For more than 20 years, federal law has kept Medicare drug plans from paying for medicines used only for weight loss, and that law has not changed. Since July 1, 2026, a short-term CMS demonstration called the Medicare GLP-1 Bridge has worked around it by covering certain GLP-1 drugs for obesity. The copay is a flat $50 a month. You have to be enrolled in Medicare Part D to use it. The Bridge runs outside the normal Part D benefit rather than through it.
This is a real change for people on Medicare who qualify. But it comes with restrictions that are easy to miss, and the details determine whether you actually qualify.
Key Takeaways
- The Medicare GLP-1 Bridge runs July 1, 2026 through December 31, 2027.
- Covered drugs: Wegovy (injection and pill), the Zepbound KwikPen, and Foundayo. Single-dose Zepbound vials and pens are not covered, and neither are Ozempic and Mounjaro.
- Copay is $50/month flat, regardless of where you are in your Part D benefit phase.
- You must be enrolled in Medicare Part D and meet specific BMI criteria.
- Prior authorization is required. Your provider submits it on your behalf.
- The Bridge sits outside the Part D benefit. Your Part D deductible does not apply. None of the $50 counts toward your annual out-of-pocket limit, and low-income subsidies do not apply.
What Changed, and Why
Part D began in 2006, and since then the law has excluded drugs used only for weight loss from Part D coverage. Congress explicitly wrote that exclusion into law. Legislation like the Treat and Reduce Obesity Act has pushed to overturn it for years, with bipartisan support but slow progress.
The GLP-1 Bridge is a different approach: a temporary program run by Medicare (CMS) that works around that old ban by sitting outside the normal Part D drug list. Novo Nordisk and Eli Lilly both take part, for Wegovy and Zepbound. Eligible beneficiaries pay a $50 copay. CMS says the Bridge has been extended through December 31, 2027, so it now runs from July 1, 2026 through that date.
Whether or not this coverage is ever made permanent, the practical result for now is that Medicare covers these drugs for obesity through December 31, 2027.
Who Qualifies
You must be enrolled in Medicare Part D. Beyond that, eligibility hinges on BMI and, in some cases, a qualifying health condition. Your provider will submit a prior authorization request attesting that you meet one of these three criteria:
One exclusion applies to every tier: if you have type 2 diabetes, moderate to severe obstructive sleep apnea or noncirrhotic MASH with moderate to advanced liver scarring (fibrosis), you are not eligible for the Bridge. CMS routes those indications to standard Part D, where coverage follows your plan's rules and carries the usual appeal rights.
BMI 35 or higher (no additional condition required)
If your BMI is 35 or above, you qualify based on BMI alone. You do not need a separate diagnosis to access the bridge program. Use our BMI calculator to check where you stand.
BMI 27 or higher with one of these conditions
- Pre-diabetes (by American Diabetes Association guidelines)
- Previous heart attack
- Previous stroke
- Symptomatic peripheral artery disease (poor blood flow in the limbs)
BMI 30 or higher with one of these conditions
- Heart failure with preserved ejection fraction (a common type of heart failure)
- Uncontrolled hypertension (systolic above 140 or diastolic above 90, despite two antihypertensive medications)
- Chronic kidney disease, stage 3a or above
These criteria are tighter than the standard FDA labeling for Wegovy and Zepbound, which allows prescribing at BMI 30+ or 27+ with any weight-related condition. If your BMI is between 27 and 34 and you don't have one of the listed conditions, you won't qualify for the bridge program, even if a doctor would otherwise prescribe the medication.
What It Actually Costs
The copay is $50 per month, flat. It doesn't change based on which Part D phase you're in (deductible phase, coverage gap, catastrophic coverage: it's always $50).
There are a few things that make this less straightforward than it sounds. The Part D deductible does not apply, and the $50 does not count toward your Part D annual out-of-pocket limit. So if you're already managing other prescription costs through Part D, the bridge program's copay exists in its own accounting lane. It won't help you reach your out-of-pocket limit faster.
Low-income subsidy (LIS/Extra Help) benefits do not apply to the bridge program copay either. For beneficiaries who rely on those subsidies to manage medication costs, that's a meaningful limitation. You'll pay $50 regardless of income.
To put it in context: Novo Nordisk lists Wegovy at $1,349.02 for a month's package of 4 pens. Under the Bridge, eligible beneficiaries pay a $50 copay.
