Insurance / Medicare
Medicare and GLP-1 drugs
The Medicare GLP-1 Bridge is a temporary program for people with Medicare drug coverage (Part D). Here is what it covers and costs, from Medicare.gov and CMS.
What it covers and costs
- Covered drugs: Foundayo (tablet), Wegovy (injection or tablet), and Zepbound KwikPen only. Single-dose Zepbound vials and pens are not covered.1
- Cost: a $50 copayment to the pharmacy for a one-month supply (28 or 30 days, depending on the drug).2
- That $50 does not count toward your Part D deductible or out-of-pocket limit, and Extra Help cannot lower it.34
- It runs outside your Part D plan, through a central processor that handles prior authorization, claims and pharmacy payment.10
- CMS has extended it through December 31, 2027.8
Who qualifies
Medicare.gov lists the rules below. We copy them word for word and do not check anyone's eligibility; this site never asks about your health.
“You must be 18 or older and meet one of these requirements when you start GLP-1 therapy: You have a body mass index (BMI) of 35 or higher. You have a BMI of 30 or higher and you have at least one of these conditions: Diastolic heart failure (also called heart failure with preserved ejection fraction) Uncontrolled high blood pressure (also called hypertension) Chronic kidney disease at stage 3a or higher You have a BMI of 27 or higher and have at least one of these conditions: Prediabetes A previous heart attack (also called myocardial infarction) or stroke Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms”
“You aren't eligible if you: Already get GLP-1 drugs covered through your Medicare Part D plan . Have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (but your Part D plan might cover your GLP-1s).”
How to get it
- Your doctor or other provider sends a prescription for a covered drug to the pharmacy and completes a prior authorization when asked.5
- Your provider must certify that you are using the drug as part of a lifestyle program focused on diet and exercise.6
- Once approved, the prior authorization is valid through December 31, 2027, including refills and dose changes, unless you change GLP-1s.7
Paying cash instead
- Buying with TrumpRx or another discount card instead of your Medicare plan does not count toward your Medicare deductible or out-of-pocket maximum.11
- Some makers' self-pay offers carry their own wording about government insurance. See NovoCare Pharmacy for both official versions.
What comes next
- CMS has delayed the Medicare Part D part of its BALANCE model for 2027.9
Which drug, which dose, and whether to start, stop or switch are medical decisions. Ask your doctor or pharmacist.
Official sources for this page (11)
“Starting July 1, 2026, Medicare covers these GLP-1 drugs: Foundayo® (tablet) Wegovy® (injection or tablet) Zepbound® (KwikPen® only. The program doesn’t cover single-dose Zepbound® vials or pens).”
Medicare.gov: Weight loss drugs · as of Oct 17, 2026“You’ll pay a $50 copayment to the pharmacy for a one-month supply (either 28 or 30 days, depending on drug).”
Medicare.gov: Weight loss drugs · as of Oct 17, 2026“Doesn’t count towards your yearly Medicare drug plan deductible or out-of-pocket limit and won’t appear on your Part D Explanation of Benefits (EOB).”
Medicare.gov: Weight loss drugs · as of Oct 17, 2026“Can’t be lowered by programs like Extra Help (a Medicare program that helps people with limited income and resources pay Part D costs).”
Medicare.gov: Weight loss drugs · as of Oct 17, 2026“If you’re eligible, your doctor or other health care provider must send a prescription for a covered GLP-1 drug to the pharmacy and when requested, complete a prior authorization .”
Medicare.gov: Weight loss drugs · as of Oct 17, 2026“Your provider must certify that you're using the GLP-1 drug as part of a lifestyle program that focuses on diet and exercise.”
Medicare.gov: Weight loss drugs · as of Oct 17, 2026“Your prior authorization is valid (including for refills and dose changes) through December 31, 2027, unless you change GLP-1s.”
Medicare.gov: Weight loss drugs · as of Oct 17, 2026“The Centers for Medicare & Medicaid Services (CMS) is extending the Medicare GLP-1 Bridge through December 31, 2027.”
CMS HPMS memo, April 21, 2026 · as of Oct 17, 2026“CMS will delay implementation of the Medicare Part D portion of Better Approaches to Lifestyle and Nutrition for Comprehensive Health (BALANCE) Model for Calendar Year (CY) 2027 pending further evaluation and data collection.”
CMS HPMS memo, April 21, 2026 · as of Oct 17, 2026“Medicare GLP-1 Bridge will operate outside of Medicare Part D plan coverage and use a central processor to manage prior authorization, claims processing, and pharmacy payment.”
CMS: Medicare GLP-1 Bridge information for prescribers · as of Oct 17, 2026“TrumpRx and other types of discount cards aren’t considered creditable coverage. When you use them (instead of your Medicare plan) to buy drugs, it doesn’t count toward your Medicare deductible or out-of-pocket maximum.”
Medicare.gov: Weight loss drugs · as of Oct 17, 2026