Two ways Medicare covers GLP-1s
| Path | Who it's for | What you pay |
|---|---|---|
| Your Part D plan | Type 2 diabetes, moderate to severe obstructive sleep apnea, noncirrhotic MASH (a fatty liver disease), or lowering the risk of major heart events | Your plan's normal copay or coinsurance |
| Medicare GLP-1 Bridge | Weight management for eligible Part D members who don't qualify through their plan | $50 per one-month supply |
CMS tells prescribers to send prescriptions for type 2 diabetes, sleep apnea, MASH or heart risk reduction to the person's Part D plan, even when weight loss is also a goal. Ask your plan whether a specific drug is on its list and what you'd pay.
The Medicare GLP-1 Bridge
- Dates: July 1, 2026 through December 31, 2027, nationwide.
- Drugs: Foundayo (tablet), Wegovy (injection or tablet) and Zepbound (KwikPen only, not vials or single-dose pens).
- Cost: $50 for a one-month supply (28 or 30 days, depending on the drug).
- Plans that count: standalone Part D plans, Medicare Advantage plans with drug coverage, Special Needs Plans, employer or union group plans, and the LI NET program.
Who qualifies. You must be 18 or older and meet one of these when you start:
- BMI of 35 or higher.
- BMI of 30 or higher with heart failure with preserved ejection fraction, uncontrolled high blood pressure, or stage 3a or higher chronic kidney disease.
- BMI of 27 or higher with prediabetes, a prior heart attack or stroke, or peripheral artery disease with symptoms.
Who doesn't. People with type 2 diabetes, moderate to severe sleep apnea or fatty liver disease aren't eligible, because their Part D plan may cover a GLP-1 for those conditions. People already getting a GLP-1 through their Part D plan aren't eligible either.
How to get a GLP-1 through the Bridge
- Talk with your clinician about whether a GLP-1 fits your health needs.
- Your prescriber sends the prescription to a pharmacy and completes prior authorization when asked, certifying the drug is part of a diet and exercise program.
- You get a letter confirming coverage. The prior authorization lasts through December 31, 2027, including refills and dose changes, unless you switch GLP-1s.
- At the pharmacy, you may be asked for your Medicare number or the last four digits of your Social Security number.
The $50 Bridge copay doesn't count toward your Part D deductible or yearly out-of-pocket limit, isn't lowered by Extra Help, and can't be spread out through the Medicare Prescription Payment Plan.
Manufacturer savings cards and Medicare
Manufacturer copay savings cards, such as the $25 offers for Ozempic, Wegovy and Zepbound, can't be used by people on Medicare, including Part D and Medicare Advantage. For brand cash prices, see semaglutide cost and Zepbound cost without insurance.
What happens after the Bridge
The Bridge is temporary. CMS also runs a voluntary model called BALANCE, in which it negotiates GLP-1 prices and coverage terms with manufacturers for Medicaid programs and Part D plans. As of its page updated September 29, 2026, CMS says BALANCE is not launching in Medicare in 2027 and could come to Part D later. What replaces the Bridge after 2027 isn't settled, so check Medicare.gov for updates.
Common questions
Does Medicare cover Wegovy for weight loss?
Through the Medicare GLP-1 Bridge, eligible Part D members can get Wegovy (injection or tablet) for weight management for $50 a month, July 1, 2026 through December 31, 2027. Your prescriber must request prior authorization.
Does Medicare cover Zepbound?
For weight management, only the Zepbound KwikPen is covered through the Bridge, for $50 a month. Part D plans may cover Zepbound for moderate to severe sleep apnea.
Does Medicare cover Ozempic?
Part D plans may cover Ozempic for type 2 diabetes. Ozempic isn't one of the Bridge drugs, which are Wegovy, Zepbound KwikPen and Foundayo.
Does Medicare Advantage cover GLP-1s?
Medicare Advantage plans with drug coverage count for the Bridge, and they may cover GLP-1s for diabetes and other qualifying conditions. Check with your plan.
How do I know if I qualify for the Medicare GLP-1 Bridge?
Take the eligibility quiz at Medicare.gov/glp1bridge or call 1-800-MEDICARE (TTY 1-877-486-2048). Eligibility is based on age, BMI and certain health conditions, and your prescriber handles prior authorization.
Sources
- Medicare GLP-1 Bridge Medicare.gov, Centers for Medicare & Medicaid Services
- Weight loss drugs Medicare.gov, Centers for Medicare & Medicaid Services
- Medicare GLP-1 Bridge: information for providers Centers for Medicare & Medicaid Services
- CMS launches Medicare GLP-1 Bridge, expanding access to GLP-1 medications Centers for Medicare & Medicaid Services
- BALANCE Model Centers for Medicare & Medicaid Services
- Zepbound coverage and savings Eli Lilly and Company
This guide is general information, not medical advice. It does not replace a visit with a licensed clinician. Gabriel membership is not health insurance.