For years, Medicare has not covered GLP-1 medications like Wegovy or Zepbound when prescribed solely for weight loss. That is changing. Starting July 1, 2026, a new temporary program called the Medicare GLP-1 Bridge will give eligible beneficiaries access to certain GLP-1 drugs for a flat $50 monthly copay. Here's what the program covers, who qualifies, and how to get started.
Key Dates
- July 1, 2026 — The Medicare GLP-1 Bridge program begins.
- December 31, 2027 — The program is scheduled to end. It was originally planned to run only through the end of 2026, but in May 2026, the Centers for Medicare & Medicaid Services (CMS) announced it would extend the Bridge through the end of 2027 while a longer-term coverage model, called the BALANCE Model, continues to be developed.
What Medications Are Covered
The Bridge program covers specific formulations of three GLP-1 medications:
- Foundayo® (orforglipron) — oral tablet
- Wegovy® (semaglutide) — both the injection and the tablet form
- Zepbound® (tirzepatide) — KwikPen® only. Single-dose vials and pens are not included.
Who Is Eligible
To qualify, you must be 18 or older, have Medicare drug coverage (Part D), and meet one of the following clinical thresholds at the time you start GLP-1 therapy:
- A body mass index (BMI) of 35 or higher, or
- A BMI of 30 or higher, plus at least one of: heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease at stage 3a or higher, or
- A BMI of 27 or higher, plus at least one of: prediabetes, a previous heart attack or stroke, or peripheral artery disease with symptoms
You are eligible whether you have a standalone Part D drug plan, a Medicare Advantage plan with drug coverage (MA-PD), a Special Needs Plan, an employer/union group waiver plan, or the Limited Income Newly Eligible Transition program. The program is available nationwide, including all U.S. territories.
You are not eligible if you:
- Already have a GLP-1 covered through your regular Part D plan
- Have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease — though your Part D plan may cover a GLP-1 for those conditions separately
How the Process Works
- Talk to your doctor. Your health care provider needs to confirm you meet the eligibility criteria and that you're using the GLP-1 as part of a lifestyle program focused on diet and exercise.
- Your provider sends the prescription to your pharmacy. If a prior authorization is requested, your provider will need to complete it.
- You'll get a confirmation letter in the mail once your GLP-1 drug is approved under the Bridge program.
- Fill your prescription for $50 per month. This flat copay applies to a one-month supply (28 or 30 days, depending on the drug).
- Your prior authorization stays valid through December 31, 2027 — including for refills and dose changes — unless you switch to a different GLP-1 medication.
Note that this program runs outside your normal Part D benefit. That means the $50 copay:
- Does not count toward your yearly Part D deductible or out-of-pocket limit
- Won't show up on your Part D Explanation of Benefits or Medicare Summary Notice
- Cannot be reduced by Extra Help
- Cannot be spread out using the Medicare Prescription Payment Plan
Questions About Your Eligibility
Your pharmacy may ask for your Medicare Number or the last four digits of your Social Security number to process the prescription — this is a normal part of verifying Bridge eligibility. If anything about a request feels off, you can report suspected fraud by calling 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).
If you have questions about whether you qualify or want to check the status of a prior authorization, call 1-800-MEDICARE or talk with your doctor.
What Happens After 2027
The Bridge is meant to be a stopgap. CMS has also been developing the BALANCE Model, a broader, longer-term approach to Medicare coverage of GLP-1s, but its Part D component has been delayed indefinitely. For now, the Bridge program is the pathway to affordable GLP-1 access for weight management under Medicare, and it's worth discussing with your doctor well before your next prescription refill if you think you might qualify.
This article summarizes publicly available information from Medicare.gov and the Centers for Medicare & Medicaid Services as of August 2026. Program details can change — confirm your specific situation with your health care provider or by calling 1-800-MEDICARE.