Medicare GLP-1 Bridge: eligibility, products and cost

Does Medicare cover GLP-1 weight loss drugs in 2026?

Yes, for eligible people, through a temporary demonstration. Since July 1, 2026, the Medicare GLP-1 Bridge has given eligible Part D beneficiaries Foundayo, Wegovy or Zepbound KwikPen for a $50 copay.

Part D itself still excludes drugs when used for weight loss. CMS calls these "agents when used for weight loss" in its memo to plans, and KFF explains that Medicare has been barred by statute from covering weight-loss drugs. The Bridge works around that by operating outside the Part D benefit, as a demonstration under the Social Security Act's authority to test changes in Medicare payment.

In practice this means three things that often confuse people. Your Part D plan does not run it: CMS uses one central processor for prior authorization, claims and pharmacy payment in 2026. Your plan does not have to opt in. And plans may not advertise it as a benefit, so your plan's member materials may say little about it. CMS tells plans to send you to 1-800-MEDICARE with Bridge questions.

The Bridge was first set to run from July to December 2026. CMS extended it through December 31, 2027, and said the longer period lets it collect more GLP-1 use data to share with plans ahead of any BALANCE implementation in Part D.

How many people does this reach? CMS has not published an estimate in the pages we read. KFF's analysis of 2023 data found 47.5 million Part D enrollees, 9.7 million who met the clinical criteria and about 3.8 million who appeared eligible once the other rules applied. That is an estimate from older data, not a count of who has enrolled.

Does Medicare cover Ozempic, Wegovy or Zepbound for weight loss?

Ozempic: not under the Bridge. Wegovy: yes under the Bridge, injection or tablet. Zepbound: the KwikPen only.

A Part D plan may cover Ozempic or Mounjaro for type 2 diabetes under its own formulary and cost sharing. It may also cover Zepbound to treat moderate to severe obstructive sleep apnea in adults with obesity, or Wegovy to reduce the risk of major adverse cardiovascular events in adults with established cardiovascular disease and obesity or overweight. CMS names both of those as examples of uses that stay with Part D. Those people are not moved to the Bridge, even when the Bridge copay would be lower, because CMS says eligibility does not depend on any cost-sharing difference.

How much does Medicare GLP-1 coverage cost?

You pay a $50 copay to the pharmacy for a one-month supply, which is 28 or 30 days depending on the drug. The amount is the same at any income level.

For scale, our recorded list prices are $1,349 a month for Wegovy and $1,086 a month for Zepbound. Those list prices are not what a self-pay patient usually pays: the comparison table below shows current manufacturer self-pay offers.

What the $50 does and does not do:

• It is flat. CMS says it stays the same whichever phase of the Part D benefit you are in when you fill.
• No deductible applies, and the payment does not count toward your Part D deductible or yearly out-of-pocket limit. KFF puts that limit at $2,100 in 2026 and $2,400 in 2027.
• Manufacturers supply the drug at a net price. CMS says participating manufacturers provide eligible drugs at $245 per monthly supply. No part of it counts toward your Part D drug costs.
• Extra Help does not lower it. Low-income subsidies do not apply. KFF notes this may make the copay harder for people with low or modest incomes to afford.
• You cannot spread it out. These drugs are not eligible for the Medicare Prescription Payment Plan.
• Coupons do not apply. CMS says coupons and discount programs may not be applied.
• It does not appear on your statements. Medicare.gov says it is not on your Part D Explanation of Benefits or your Medicare Summary Notice, so keep your pharmacy receipts.

Which GLP-1 drugs does Medicare cover?

Three products, and the form matters: Foundayo tablets, Wegovy injection or tablet, and Zepbound KwikPen. Medicare fact sheet, June 2026. Do not assume every product with the same active ingredient qualifies.

What is not covered

• Ozempic and Mounjaro. They are not on the Bridge list. A Part D plan may cover them for type 2 diabetes.
• Zepbound vials and single-dose pens. Medicare's fact sheet excludes them by name.
• Compounded semaglutide or tirzepatide. They are not on the list. FDA says compounded drugs are not FDA-approved and it does not review them for safety, effectiveness or quality before they are marketed.
• Rybelsus and Saxenda. Neither is on the Bridge list. If your plan pays for one, Medicare says to keep getting it through your plan.
• Pen needles. CMS says they are not covered and should not be billed to the Bridge or Part D.

Who is eligible for Medicare GLP-1 coverage?

You must meet all four requirements in Medicare's fact sheet: eligible Part D coverage, no way to get a GLP-1 through your plan, none of three named conditions, and the age and BMI rules.

