Medicare was established in 1965, when President Lyndon B. Johnson signed it into law as part of the Social Security Amendments of 1965. It began covering enrollees the following year, on July 1, 1966. Johnson signed the bill in Independence, Missouri, with former President Harry Truman present. Truman had proposed a national health insurance program back in 1945, and Johnson gave him (and his wife Bess) the first two Medicare cards as a symbolic gesture. Medicare gave me my red, white and blue card in 2019, when I turned 65. At that time I was enrolled in Medicare Part A (Hospital Insurance that covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care). I got that premium-free since I paid Medicare taxes for more than 10 years. I was also enrolled in Part B (Medical Insurance, which covers outpatient care: doctor visits, preventive services, durable medical equipment, and some home health care). That requires a monthly premium and has an annual deductible. I also enrolled at that time in Part D (Prescription Drug Coverage, which covers prescription medications, offered through private insurers…Aetna via Cornell in my case). Medicare isn’t “mandatory” in the sense of a legal mandate with fines for refusal, but the penalty structure and the Social Security linkage make it functionally close to compulsory for most retirees. So there we are.
As everyone in the Western Hemisphere knows by now, I have been taking a prescribed weekly injection of Zepbound, the latest generation of GLP-1, since last October. When I started, I had a BMI of 43 and now, after losing over 90 pounds, my BMI is below 32. Medicare has a long history with coverage of GLP-1’s under Part D coverage. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created Part D and, borrowing from Medicaid’s exclusion list, explicitly barred coverage of agents used for anorexia, weight loss, or weight gain. At the time, available weight-loss drugs had limited effectiveness and unfavorable safety profiles that failed to generate justification for coverage of drugs perceived to be used primarily for cosmetic purposes. When GLP-1s arrived, they were covered but only for diabetes. But then, in 2024, Wegovy (semaglutide) received FDA approval to reduce cardiovascular risk in adults so that category of GLP-1 became covered Part D drugs for treatment of those specific conditions…but still not for weight loss itself. Then in 2025–2026, Zepbound (tirzepatide) was approved for moderate-to-severe obstructive sleep apnea, and Wegovy for MASH (fatty liver disease) and both became Part D-coverable through the same indication-based logic, while remaining excluded for weight loss.
Then, in July 2026, the GLP-1 Medicare Bridge Program became the first-ever weight-loss coverage by CMS. They launched the Medicare GLP-1 Bridge, covering Wegovy, Zepbound, and Foundayo for weight loss specifically, at a $50/month copay (compared to the $495/month I pay through LilyDirect. The program is a trial and now runs through December 31, 2027. That’s a big savings for me. The folks at LilyDirect have been texting me notes to remind me to apply for the program. I dutifully went to my doctor and she set the wheels in motion…and that’s when the fun began.
The players in this play are my doctor, LilyDirect, Walgreens Pharmacy, OptumRX mail-delivery prescription provider, Medicare, Aetna and Humana (who administers the GLP-1 Bridge Program for Medicare). I have talked to each and every one of those players multiple times trying to sort out this money-saving program, for which I am supposedly eligible (per my doctor, who says that while my BMI is below the 35 threshold, I need to use Zepbound to maintain that lower level). So far I have been told that I do not have Part D (which is ridiculous since all of my providers’ records show that I have it), that I am delisted from Medicare altogether (even more ridiculous as Medicare will verify that I have had continuous coverage since 2019), that I do not qualify since I have Apnea (which I do not have and for which the Bridge Program is specifically not designated), and that my insurance does not cover it (totally nonsensical). My provider has told me I have to get Bridge Program meds only through my local pharmacy (Walgreens) and yet they have requested application from LilyDirect and OptumRX as well as Walgreens several times since this began. I have gotten from the folks at Humana the exact procedure that my doctor needs to follow to file a pre-approval request to Medicare (technically to the GLP-1 Bridge Program)… and they have yet to do that. I have been told that the Bridge Program only uses something called KWIKPENS as dispensers (I have been using vials and syringes for 10 months), but I have no idea if that’s fact or fiction. I have sent multiple MyChart memos to the doctor’s office to explain what they need to do and they keep getting it wrong. I have spoken to Walgreens Pharmacy multiple times and have given them my Medicare and Aetna policy numbers several times because I keep getting told they don’t have my numbers….which they do, clearly. So, its pretty much a clusterfuck.
It’s amazing to be saying this, but the only players in this that have been efficient and consistent are Medicare and Humana on behalf of Medicare. I haven’t yet decided who is the real bumblefuck in this, but right now the top contender is my doctor’s office with Walgreens a close second. It’s quite an indictment on our healthcare system and our corporate system that they cannot keep up with a government agency that is constantly under the gun from the Republican Administration. Think about it…a major improvement in American healthcare coverage to address the significant obesity crisis in the nation…a proven effective solution, gets put in place over the normal bureaucratic hurdles, only to be blocked every which way by doctors and pharmacists that can’t read the procedures and then get it right for a qualified applicant. Turns out the notion that the private sector works better than government isn’t always right.
This saga is still in process and I’m heading out of the country, so maybe I can find a foreign pharmacy where I can buy Zepbound for a fraction of the cost that its available here in the good old U.S.A.. We do such a shit job of managing healthcare in this country and where the Great Society cared enough to establish Medicare, circumstances have taken us to a place I call Medi-Who-Cares.