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Nursing home leaders say GLP-1 medications are increasingly common among new residents, with one operator reporting that 30% to 40% of new admissions use them. Their use brings added clinical monitoring needs and unresolved payment questions, including a $50 monthly fee under a temporary Medicare Part D bridge program for eligible drugs.
GLP-1 medications are becoming more common among nursing home residents, with one care provider reporting that about 30% to 40% of its new admissions are taking them. The trend is prompting facilities to expand clinical monitoring and staff education while confronting questions about who pays for high-cost prescriptions, according to a report by Skilled Nursing News.
Lisa Chubb, chief nursing officer at New Jersey-based Venza Care, said the medications are appearing among residents for reasons beyond diabetes and weight loss, including cardiovascular prevention and other chronic health concerns. She said the share is higher at facilities with more short-stay residents. The report does not provide an industry-wide estimate, so Venza’s figures should not be treated as representative of all nursing homes.
Chubb said Venza uses weekly “nutrition at risk” meetings to review residents’ needs. The operator also builds medication review and education into electronic health record assessments, tracks weight loss and involves registered dietitians in care planning. Clinicians are weighing possible benefits against concerns including muscle weakness, frailty and nutritional risk.
Payment depends on the resident’s coverage and the medication’s purpose. Jessie McGill of the American Association for Post-Acute Care Nursing said a temporary Medicare Part D bridge program covers certain GLP-1 drugs prescribed for weight loss for eligible residents, with a $50 monthly fee in addition to Part D coverage. The eligible drugs named in the report are Wegovy, Zepbound and Foundeo. The program does not cover every prescription or eliminate residents’ costs.
Care Plans Meet New Drug Costs
The increase affects both resident care and facility finances. GLP-1 use may require more frequent review of nutrition, hydration, weight changes and medication effects, particularly for older adults who already have chronic conditions or limited functional ability. Weight loss may not be an appropriate goal for every resident, making decisions dependent on individual clinical circumstances.
Facilities may also face direct expenses. McGill said that when residents are covered under Medicare Part A, nursing homes can be responsible for the medication cost. If a resident’s prescription is not eligible for the bridge program, or the resident cannot afford its monthly fee, the cost can complicate care planning and facility budgets. Providers and clinicians are therefore balancing treatment choices with coverage rules and operational costs.
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Temporary Medicare Coverage Rules
The report describes a federal bridge program for certain GLP-1 prescriptions under Medicare Part D. According to McGill, it applies to qualifying weight-loss prescriptions when the resident was not already prescribed a GLP-1 for diabetes; diabetes prescriptions are covered under Part D. The bridge program has been extended through 2027.
A more permanent coverage approach, called BALANCE, was delayed and had no future implementation date in the report. McGill said one possible policy change would be for Congress to expand Medicare consolidated billing to include high-cost medications such as GLP-1s. The report notes that some excluded drugs, including chemotherapy and dialysis medications, can be billed directly to Medicare Part B by providers.
“We see a lot of our new admissions coming in with GLP-1s. Initially it was used solely for weight loss and diabetes, but now we’re seeing it trend in other directions as well.”
— Lisa Chubb, chief nursing officer for Venza Care
Coverage and Resident Risks Remain
The report does not establish how widespread GLP-1 use is across nursing homes nationally, nor does it quantify the total cost to facilities or residents. It also does not specify how many residents qualify for the bridge program or how often affordability affects whether a prescription is continued.
Clinical effects and risks can differ by resident. Stenson said nursing home populations often have frailty, multiple chronic conditions, nutritional concerns and functional limitations; potential side effects include nausea, vomiting, constipation and dehydration. The report does not provide outcome data showing how GLP-1 use affects health or quality of life in this population. The future timing of BALANCE also remains unknown.
Facilities Await Policy and Practice Changes
For now, the bridge program is set to continue through 2027, while the permanent BALANCE program has no scheduled start date in the report. Nursing home operators will need to account for residents’ coverage, eligibility and any out-of-pocket charges when reviewing medication plans and facility expenses.
At the care level, Venza’s approach illustrates the monitoring and team education operators may use as more residents arrive on these drugs. Any broader policy change, including an expansion of consolidated billing, would require further action by Congress. The report does not identify a timetable for such a change.
Key Questions
How common are GLP-1 medications among nursing home residents?
Venza Care’s Lisa Chubb said about 30% to 40% of the operator’s new admissions are taking GLP-1s, with higher proportions at facilities with more short-stay residents. The report provides no national estimate.
Which GLP-1 drugs are eligible for the Medicare bridge program?
The report names Wegovy, Zepbound and Foundeo as eligible for the temporary program, subject to its coverage rules. It describes coverage for qualifying weight-loss prescriptions under Medicare Part D.
What does the bridge program cost residents?
According to AAPACN’s Jessie McGill, the program adds a $50 monthly fee alongside Part D coverage. That fee may still be difficult for some residents to pay, and the program does not cover every GLP-1 prescription.
Why do clinicians monitor GLP-1 use closely in nursing homes?
Residents may have frailty, chronic conditions, nutritional concerns or limitations in daily functioning. Clinicians described monitoring weight and nutrition and considering possible effects such as dehydration, constipation, nausea and vomiting.
When will the permanent BALANCE program begin?
The report says BALANCE was delayed and gives no future implementation date. The temporary bridge program has been extended through 2027.
Source: skillednursingnews.com
