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Nursing home operators report that more residents are arriving on GLP-1 medications, with one operator estimating 30% to 40% of new admissions are taking them. The drugs may bring health benefits, but providers are adapting monitoring and staff education while Medicare coverage rules leave some costs with residents or facilities.
GLP-1 medications are increasingly showing up among nursing home residents, prompting operators to adjust clinical monitoring and staff education while they work out how to pay for the drugs. Venza Care Chief Nursing Officer Lisa Chubb said about 30% to 40% of new admissions at the company are taking a GLP-1, as use expands beyond diabetes and weight loss into other chronic conditions.
Chubb told Skilled Nursing News that Venza is seeing residents arrive on GLP-1s prescribed for a wider range of reasons, including cardiovascular prevention and metabolic or organ health. She said the share is higher at facilities with more short-stay residents.
At Venza, teams discuss residents at risk of nutritional problems in weekly meetings, use electronic health record assessments to document medication review and education, and monitor weight loss. Registered dietitians are involved in care for residents taking the drugs, Chubb said. The report also discusses resident choice, potential health benefits, and possible concerns such as muscle weakness, frailty and inadequate nutrition.
Payment remains a separate challenge. Jessie McGill of the American Association for Post-Acute Care Nursing said Medicare’s temporary bridge program covers certain GLP-1s prescribed for weight loss for eligible Part D beneficiaries, with eligibility criteria involving body mass index and other chronic conditions and a $50 monthly fee. She said only Wegovy, Zepbound and Foundeo are eligible under the program. Residents who cannot afford the fee may still face a barrier, and McGill said the nursing home would be responsible for the medication cost for residents covered under Medicare Part A.
Clinical Work and Facility Budgets
The increased presence of these medications can affect both day-to-day care and facility finances. Nursing home residents may already have frailty, multiple chronic conditions, nutrition concerns or limits on daily functioning. Weight loss that may be sought in other settings is not automatically beneficial for every older resident, and staff need to track whether a medication is affecting nutrition or strength.
Lauren Stenson, a curriculum development specialist at AAPACN, cited possible adverse effects including nausea, vomiting, constipation and dehydration. The report also describes the need for staff education and individualized assessment as use rises.
The financial exposure varies by coverage and circumstances. A resident’s Part D coverage, eligibility for the bridge program and the drug prescribed can affect who pays; when a resident is covered under Part A, McGill said the nursing home would be responsible for the medication cost. Operators have said high-cost medications are a budget concern, while some clinicians see potential benefits.
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Medicare Coverage Still in Flux
The report describes a temporary Medicare bridge program for certain Part D beneficiaries seeking coverage for qualifying GLP-1s for weight loss. McGill said Part D coverage for these drugs when prescribed for diabetes is handled differently, and the bridge program is aimed at eligible residents who do not already have a GLP-1 prescription for diabetes. Eligibility also involves criteria related to body mass index and other chronic conditions.
A more permanent program, called BALANCE in the report, was delayed and had no future implementation date at the time of publication. The bridge program, by contrast, was extended through 2027. McGill said one possible policy change would be for Congress to expand consolidated billing to include high-cost drugs such as GLP-1s. The report presents that as a proposed next step, not an enacted change.
Operators are also responding within their own care systems. Journey Skilled Nursing Chief Nursing Officer Jody O’Mara said her company was discussing a pharmacy-services joint venture for its Georgia residents. She said GLP-1 costs would become part of the operator’s expenses under that arrangement, while expressing her view that the benefits outweigh the costs.
“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 Outcomes Unsettled
The report gives Venza’s estimate that 30% to 40% of its new admissions take GLP-1s, but does not provide an industry-wide estimate. It describes bridge-program eligibility criteria related to body mass index and chronic conditions.
It is also unclear when the delayed BALANCE program might begin or whether Congress will change consolidated billing. The report discusses medication costs for residents and facilities but provides no aggregate cost figure. Individual coverage and clinical decisions remain dependent on each resident’s circumstances.
Providers Adapt as Rules Evolve
Venza says its teams discuss residents at risk of nutritional problems, document medication review and education, and monitor weight loss. Operators will also have to account for different coverage pathways and potential Part A costs when considering budgets and pharmacy arrangements.
The bridge program is scheduled to continue through 2027, but the report gives no implementation date for BALANCE. Any change to consolidated billing would require congressional action. Coverage considerations described in the report include the medication, eligibility criteria and who is responsible for payment.
Key Questions
How common are GLP-1 medications among nursing home residents?
Venza Care’s Lisa Chubb said about 30% to 40% of the company’s new admissions are taking GLP-1s, with a higher share at facilities serving more short-stay residents. The report does not give a national estimate.
Does Medicare cover GLP-1 drugs for nursing home residents?
Coverage depends on the resident’s situation and the medication’s use. The report says certain drugs prescribed for weight loss may qualify for Medicare Part D’s temporary bridge program, which carries a $50 monthly fee and eligibility requirements. Diabetes prescriptions are covered under a different Part D arrangement, according to the report.
Who pays when a resident is covered under Medicare Part A?
AAPACN’s Jessie McGill said the nursing home would be responsible for the medication cost for a resident on Medicare Part A. The financial impact depends on the prescription and whether another coverage route applies.
What risks are nursing home staff watching for?
The report identifies potential concerns including weight loss, muscle weakness, frailty, nausea, vomiting, constipation and dehydration. Staff may monitor nutrition and weight and assess whether treatment is appropriate for the individual resident.
When will permanent Medicare coverage begin?
The report says the proposed permanent BALANCE program was delayed and had no future implementation date at publication. The temporary bridge program was extended through 2027.
Source: skillednursingnews.com