1. Medicare drug coverage

You need Part D coverage, under a standalone drug plan or a Medicare health plan that includes drug coverage. Original Medicare alone has no drug coverage. Medicare.gov lists these as eligible: a standalone drug plan (PDP); a Medicare Advantage coordinated care plan with drug coverage (HMO, HMOPOS, Local and Regional PPO); a Special Needs Plan; an employer or union group waiver plan; and the Limited Income Newly Eligible Transition (LI NET) program.

You are not eligible if your only Medicare coverage is through certain special plan types. Medicare names private fee-for-service plans, cost contract plans and PACE organizations, and CMS's pharmacy page adds section 1833 prepayment plans. Moving to one of these leads to a rejected refill.

2. No GLP-1 available through your drug plan

You are not eligible if you are eligible to receive a GLP-1 through your Medicare drug plan. CMS's memo says this holds whether or not the drug is on your plan's formulary, and regardless of any cost-sharing difference. It also says a person who has received a GLP-1 through Part D in calendar year 2026 is not eligible, even when prescribed an eligible drug for weight management.

3. None of three named conditions

You are not eligible if you have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease. CMS's memo describes the liver condition as noncirrhotic metabolic dysfunction-associated steatohepatitis with moderate to advanced liver scarring. A prior authorization that attests to one of these diagnoses will be denied. Contact your drug plan, which may already cover a GLP-1 for you.

4. Age and BMI when you start therapy

You must be at least 18, and one of these must have been true when you started GLP-1 therapy:

• BMI of 35 or higher, with no further condition.
• BMI of 30 or higher, plus at least one of: diastolic heart failure (heart failure with preserved ejection fraction), uncontrolled high blood pressure (CMS: despite two antihypertensives), or chronic kidney disease stage 3a or above.
• BMI of 27 or higher, plus at least one of: prediabetes, a prior heart attack or stroke, or peripheral artery disease with symptoms.

These tiers are narrower than the labels for Wegovy and Zepbound. A BMI of 30 to 34.9 with only high cholesterol does not meet them, for example, and a BMI of 27 to 29.9 without a listed condition does not either.

Who the Bridge does not reach

• People with Original Medicare and no Part D plan.
• People whose only Medicare coverage is one of the excluded plan types.
• People with Medicaid but not Medicare. Medicaid has separate rules by state.
• People who do not meet the BMI rules.
• People prescribed a GLP-1 to reduce cardiovascular risk. CMS routes those prescriptions to Part D, even if weight reduction is also a goal.

Medicare fact sheet, Medicare.gov, CMS prescriber facts, CMS pharmacy facts, CMS FAQ memo.

How do you get a first fill under the Bridge?

There is no separate sign-up form for you to send, and coverage is not automatic. It runs through your doctor and pharmacy. Medicare's steps and CMS's pharmacy steps, in order:

1. 1

   Check your plan type

   Log in to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Eligible plan types are a standalone drug plan, a Medicare Advantage coordinated care plan with drug coverage (HMO, HMOPOS, Local and Regional PPO), a Special Needs Plan, an employer or union group waiver plan and LI NET. If you have no drug coverage, Open Enrollment runs October 15 to December 7, with coverage from January 1. A Special Enrollment Period applies only in certain situations, such as moving, losing coverage or getting Medicaid or Extra Help. Your State Health Insurance Assistance Program (SHIP) can help you check.

2. 2

   Talk to your doctor

   Ask whether a GLP-1 is right for you and whether you meet the Bridge rules. Bring your BMI at the time you started any GLP-1, and any records of heart failure, blood pressure treatment, kidney disease, prediabetes, a heart attack, a stroke or peripheral artery disease. Telehealth is not addressed on the CMS pages we read. A prescriber does not need to be enrolled in Medicare, but must not be on the Medicare Preclusion List.

3. 3

   Your doctor sends a prescription to the pharmacy

   A diagnosis code and a note directing the pharmacy to the Bridge are recommended but not required. A Part D denial is not required first. Prescribers should wait for the pharmacy's request: submitting a prior authorization before a pharmacy claim establishes eligibility returns a "patient not found" error.

4. 4

   Give the pharmacy your Medicare number

   The pharmacy needs the number on your Medicare card. If you do not have the card, the pharmacist can look it up with the last four digits of your Social Security Number.

5. 5

   Your doctor completes the prior authorization

   The pharmacy sends the request to your doctor, typically within 24 to 72 hours. If none arrives within 72 hours, the doctor can download the fax form and submit it directly. CMS says the decision comes within 72 hours of submission and is mailed to you.

6. 6

   Pick up your medicine and pay $50

   You get a letter from Medicare confirming coverage. Refills need no new approval as long as you stay on the same drug, even if your dose changes.

7. 7

   Follow your doctor's dose schedule

   Each of these drugs starts at a low dose and increases over time. See our GLP-1 dosage chart, and follow the schedule your prescriber gives you.

