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A new USC study, posted October 28 and not yet peer reviewed, projects that broader GLP-1 coverage could save Medicare $21.2 billion to $27.1 billion over 10 years.¹ But that total counts $31.9 billion from an assumed price cut on GLP-1s Medicare already covers for diabetes. That price cut isn't part of the Bridge today, and the Medicare pilot that would have delivered it is on hold indefinitely.^1,2

The authors state that assumption plainly. They also assume the coverage lasts a full decade, even though the Bridge is scheduled to end on December 31, 2027.^1,3 Keep both assumptions in mind when someone tells you the program, as it exists today, pays for itself.

A treatment can be worth covering even if it costs money overall, and that's where this paper is on firmer ground. Even after I take out the price cut, the health gains the model projects are worth more than they cost, in every scenario. In August, I argued here that the case for covering obesity drugs in Medicare never depended on the drugs paying for themselves. Read carefully, this paper backs that argument better than it backs the pays-for-itself claim.

Since July 1, Medicare Part D enrollees who qualify can get Wegovy, Foundayo, or the Zepbound KwikPen for weight loss for $50 a month.³ Who qualifies depends on a person's BMI when they first started a GLP-1, beginning at 27 for people with certain health conditions; CMS lists the full criteria. Drugmakers supply the drugs for $245 a month, so after the patient's $50, Medicare pays $195.¹ That doesn't include the fee pharmacies get each time they fill a prescription⁴ or the program's other costs.

To look 10 years ahead, the USC team used a computer model that simulates a representative group of older Americans over time. Weight affects each simulated person's chances of diabetes, heart disease, disability, and death, and the model adds up the cost of their care.¹ Think of it as a flight simulator for health policy: good at showing which way a policy tilts when you pull a lever, much less reliable about exactly where it lands.

Start with the drugs. Over the decade, Medicare spends $12.5 billion to $18.5 billion on Bridge prescriptions, and gets $5.7 billion to $10.0 billion back because treated patients need less other care.¹ By my math, Medicare gets back 41 to 62 cents in lower medical bills for every dollar it spends on the drugs. That's real money, but it's less than a dollar. It's also a different measure from the return on investment the authors report, which comes up below.

Then comes the $31.9 billion. Starting in 2028, the model applies the $245 price to the GLP-1s Medicare already covers for diabetes and counts the difference from current net prices (prices after discounts) as savings.¹ That number is the same in every scenario because it has nothing to do with who joins the Bridge. It's a discount on prescriptions Medicare was already filling.

Take that discount away and the math flips. By my calculation from the paper's main table, the expansion on its own costs Medicare $4.7 billion to $10.7 billion more than it saves over the decade. The authors don't hide this. They write that whether the program pays for itself from Medicare's point of view depends on extending the lower price to GLP-1 uses Medicare already covers, like diabetes.¹

The stronger case is about value. The authors put a dollar figure on longer, healthier lives and lower disability costs, counting $150,000 for each year of life in perfect health. Then they subtract the net cost of treatment. They call the result net social value.¹ Their totals include the $31.9 billion price cut, so I took it out. What's left is still positive in every scenario, $12.4 billion to $26.6 billion. Those dollars measure health. They aren't cash that can pay Medicare's bills. But under the model's assumptions, those numbers mean the health is worth the price, and that's a stronger argument than “free.”

This is the finding most likely to be quoted out of context. Medicare's 10-year return on investment was higher when more patients stopped the drug: 194 to 216%, compared with 117 to 126% when fewer stopped.¹ The reason is mostly arithmetic. The authors' return adds medical savings and the fixed $31.9 billion price cut, subtracts the drug bill, then divides by the drug bill. When patients stop, the drug bill shrinks, so the same $31.9 billion is divided by a smaller number, and the return goes up.

There are 2 more things to know. The scenarios don't change stopping alone: the one with more stopping also has more restarting, so the authors can't separate the two.¹ And fewer people stopping raised the paper's overall value measure by only 2 to 7%, while raising Medicare's drug spending by roughly 40 to 50%.¹ That doesn't mean the program works better when patients quit. It means people who stop also stop running up drug costs, and in the model the value lost is smaller than the money saved. The measure patients care about went the other way: by my math, fewer people stopping avoided about 44% more years lived with diabetes.

