Medicare is about to do something it has never done before: cover prescription weight loss drugs. Starting July 1, 2026, eligible Medicare beneficiaries can get Wegovy, Zepbound, or Foundayo for just $50 a month through a new program called the Medicare GLP-1 Bridge. But there are important details buried in the fine print that most news stories are not telling you.
What Is the Medicare GLP-1 Bridge?
The Medicare GLP-1 Bridge is a short-term demonstration run by CMS that provides eligible Medicare Part D beneficiaries with access to certain GLP-1 weight loss drugs from July 1, 2026 through December 31, 2027. It was created to fill a gap while a longer-term program, called the BALANCE Model, gets off the ground.
Which Drugs Are Covered?
Beginning July 1, 2026, all formulations of Foundayo, all formulations of Wegovy (injection and pill), and the KwikPen formulation of Zepbound are covered. The single-dose vial and pen versions of Zepbound are not included.
Important: Ozempic Is NOT Covered
Ozempic contains the same active ingredient as Wegovy, but it is FDA-approved for Type 2 diabetes, not weight loss. The GLP-1 Bridge only covers the weight loss versions of these drugs. Medicare Part D already covers Ozempic and Mounjaro for diabetes, and this program does not change that.
Who Qualifies?
You must be enrolled in a Medicare Part D plan or a Medicare Advantage plan with drug coverage, and meet one of these clinical criteria:
- BMI of 35 or higher
- BMI of 30 or higher with heart failure, uncontrolled hypertension, or chronic kidney disease (stage 3a or above)
- BMI of 27 or higher with pre-diabetes, prior heart attack, prior stroke, or symptomatic peripheral artery disease
5 Catches You Need to Know
- The $50 copay does not count toward your out-of-pocket cap. Because the program runs outside the standard Part D benefit, the $50 does not apply toward your deductible or the $2,100 annual out-of-pocket cap.
- Low-Income Subsidy does not apply. If you qualify for the Part D Low-Income Subsidy, you cannot use it to reduce the $50 copay under this program.
- Your doctor must submit prior authorization. You cannot simply pick up a prescription. Your provider must submit a prior authorization request through a CMS centralized processor before you can fill it.
- Already getting a GLP-1 for diabetes or sleep apnea? You stay on your Part D plan. If your GLP-1 is prescribed for a currently covered condition, you continue through your existing plan and pay your plan’s cost-sharing, even if it is more than $50.
- Keeping coverage in 2027 may require switching plans. The Bridge ends December 31, 2027. To stay covered, you will need a Part D plan that joins the BALANCE Model. Not all plans are required to participate, so review your options during open enrollment (October 15 through December 7, 2026).
What Should You Do Right Now?
Talk to your doctor before July 1. Ask if you meet the BMI and clinical criteria and make sure they know about the prior authorization requirement. Then, during open enrollment this fall, confirm that your Part D plan will participate in the BALANCE Model so your coverage continues into 2027.
If you need help reviewing your Medicare plan options, reach out to a licensed Medicare advisor.
Sources: CMS Medicare GLP-1 Bridge FAQ • KFF Medicare GLP-1 Analysis