Which GLP-1 drugs does the Medicare GLP-1 Bridge cover?

Foundayo (tablets) Wegovy (injection and tablets) Zepbound (KwikPen only; single-dose pens and vials NOT covered)

Who is eligible for the Medicare GLP-1 Bridge?

Has Part D coverage, via standalone drug plan or Medicare health plan with drug coverage Covered plan types: standalone Medicare drug plans (PDP), Medicare Advantage plans with drug coverage, Special Needs Plans (SNP), and employer or union group waiver plans (EGWP). Not eligible if your only Medicare coverage is a private fee-for-service plan, cost contract plan or PACE organization. Not already getting a GLP-1 through your Part D plan in 2026 Does not have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (MASH) At least 18 AND one of: BMI of 35 or higher; BMI 30+ with heart failure with preserved ejection fraction, uncontrolled hypertension, or CKD stage 3a or above; BMI 27+ with pre-diabetes, previous myocardial infarction, previous stroke, or symptomatic peripheral artery disease Prescribed for weight management

How do I get a GLP-1 through the Medicare GLP-1 Bridge?

Talk to doctor and get a prescription sent to a pharmacy Prescriber transmits Rx with obesity diagnosis code E66 and note 'SEND TO BRIDGE FOR WEIGHT MANAGEMENT' Give Medicare ID to pharmacy; pharmacy confirms eligibility and initiates prior authorization request Prescriber submits approval/attestation form electronically or by fax; decision within 72 hours Beneficiary receives Medicare confirmation letter; picks up drug and pays $50 Enrollment is automatic for eligible beneficiaries; Part D plans do not opt in. Only 28-day or 30-day fills covered. Prior authorizations valid through 12/31/2027 unless the GLP-1 is changed.

Medicare GLP-1 Bridge

A time-limited CMS demonstration, documented from CMS and Medicare.gov. Not a decision for your member ID.

Sources last checked October 4, 2026

Spot an error? Report a correction

Estimate whether you may qualify using published Medicare.gov Bridge rules. This is an estimate, not a coverage decision.

What it is

The Medicare GLP-1 Bridge is a short-term CMS demonstration that gives eligible Medicare Part D beneficiaries access to certain GLP-1 drugs for weight management, outside the standard Part D benefit. CMS extended it through December 31, 2027 to collect utilization data ahead of the possible rollout of its BALANCE model in Part D.

Source: CMS, Medicare GLP-1 Bridge: Information for Providers, August 6, 2026

Dates

July 1, 2026 through December 31, 2027

Source: CMS, Medicare GLP-1 Bridge: Information for Providers, August 6, 2026

Covered drugs

Foundayo (tablets)
Wegovy (injection and tablets)
Zepbound (KwikPen only; single-dose pens and vials NOT covered)

Source: CMS, Medicare GLP-1 Bridge: Information for Prescribers, June 2026

Copay

$50 per month (one-month supply of 28 or 30 days), no matter income level. Does not count toward deductible, TrOOP/out-of-pocket limit; not eligible for Medicare Prescription Payment Plan; Extra Help/LIS cannot lower it. Part D deductible does not apply.

Source: Medicare.gov, GLP-1 Bridge fact sheet, June 2026

Who might be eligible

Has Part D coverage, via standalone drug plan or Medicare health plan with drug coverage
Covered plan types: standalone Medicare drug plans (PDP), Medicare Advantage plans with drug coverage, Special Needs Plans (SNP), and employer or union group waiver plans (EGWP). Not eligible if your only Medicare coverage is a private fee-for-service plan, cost contract plan or PACE organization.
Not already getting a GLP-1 through your Part D plan in 2026
Does not have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (MASH)
At least 18 AND one of: BMI of 35 or higher; BMI 30+ with heart failure with preserved ejection fraction, uncontrolled hypertension, or CKD stage 3a or above; BMI 27+ with pre-diabetes, previous myocardial infarction, previous stroke, or symptomatic peripheral artery disease
Prescribed for weight management

Source: Medicare.gov, GLP-1 Bridge fact sheet, June 2026

How to get it

Talk to doctor and get a prescription sent to a pharmacy
Prescriber transmits Rx with obesity diagnosis code E66 and note 'SEND TO BRIDGE FOR WEIGHT MANAGEMENT'
Give Medicare ID to pharmacy; pharmacy confirms eligibility and initiates prior authorization request
Prescriber submits approval/attestation form electronically or by fax; decision within 72 hours
Beneficiary receives Medicare confirmation letter; picks up drug and pays $50
Enrollment is automatic for eligible beneficiaries; Part D plans do not opt in. Only 28-day or 30-day fills covered. Prior authorizations valid through 12/31/2027 unless the GLP-1 is changed.

Source: CMS, Medicare GLP-1 Bridge: Information for Providers, August 6, 2026

What it does not cover

Type 2 diabetes, moderate-to-severe sleep apnea, MASH: continue to get GLP-1 through Part D
Anyone who already gets a GLP-1 through Part D
Not eligible if your only Medicare coverage is a private fee-for-service plan, cost contract plan or PACE organization
LIS/Extra Help does not reduce the $50
Only 28-day or 30-day fills; Zepbound single-dose pens and vials excluded
No appeals process

Source: CMS, Medicare GLP-1 Bridge: Information for Prescribers, June 2026

Formulary listings for standard Part D (not this demonstration) are on Medicare Part D.

Not eligible, or the Bridge does not apply to you?

Cash-pay and telehealth options do not depend on this demonstration. They are not a Medicare coverage decision.

Ro
PlushCare

See Cash-Pay Options →