What are the BMI rules and prior authorization steps?

Your prescriber attests on a CMS form that you met one of the BMI tiers when you started therapy. The decision comes within 72 hours of submission.

What the form asks

The Bridge prior authorization form asks clinical questions about diagnoses. CMS says the criteria must be met when GLP-1 therapy started, not when the request is made. Its example: someone with a BMI of 37 when they started in September 2024 and a BMI of 34 at a July 2026 request still meets the rule, because the attestation refers to the starting BMI. Prescribers should apply clinical judgment, especially when a condition may no longer apply or is well controlled.

By completing the form, the prescriber attests under penalty of perjury that the information is accurate and complete. CMS may check it against Medicare data, such as whether you have type 2 diabetes. So a request should not be shaped to fit a tier. Ask your doctor what your records actually support.

Your doctor must also certify that you are using the drug as part of a lifestyle program focused on diet and exercise. Medicare.gov lists this as a requirement.

How long it takes

• The pharmacy sends its request to the prescriber electronically or by fax, typically within 24 to 72 hours.
• CMS strongly encourages electronic submission. If no request arrives in 72 hours, the prescriber can fax the form directly.
• The decision is mailed to you and sent to the prescriber within 72 hours of submission.
• Without an electronic notice, the pharmacy may need to resubmit the claim once approved.
• Prescribers can call 855-273-0102, Monday through Friday, 8 a.m. to 7 p.m. ET, about prior authorization questions and status. You can ask 1-800-MEDICARE about status too.

If your prior authorization is denied

CMS says there is no appeals process under the Medicare GLP-1 Bridge. A prescriber may resubmit the form if the original held incorrect information, or if updated or additional information is available. This differs from Part D, where CMS says your appeal rights are unchanged. If you think your plan should be covering a GLP-1 for a Part D use, the plan's coverage determination and exception processes still apply.

The BALANCE Model, and what happens when the Bridge ends

CMS has not said what follows December 31, 2027. Treat coverage after that date as undecided.

BALANCE stands for Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth. CMS's page lists its model drugs as all formulations of Mounjaro, Ozempic, Rybelsus and Wegovy, the KwikPen formulation of Zepbound, and Foundayo.

• In Medicaid: CMS says state Medicaid agencies can join from May 2026 through January 1, 2027, and that coverage for weight loss under BALANCE would launch in Medicaid as early as May 2026. Coverage depends on manufacturer and state participation, and the model does not guarantee coverage for any individual. See our Medicaid guide for what we can confirm by state.
• In Medicare Part D: KFF reports that CMS said on April 21, 2026 it would not move forward with BALANCE in Medicare in 2027, after plan participation fell short of the level CMS required. CMS's own page refers only to a "potential implementation of BALANCE in Part D," with no date.
• For the Bridge: CMS answers the question of what happens if BALANCE does not launch in Medicare in 2027 by saying the Bridge will be extended through December 31, 2027.
• After that: KFF says it is unclear how coverage would continue. The CMS pages we read say nothing further.

How does the Bridge compare with other options?

For the people it covers, $50 a month is below the manufacturer self-pay prices we read. Other routes, for those it does not cover:

Manufacturer savings cards are not available to people with government coverage, according to the terms we read at wegovy.com and zepbound.lilly.com, and CMS says coupons cannot be applied to the Bridge copay.

Other ways to save, from Medicare.gov

For people who are not eligible or want other options, Medicare.gov suggests checking whether the manufacturer offers payment assistance, whether your state helps with drug costs, whether mail-order pharmacy prices are lower, and whether the Medicare Prescription Payment Plan can help you manage costs. It also mentions TrumpRx.gov, which lists offers and cash prices. You cannot buy drugs from it directly, and discount cards do not count toward your deductible or out-of-pocket maximum.

What to do now

1. Confirm your plan type on Medicare.gov or with 1-800-MEDICARE. If you are unsure, your SHIP counselor can help.
2. Find your starting BMI. Ask for the BMI and date from when you began any GLP-1, and for your records of any listed condition.
3. Talk through the choice. Ask your doctor whether Foundayo, Wegovy or Zepbound KwikPen fits your history and current medicines, and how side effects would be managed. Read our side effects guide.
4. Ask the pharmacy to run the claim to the Bridge. Pharmacies do not need to opt in. If a claim is rejected, ask the pharmacist to route it with the Bridge details on the CMS pharmacy page.
5. Be careful with compounded medicine as a stopgap. It is not on the Bridge list, and FDA says compounded drugs are not FDA-approved. Moving from a compounded dose to a brand dose is a decision for your prescriber.
6. Keep your paperwork. Keep the letter from Medicare and your pharmacy receipts, since the copay does not appear on your Part D statements. Report suspected fraud to 1-800-MEDICARE.