The people's voice of reason
The people's voice of reason
Historically, Medicare could not cover medications solely for weight loss. For Medicare enrollees interested in GLP-1 and related medications, this meant facing hundreds of dollars in out-of-pocket costs every month. But that changed on July 1, 2026, with a new pilot program that offers Medicare prescription plan enrollees access to weight-loss medications for a $50 monthly copay.
Here, GoodRx, a platform for medication savings, covers everything you need to know about the Medicare GLP-1 Bridge program, and whether you qualify.
The Medicare GLP-1 Bridge program is a short-term initiative for Medicare Part D prescription plan enrollees to access certain glucagon-like peptide-1 (GLP-1) receptor agonists and related medications for weight loss and pay $50 a month. The pilot program is initially planned as an 18-month project starting July 1, 2026 and ending December 31, 2027.
This program offers a chance for Part D enrollees, mostly older adults, to access medications for weight loss that have long been out of reach for many because of cost.
Only certain medications will be covered under the Medicare GLP-1 Bridge program. They include all formulations of the following:
You must have Medicare Part D to participate, but the Medicare GLP-1 Bridge program is the primary payer — not your prescription insurance plan. You also can’t use additional coupons and discounts.
Only Foundayo, Wegovy (pills and injections), and Zepbound KwikPens are covered by the program. Zepbound single-use pens and vials are not. Neither are other GLP-1s. Ozempic (semaglutide) is often associated with weight loss, but it’s FDA approved to treat Type 2 diabetes, and it’s also not included.
Medicare Part D enrollees are eligible if they:
Here are the specifics of these requirements.
To qualify, you need to meet all of the medical and lifestyle requirements of the program. All eligible enrollees must be at least age 18, prescribed a GLP-1 to reduce excess body weight and maintain weight reduction, and commit to lifestyle changes. These include nutrition and physical activity consistent with the medication’s FDA-approved label.
Your prescriber’s prior authorization form also must confirm that you meet one the following clinical criteria:
You must meet the Medicare GLP-1 Bridge program clinical criteria at the time you start therapy, even if you began taking one of the covered medications before July 1, 2026. GLP-1s for several other conditions are covered by Part D plans, but they aren't eligible for the Bridge program — or the $50 copay — even if you meet the clinical criteria.
Eligible Part D prescription plans
You must be enrolled in a standalone Part D plan or a standard Medicare Advantage plan that offers Part D coverage. Enrollees who have Special Needs Plans (SNPs), employer/union group waiver plans, and limited-income newly eligible transition program plans can also participate. If you have other types of Medicare coverage, such as enrollment in the Program of All-Inclusive Care for the Elderly (PACE), you won’t be eligible for the Bridge program unless you also have a standalone Part D plan. People dually eligible for Medicare and Medicaid who also meet the prior authorization criteria can access GLP-1s through the program.
Use of covered GLP-1 medications
To access the medication, your healthcare professional must submit a prior authorization request form and a prescription for an eligible GLP-1 medication included in the Medicare GLP-1 Bridge program. The monthly prescription can be a 28-day or 30-day supply. The prior authorization form will be accepted electronically or by fax. Your prescriber will receive a request to complete the prior authorization form after your prescription is submitted to the pharmacy. Your prescriber is not required to be enrolled in Medicare, but also can’t be on the preclusion list of healthcare professionals banned from receiving Medicare payments.
The Medicare GLP-1 Bridge program began on July 1, 2026.
Here are 6 steps to help you access the Medicare GLP-1 Bridge program:
It’s unclear what will happen if the Medicare GLP-1 Bridge program ends as scheduled on December 31, 2027 without another option for enrollees. CMS originally proposed the program as part of a two-step plan to expand Medicare coverage of GLP-1s for obesity.
The Medicare GLP-1 Bridge program was the first step. The second stage — a five-year program called BALANCE, which was set to launch in January 2027 for Medicare enrollees to continue low-cost coverage for weight-loss medications more permanently — has been paused. CMS has reported to Part D plans that BALANCE may be implemented, so there’s a chance the longer-term program could be revived.
If the end date for the Medicare GLP-1 Bridge program remains Dec. 31, 2027, and you wish to continue your medication in 2028 for an approved purpose, you may need to switch Part D plans for the 2028 coverage year. You can do this during Medicare open enrollment in the fall of 2027. If you have a Medicare Advantage plan, you can also make Part D changes during the first three months of 2028 during the Medicare Advantage open enrollment season. At that time, you will need to ensure the medication you take will be included in whatever Medicare program covers GLP-1s for weight loss — or that your medication is covered by your prescription plan to treat another condition.
Medicare Part D plans cover GLP-1 medications for other conditions, including:
Part D enrollees with these conditions can receive GLP-1s through their plans and are not eligible for the Medicare GLP-1 Bridge Program — even if they meet the clinical criteria. For many people, weight loss is a side effect of taking GLP-1s for other conditions.
If you don’t have insurance or pay on your own, subscription programs can help you save on prescriptions with a monthly fee plus the cost of medication. Or you may be able to pay less for weight-loss medications through manufacturer savings programs.
The Medicare GLP-1 Bridge Program is a new way for Medicare Part D prescription plan enrollees to access certain glucagon-like peptide-1 (GLP-1) medications for weight loss at a $50 monthly copay. The program started July 1, 2026, and is scheduled to end on December 31, 2027. The Foundayo (orforglipron) tablet, Wegovy (semaglutide) pills and injections, and the Zepbound (tirzepatide) KwikPens will be available through the program. To qualify, you must be enrolled in certain Part D plans, meet clinical criteria, and have a prescription for an included GLP-1 medication for the purpose of weight loss.
This story was produced by GoodRx and reviewed and distributed by Stacker.
Reader Comments(0)