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New Medicare Program to Offer Limited Coverage for GLP-1 Weight Loss Medications

Jessica Lippert

Starting July 1, 2026, some people with Medicare may be able to get GLP-1 weight loss medications at a lower cost through a new, temporary pilot program called the Medicare GLP-1 Bridge.

Right now, Medicare usually doesn’t cover GLP-1 medications when they’re prescribed only for weight loss. Coverage is generally available only when these medications treat conditions like diabetes, sleep apnea, or certain heart diseases.

The GLP-1 Bridge Program — announced by the Centers for Medicare & Medicaid Services (CMS) — is meant to give limited access to certain GLP-1 weight loss medications while Medicare continues to review its coverage policies. CMS expects the program to run through December 31, 2027.

Who Qualifies?

To be eligible, you must:

  • Be enrolled in a standalone Medicare Part D plan (PDP) or a Medicare Advantage plan with prescription drug coverage (MA-PD)
  • Be at least 18 years old
     

You must also meet one of the following Body Mass Index (BMI) and health condition guidelines:

✓  BMI of 35 or higher

  • A BMI of 35 or greater when GLP-1 therapy begins.
     

✓  BMI of 30 or higher, plus a health condition

  • A BMI of 30 or greater when therapy begins, and at least one of the following:
    • Heart failure with preserved ejection fraction
    • Uncontrolled high blood pressure despite treatment with two medications
    • Chronic kidney disease, stage 3a or higher
       

✓  BMI of 27 or higher, plus a health condition 

  • A BMI of 27 or greater when therapy begins, and at least one of the following:
    • Pre-diabetes
    • A previous heart attack
    • A previous stroke
    • Symptomatic peripheral artery disease

Which Medications Are Included?

Eligible beneficiaries may be able to get a one-month supply of select GLP-1 medications for a $50 copay. The medications currently included are:

  • Foundayo
  • Wegovy (injection or tablet)
  • Zepbound (KwikPen)

How To Access the Program

The Bridge Program works outside the standard Medicare Part D benefit, so providers and beneficiaries won’t use the usual prescription drug claim system. Instead, your prescriber must send a prescription and a prior authorization request to Humana, the company chosen to process claims under the program. If it’s approved, you can then pick up your medication at the pharmacy.

What It Costs — What To Know

Because the program runs outside the Part D framework, it’s important to understand the following:

  • There is a $50 copay for a one-month supply.
  • What you pay through the program will not count toward your Part D deductible or out-of-pocket maximum.
  • The $50 copay stays the same no matter which Part D coverage phase you’re in.
  • Extra Help copay amounts do not apply to medications from the Bridge Program.
     

Dual eligible beneficiaries who meet the eligibility requirements can take part in the program. However, they will still owe the $50 copay, because Medical Assistance will not reimburse this cost.

Next Steps

If you think you may qualify, the best first step is to talk with your doctor to review your eligibility and decide whether the program is right for you.

For the most up-to-date information, visit the CMS Medicare GLP-1 Bridge Program website.