In just a day or two, the Centers for Medicare and Medicaid Services (CMS) will start a demonstration program to provide Medicare beneficiaries with access to select GLP-1 medications for weight control outside the standard Medicare Part D benefit for a flat $50 monthly co-pay no matter income or Part D coverage phase.

This program is called Medicare GLP-1 Bridge and will run from July 1 through the end of next year on Dec. 31, 2027. It is called “bridge” because it is temporary until the BALANCE model brings more expansive coverage of GLP-1 medications to Medicare.

Bridge operates independently of Part D plans, and beneficiaries do not need their plan to opt in for access. CMS said the program covers three GLP-1 drugs specifically for weight loss:

• Foundayo® (tablet)

  
  

• Wegovy® (injection and tablet)

  
  

• Zepbound® (KwikPen only; single-dose pens and vials are excluded)

  
  

Medicare beneficiaries must meet both plan enrollment and clinical criteria:
Plan enrollment requirements include:

-              Enrolled in a standalone Medicare Part D plan or a Medicare Advantage plan with drug coverage

-              Certain Special Needs Plans (SNPs), dual-eligible individuals, and Tricare for Life beneficiaries may also qualify

-              Excluded plans include private fee-for-service, PACE organizations, cost contract plans, and some employer/union plans unless also enrolled in a standalone PDP

On the clinical side, the rules are:

-              BMI ≥ 35: eligible without additional conditions

-              BMI ≥ 30: must have heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or higher

-              BMI ≥ 27: must have prediabetes, previous heart attack, stroke, or symptomatic peripheral artery disease

-              Must be 18 years or older and using the drug to reduce excess body weight in combination with lifestyle modifications

So, What’s it All Mean?

Jessie McGill, senior curriculum development specialist, American Association of Post-Acute Care Nursing (AAPACN), breaks down some of the coverage issues and what the Bridge model could mean for SNFs in particular.

She said for SNFs, coverage for medications is a little different, depending on if residents are on a Medicare Part A skilled stay or not.

“For residents who are not on a Medicare Part A stay, they may have a Medicare Part D plan, which covers prescription costs. Part D currently does not cover GLP-1s, but the Bridge program may increase access to these medications,” McGill said.

She said on a side note, when a resident is on a Medicare Part A stay, all medications are included under the daily rate, unless it is specifically excluded. This is part of consolidated billing under Medicare, but typically to be excluded the medication must meet “high-cost, low-probability” requirements and accepted into consolidated billing using the rulemaking process.

“This is part of the SNF PPS Rules. In our comments to CMS for the FY 2027 proposed rule, we suggested CMS consider expanding consolidated billing to cover GLP-1s,” McGill said.

Beyond Coverage, What Does it Mean to Clinical Care

Now that the rules and coverage are clear, what does an influx of weight management drugs mean to the seniors in long-term care, and their caregivers?

To answer that, Lauren Stenson, curriculum development specialist, AAPACN, said there are many factors for providers to consider.

First off, any widespread use of GLP-1 receptor agonists in long-term care has implications that extend well beyond diabetes management and weight reduction. These medications may affect multiple aspects of resident care and facility operations, she said.

Nutrition and Weight Management: “Although GLP-1 medications are frequently prescribed to improve glycemic control, they also suppress appetite and delay gastric emptying. While these effects can benefit residents with obesity, unintended weight loss in frail older adults may increase the risk of malnutrition, sarcopenia, dehydration, pressure injuries, falls, and functional decline. As a result, facilities may need more frequent nutritional assessments, closer weight monitoring, and earlier involvement of the registered dietitian,” Stenson said.

Dining Services: She said appetite suppression may significantly alter residents' eating patterns. “Dietary departments may need to adapt menus by offering smaller, nutrient-dense meals, fortified foods, and high-protein snacks to help residents meet their nutritional needs despite reduced intake. Changes in meal consumption may also affect food purchasing, meal planning, and food waste, requiring ongoing collaboration between dietary and nursing staff,” Stenson said.

Medication Management: Further, as GLP-1 therapy improves glycemic control, residents receiving insulin or sulfonylureas may require medication adjustments to reduce the risk of hypoglycemia. Nursing staff should also closely monitor for common gastrointestinal adverse effects, including nausea, vomiting, constipation, and diarrhea, while assessing hydration status and medication tolerance, she noted.

Rehabilitation Services: Weight loss associated with GLP-1 medications may include a decline in lean muscle mass, particularly in older adults. Stenson said, “physical and occupational therapy may need to place greater emphasis on resistance training, strength preservation, and functional mobility, while reinforcing adequate protein intake in collaboration with dietary services.”

Operational Considerations: Finally, facilities should anticipate the need for staff education, interdisciplinary care planning, updated clinical protocols, pharmacy collaboration, dietary interventions, and enhanced monitoring of weight, hydration, and nutritional status.

“Policies may need to evolve to ensure residents receiving GLP-1 therapy are assessed consistently and managed proactively,” she said.

If Medicare coverage expands significantly, long-term care facilities could experience a rapid increase in GLP-1 prescribing. “The primary operational challenge may not be the medications themselves but ensuring that systems are in place to monitor outcomes, prevent avoidable weight loss and functional decline, and coordinate care across nursing, dietary, pharmacy, rehabilitation, and medical providers,” Stenson explained.

Questions or comments on this article? Contact Patrick Connole at pconnole@parkplacelive.com.