The model also assumes that who stops has nothing to do with how well the drug is working. The authors think the people who quit are probably the ones getting the least benefit, which would make the program's value higher than the model shows.¹ That's plausible: in the health-system data behind one scenario, people who lost more weight were less likely to stop.⁶ But people also stop treatments that are working because of cost, access, and side effects. In that same data, moderate or severe digestive side effects were linked to stopping.⁶ In the survey data the authors used, out-of-pocket cost was one of the strongest predictors of quitting.¹ Stopping isn't a reliable sign that a drug wasn't helping.

Stopping also has a predictable cost. A 2026 review that pooled trial data estimated that people regain about 60% of the weight they lost within a year of stopping, on average.⁵ The authors also note that their model doesn't capture possible health effects of stopping and restarting over and over.¹

The paper's other big finding is that who starts treatment mattered more than how long they stayed on it. The model was run two ways, with the same 2.35 million people starting treatment. When people with a past heart attack or stroke were left out, the overall value was 23 to 29% higher.¹ The authors' reasoning makes sense on its face. Those patients already have conditions a GLP-1 might have prevented, and they're more likely to die sooner, so each has less to gain.

This is where I'd push back. The SELECT trial studied patients like these: 17,604 adults 45 or older who already had cardiovascular disease (a past heart attack, stroke, or peripheral artery disease that causes symptoms), a BMI of 27 or more, and no diabetes. Semaglutide 2.4 mg lowered the combined risk of heart attack, stroke, or death from heart or blood vessel disease by 20% compared with placebo.⁷ A planned analysis of the same trial found that how much weight people on semaglutide lost in the first 20 weeks didn't track with their later risk of these events. Smaller waistlines accounted for about a third of the benefit, statistically, which suggests the drug also helps in other ways.⁸

The paper describes the drug's benefits flowing through weight, plus a direct effect on diabetes risk.¹ It doesn't describe a separate heart benefit. That raises the possibility that the model undercounts some of the benefit for people who already have cardiovascular disease. SELECT can't tell us which group would come out ahead once that benefit is counted, but it's a reason to hold the “leave them out” finding loosely. The model also leaves out 3 conditions that qualify people for the Bridge: chronic kidney disease, prediabetes, and peripheral artery disease that causes symptoms.¹

One practical point: a past heart attack or stroke doesn't automatically rule someone out of the Bridge. But if part of the reason for the prescription is to lower the risk of heart attacks, strokes, and related deaths, CMS sends it to the patient's regular Part D plan, even when weight loss is also a goal.³

Sign-ups have moved fast. Walgreens' chief pharmacy officer said volume was far beyond expectations but expects it to level off.⁹ HHS official Chris Klomp put sign-ups at about 1.1 million by early October.¹⁰ The model projected almost 740,000 people starting treatment in 2027, counting those who started in 2026, and 2.35 million by 2036.¹ Those numbers measure different things. A sign-up isn't the same as someone staying on the drug. The model also only starts treatment in people 65 to 84 and leaves out 3 qualifying conditions, while the Bridge is open to eligible people from age 18.^1,3 So the comparison doesn't show that sign-ups have outrun the model. It's still worth watching, because drug costs and medical savings grow with every person treated, while the $31.9 billion stays the same.

The Bridge itself runs 18 months. CMS has said it will review those 18 months of data to help decide whether the program continues past 2027, according to Becker's.⁹ Nothing in that report says the program has to show budget savings by then. Early data can show who's using the drugs, how many stay on them, side effects, and spending. The health payoff takes longer: in the model, the overall value was close to zero in the first year and grew every year after.¹ The authors suggest pairing early data with models that look further ahead, and that's sensible.¹

A computer model is only as good as what goes into it, and this one makes choices that cut both ways.

Read with its assumptions in view, this paper makes a conditional case for value. If the model's assumptions hold, covering GLP-1s for older adults with obesity buys health worth more than its net cost, even without the price cut. Saving Medicare money is a different claim. That depends on 2 policies the Bridge doesn't have: a lower price on the GLP-1s Medicare already covers, and coverage that lasts well past 2027. The question was never whether these drugs pay for themselves. It's whether the health is worth the price.