Which Drugs Are Covered (and Which Aren't)
The Medicare GLP-1 Bridge covers three drugs when prescribed specifically for weight reduction, with Wegovy covered in both its forms:
- Wegovy (semaglutide injection, weekly)
- Wegovy tablets (the oral semaglutide pill)
- Zepbound KwikPen (tirzepatide injection, weekly)
- Foundayo (orforglipron, Eli Lilly's once-daily GLP-1 pill approved in 2026)
Ozempic is not covered under the bridge program. Ozempic (semaglutide) is FDA-approved for type 2 diabetes, and Medicare Part D already covers it for that indication through standard formulary coverage. If you're on Ozempic for diabetes, that prescription stays on your Part D plan as before. You don't move it to the bridge. If you don't have diabetes and want semaglutide for weight loss, Wegovy is the correct drug to ask for.
Mounjaro is also not covered under the bridge. Like Ozempic, Mounjaro (tirzepatide) is approved for type 2 diabetes and is covered through standard Part D for that use. Zepbound is the tirzepatide product approved for weight management, and Zepbound is what the bridge covers.
This distinction isn't just regulatory housekeeping. It matters when you talk to your doctor. If you ask for Ozempic for weight loss, you're asking for something the bridge doesn't cover and that most Medicare plans won't pay for outside a diabetes diagnosis. Ask for Wegovy or Zepbound.
What You Need to Do
The process runs through your prescribing provider, not through Medicare directly. Here's how it works in practice:
- Talk to your doctor or a weight loss clinic. Tell them you want to use the Medicare GLP-1 Bridge. Make sure they're familiar with it. Not every provider has caught up yet.
- Confirm you meet the eligibility criteria. BMI documentation and any qualifying diagnoses will be part of the prior authorization paperwork.
- Your provider submits a prior authorization. It goes to a central processor CMS set up for the Bridge, not to your Part D plan. The authorization attests that you meet the bridge program's BMI and medical criteria and that the prescription is for weight reduction, not for a diabetes or cardiovascular indication.
- Fill the prescription at a participating pharmacy. You pay the $50 copay at the pharmacy counter.
If the Bridge says no, there is no appeal. Your prescriber can resubmit the request with corrected or new information, and CMS sends decisions within 72 hours. If your medicine is being prescribed to lower your risk of heart attack or stroke, it goes through your regular Part D plan instead, where the normal Part D appeal rights apply.
If you don't currently have a provider who prescribes GLP-1 medications, now is a good time to find one. The program is live now, and prior authorization takes time to process. Booking an appointment soon puts you in position to start coverage quickly. Find a GLP-1 clinic near you and ask whether it takes Medicare, or see how the Bridge works on our Medicare page. The rules are the same in every state.
What If You're Already on a GLP-1 for Diabetes?
If Medicare Part D is already covering Ozempic or Mounjaro for your type 2 diabetes, nothing changes. You stay on your current Part D formulary coverage for that indication. The bridge program only applies when the prescription is specifically for weight reduction. You can't switch to the bridge to get a lower copay on a drug you're already receiving for a different covered condition.
Frequently Asked Questions
No. Ozempic is covered by Medicare Part D for type 2 diabetes. If your only reason for wanting Ozempic is weight loss and you don't have a diabetes diagnosis, Medicare won't cover it under the bridge program or standard Part D. The weight-loss-approved version of semaglutide is Wegovy, which the bridge covers.
No. Mounjaro is FDA-approved for type 2 diabetes, and that's how Medicare covers it. Zepbound is the tirzepatide product approved for weight management, and Zepbound is what the bridge covers. If your doctor prescribes Mounjaro and codes it as weight loss, it won't go through the bridge program.
You won't qualify for the bridge program as written. The lowest BMI threshold with no additional condition is 35. At BMI 27 to 34, you need one of the specific qualifying diagnoses. This is stricter than the drug labels, which allow a BMI of 30 or more on its own, or 27 or more with a weight-related condition.
Not yet. The demonstration runs through December 31, 2027.
Yes. If you have a Medicare Advantage plan that includes drug coverage, you can use the Bridge. Plans do not have to sign up for it, so you do not need your plan's permission.
Tell them you want to start Wegovy or Zepbound through the Medicare GLP-1 Bridge program. Bring documentation of your BMI and any qualifying conditions. Ask them to submit the Bridge prior authorization. If your doctor isn't familiar with the bridge program, point them to the CMS page at cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge.
Talk to your doctor about whether GLP-1 treatment is the right fit for your health situation before starting any new medication.
Ready to find a provider? Find a GLP-1 clinic near you and ask whether it takes Medicare, browse clinics by state, or read our Medicare coverage guide.
Related reading: Does insurance cover GLP-1 weight loss? • Ozempic cost without insurance • Zepbound cost savings and insurance guide 2026