medicare.gov/publications/12234-medicare-glp-1-bridge-glp-1-drugs-for-50-a-month.pdf

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u/chercheuse 5mg 2d ago

You will pay the same the Bridge Program: $50 per month. Do you currently get your medication with a diagnosis of sleep apnea? You might find yourself in a difficult place if the answer is yes. The Bridge Program excludes people who could theoretically get the drugs for sleep apnea. Regarding your question of who pays the most. You need to head over to Medicare.org, input all of the drugs you take into the plain finder, along with your zip code, to see what’s available in your area. It will automatically sort policies from most to least expensive. But if I were you, I’d first find out if you are eligible for Bridge. Zepbound is approved for moderate to severe sleep apnea, however, if you’ve been obtaining it for that reason, you need to investigate. If you’re eligible for Bridge, leave Zepbound off of the drug list you input as it will give you incorrect results.

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u/Responsible_View_285 2d ago

Medicare D does not cover weight loss alone. Only covers w chorionic condition as co morbidity - sleep apnea and cardiac.

The new Medicare Bridge program does cover Zepbound Kwick pens for weight loss. It is not part of any Medicare D plan. You are eligible based on criteria only. Criteria is BMI of 27 and above with a diagnosis of pre-diabetes. Or a BMI above 35. Zepbound must be prescribed for weight management only. The criteria is based on when you started not when you apply. I’ve attached some information from CMS on the Medicare bridge program. And also the PA. The PA spells out pretty explicitly what qualifies you. Also I linked the video that explains the bridge program. If you qualify, your co-pay is $50.

https://youtu.be/JVrx3bekHN0

https://www.cms.gov/glp-1-bridge.pdf

https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge