Medicare's $50 GLP-1 Program: Who Qualifies for Wegovy, Zepbound, and Foundayo
The Medicare GLP-1 Bridge lets eligible Part D members get certain weight management drugs for $50 a month through December 31, 2027. Here is who qualifies, what the $50 covers, and how to get started.
The quick version
- Your cost
- $50 for a one-month supply, whatever your income
- Covered drugs
- Wegovy (injection or tablet), Zepbound KwikPen, and Foundayo tablets
- Program dates
- July 1, 2026 through December 31, 2027
- How it starts
- Your doctor confirms you qualify and requests approval from Medicare
- Official info
- Medicare.gov/glp1bridge or 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048
What is the Medicare GLP-1 Bridge?
By federal law, Medicare Part D plans can't cover drugs when they're used for weight loss. The GLP-1 Bridge is a temporary program from the Centers for Medicare & Medicaid Services (CMS) that opens a separate path to three FDA-approved weight management drugs at a flat $50 a month.
The Bridge runs outside your regular Part D benefit. Your plan doesn't have to sign up, and CMS handles approvals, claims, and pharmacy payments through one central processor. CMS first planned to end the program on December 31, 2026, then extended it through December 31, 2027.
Which drugs are covered?
| Drug | Active ingredient | What's covered |
|---|---|---|
| Wegovy | Semaglutide | All forms, including injection and tablet |
| Zepbound | Tirzepatide | KwikPen only. Single-dose pens and vials are not covered. |
| Foundayo | Orforglipron | All forms (tablet) |
The prescription has to be for losing weight and keeping it off, alongside ongoing changes to nutrition and physical activity. Ozempic and Mounjaro are not on the Bridge drug list. They're approved for type 2 diabetes, and coverage for that use comes through your Part D plan's formulary.
Do you qualify?
Your doctor confirms eligibility. You need to meet all four of these:
- You have an eligible type of Part D coverage. That means a standalone prescription drug plan, or a Medicare Advantage HMO or PPO that includes drug coverage. Special Needs Plans and employer or union retiree drug plans count. If your only Medicare coverage is a Private Fee-for-Service plan, a cost plan, or PACE, you don't qualify.
- You're 18 or older and fit one of the BMI tiers below.
- Your Part D plan hasn't paid for a GLP-1 for you in 2026. If it has, you keep getting your medication through your plan.
- You don't have type 2 diabetes, moderate to severe sleep apnea, or MASH (a type of fatty liver disease). Those conditions already have a path to GLP-1 coverage through Part D.
The three BMI tiers
BMI is measured when you start the medication. Below a BMI of 35, you also need at least one qualifying diagnosis.
-
35+BMI
No other diagnosis needed
A BMI of 35 or higher qualifies on its own.
-
30+BMI
Plus at least one of these
- Heart failure with preserved ejection fraction (HFpEF)
- High blood pressure that stays above 140 (top number) or above 90 (bottom number) while taking two blood pressure medications
- Chronic kidney disease, stage 3a or higher
-
27+BMI
Plus at least one of these
- Prediabetes
- A past heart attack
- A past stroke
- Peripheral artery disease with symptoms (blocked arteries in the legs or arms)
Not sure of your BMI? Your doctor calculates it from your height and weight.
When your Part D plan is the right route
CMS sends these situations to your regular drug plan instead of the Bridge:
- You have type 2 diabetes, moderate to severe obstructive sleep apnea, or MASH with moderate to advanced liver scarring. You're excluded from the Bridge even if you meet a BMI tier.
- Your doctor prescribes Wegovy to lower your risk of heart attack or stroke. That use is covered under Part D.
- You already filled a GLP-1 through your plan this year. CMS checks its records for drugs like Ozempic, Mounjaro, Trulicity, Victoza, Rybelsus, Saxenda, Wegovy, Zepbound, and Foundayo. If you're not eligible, your pharmacy gets notified.
What the $50 does and doesn't include
Because the Bridge sits outside Part D, the $50 works differently from your usual drug copays.
| Question | Answer |
|---|---|
| Does it count toward my Part D deductible (up to $615 in 2026)? | No |
| Does it count toward the $2,100 Part D out-of-pocket cap? | No |
| Does Extra Help lower it? | No. The copay is $50 regardless of income. |
| Does it change during the year? | No. It stays $50 no matter which Part D payment stage you're in. |
| Can I use a manufacturer coupon? | No. Coupons and discount programs can't be applied. |
| Can I add it to the Medicare Prescription Payment Plan? | No |
| Do refills need a new approval? | No, as long as you stay on the same drug, even if your dose changes. |
Taking other expensive prescriptions? Your $50 Bridge payments won't help you reach the $2,100 Part D cap any sooner, because Bridge costs are kept outside your Part D benefit.
How to get started
-
Talk to your doctor
Ask whether a GLP-1 is right for you and whether you meet the Bridge criteria.
-
Your doctor sends the prescription
Your pharmacy may ask for your Medicare number to check eligibility. If you don't have your card handy, they can look it up with the last four digits of your Social Security number.
-
Your doctor requests approval
Once the pharmacy confirms you're eligible, your doctor submits a form to Medicare. You'll get a letter from Medicare letting you know your medication is covered.
-
Pick it up and pay $50
Each one-month supply is $50. Refills don't need a new approval if you stay on the same drug.
For your doctor's office: prescribers with questions about the approval process can call the Medicare GLP-1 Bridge Call Center at 855-273-0102, Monday through Friday, 8am to 7pm ET.
What happens after 2027?
CMS calls the Bridge a short-term demonstration and is using it to collect data on GLP-1 use. It has delayed the Part D portion of its longer-term BALANCE Model indefinitely and hasn't announced what comes after December 31, 2027. CMS also hasn't said what lookback period it will use in 2027 for people who received a GLP-1 through Part D.
Under current law, letting Part D plans cover weight loss drugs on a permanent basis would take an act of Congress.
Check your plan type before you see your doctor
The Bridge only works with certain Part D plan types. We can check whether yours is an eligible type, explain how the Bridge fits with the rest of your drug coverage, and review your options during the Annual Enrollment Period, October 15 to December 7. There's no cost to you.
TTY users call 711.
Frequently asked questions
Is Ozempic covered through the Bridge?
No. The Bridge covers Wegovy, Zepbound KwikPen, and Foundayo when prescribed for weight management. Ozempic and Mounjaro are approved for type 2 diabetes, and coverage for that comes through your Part D plan.
I get Extra Help. Will I still pay $50?
Yes. Extra Help doesn't apply to the Bridge, so the copay stays at $50.
I already take Wegovy through my Part D plan. Can I switch to the Bridge?
Not in 2026. If your plan has paid for a GLP-1 for you this year, you keep getting it through your plan. CMS hasn't announced the rule for 2027 yet.
My plan doesn't cover a GLP-1 for my type 2 diabetes. Can I use the Bridge?
No. CMS excludes anyone with type 2 diabetes, moderate to severe sleep apnea, or MASH with moderate to advanced liver scarring, even if their plan doesn't cover a GLP-1 for that condition.