The Medicare GLP-1 Bridge is a temporary CMS program that lets eligible people with Medicare Part D drug coverage get Wegovy, Foundayo or the Zepbound KwikPen for weight reduction at a $50 monthly copay. It runs from July 1, 2026, through December 31, 2027.[1][5] To qualify, you must meet BMI and health criteria at the time you started GLP-1 therapy, and your prescriber must complete a prior authorization.[2]
Prices and program terms checked October 2026. They change often; confirm with the manufacturer or your plan.
What the Medicare GLP-1 Bridge is
The Bridge is a short-term demonstration run by CMS under its authority to test new payment methods. It is not a Part D plan.[1][2]
- It sits outside Part D. Your drug plan does not pay for these fills or have to opt in. A single central processor handles prior authorization, claims and pharmacy payment, and CMS named Humana, which runs the LI NET program, for that role.[1][3]
- It’s nationwide, in all states and U.S. territories.[3]
- It was extended. The Bridge was first planned for July to December 2026. On April 21, 2026, CMS said it would not launch the BALANCE Model in Part D in 2027 and would run the Bridge through the end of 2027 instead.[6]
CMS launched the program on July 1, 2026.[4]
Why Medicare needed a workaround
From the start, federal law has barred Part D from covering drugs used only for weight loss. Part D plans can cover GLP-1s for other FDA-approved uses, such as type 2 diabetes, heart risk reduction or sleep apnea.[6] The Bridge is a way to cover weight-loss use without changing that law. For how Part D handles each drug, see does Medicare cover Ozempic? and does Medicare cover Zepbound?
Which drugs the Bridge covers
| Drug | Form covered | Not covered |
|---|---|---|
| Wegovy (semaglutide) | Injection and tablets | — |
| Foundayo (orforglipron) | Tablets (all strengths) | — |
| Zepbound (tirzepatide) | KwikPen only | Single-dose pens and vials |
Source: CMS.[2][5] CMS added Foundayo on April 6, 2026, after its FDA approval, and at the same time said only the Zepbound KwikPen would be included. The product list may change during the program.[2]
Pen needles for the KwikPen are not covered by the Bridge, so you buy them separately.[2] Ozempic, Mounjaro and Rybelsus are not on the list; they remain Part D drugs for diabetes. Learn more about each drug in our profiles of semaglutide, tirzepatide and orforglipron.
Who qualifies
You must be enrolled in Part D through a standalone drug plan (PDP) or a Medicare Advantage coordinated care plan with drug coverage (HMO, HMO-POS, or local or regional PPO). Special Needs Plans, employer group waiver plans and LI NET also count.[2]
You must be at least 18 and be prescribed the drug to reduce or maintain weight, along with ongoing diet and exercise changes. You also need to meet one of these at the time you started GLP-1 therapy:[2]
| BMI when you started | Also needed |
|---|---|
| 35 or higher | Nothing else |
| 30 or higher | Heart failure with preserved ejection fraction, uncontrolled high blood pressure (above 140/90 despite two blood pressure drugs), or chronic kidney disease stage 3a or worse |
| 27 or higher | Prediabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease |
The “when you started” rule matters if you began a GLP-1 before joining Medicare or before July 2026. CMS gives an example: someone who started with a BMI of 37 in September 2024 and has a BMI of 34 in July 2026 still meets the BMI 35 rule.[2]
Who is not eligible
- People with type 2 diabetes, moderate to severe sleep apnea or MASH (fatty liver disease with scarring). Part D already covers GLP-1s for these, so CMS sends you to your plan instead.[2][5]
- People already getting a GLP-1 through Part D. If you fill a GLP-1 through your Part D plan after joining the Bridge, later Bridge refills will be rejected.[3][5]
- People whose GLP-1 is prescribed for heart risk reduction. That prescription should go to the Part D plan, even though a past heart attack or stroke counts toward Bridge criteria.[2]
- People in ineligible plan types: private fee-for-service, section 1876 cost plans, section 1833 prepayment plans, PACE, fallback plans and religious fraternal benefit plans, unless also enrolled in a standalone PDP.[2]
- People without Part D. The Bridge does not give drug coverage on its own.[2]
What you pay
- $50 per monthly fill. The Part D deductible does not apply.[1]
- It doesn’t count toward your Part D limits. The $50 does not count toward true out-of-pocket costs, and the Low-Income Subsidy (Extra Help) does not lower it.[1] KFF notes this means the copay stays at $50 regardless of your Part D benefit phase, and it does not count toward the $2,100 out-of-pocket cap for 2026.[6]
- No coupons. Manufacturer coupons and discount programs cannot be applied to Bridge claims.[3]
- One month at a time. Only 28- or 30-day fills are allowed; 60- and 90-day fills are not. Pharmacies can process a vacation override, but there are no overrides for lost or stolen medicine.[3]
Behind the scenes, KFF reports that manufacturers agreed to a net price of $245 per monthly supply for the Bridge.[6] For cash prices outside Medicare, see GLP-1 cost without insurance.
How to get coverage, step by step
- Check eligibility at Medicare.gov/glp1bridge or by calling 1-800-MEDICARE (1-800-633-4227).[1]
- Your prescriber sends a prescription for a covered drug to your pharmacy. A Part D denial is not required first.[2]
- The pharmacy submits the claim to the Bridge. It may ask for your Medicare Number or the last 4 digits of your Social Security number.[3][5]
- The pharmacy sends a prior authorization request to your prescriber, usually within 24 to 72 hours. The prescriber attests, under penalty of perjury, that you meet the criteria.[2]
- You get a decision within 72 hours of submission, and a letter in the mail.[2][5]
Approval lasts through December 31, 2027, including refills and dose changes, unless you switch to a different GLP-1 drug.[3][5] There is no formal appeal. If a request is denied because of wrong or missing information, your prescriber can resubmit it.[2]
What happens after 2027
KFF notes there is no clear path for Medicare coverage of GLP-1s for obesity after 2027 unless the Bridge is extended again or the BALANCE Model, or another route, launches.[6] If coverage ends, people could face full cash prices. Our guide to stopping GLP-1s explains what tends to happen to weight after stopping, and how GLP-1 drugs work covers the basics. More on these drugs is in our GLP-1 basics hub.
Questions to ask your prescriber
- Do I meet the Bridge criteria based on my BMI and health conditions when I started?
- Should my GLP-1 go through the Bridge or my Part D plan for my conditions?
- Which covered drug fits me best: an injection, a daily tablet or the KwikPen?
- What is our plan if the Bridge ends after December 2027?
