Starting in July, some Medicare beneficiaries can get a GLP-1 prescription for weight loss at $50 per month. It’s a big shift for Medicare, which has long been barred from covering weight loss treatments.
The initiative, announced by CMS (Center for Medicare and Medicaid Services), is a short-term pilot program known as the Medicare GLP-1 Bridge. It will run from July 1,2026 through December 31, 2027. It’s meant to “bridge” the gap before a longer-term program that may or may not begin in 2028.
The pilot program will offer coverage for the following GLP-1 medications approved for weight loss: the pill and injectable formulations of Wegovy, the Kwik Pen formulation of Zepbound, and the Foundayo pill. Instead of using your Medicare Part D drug plan, you will need prior authorization. Your doctor will send the prescription to a central system run by a CMS contractor, using a system already in place for another drug plan. Doctors don’t need to be enrolled as Medicare providers to write a prescription or submit a prior authorization request under this program. Once you get approved, you will pay the flat $50 copayment at the pharmacy when you pick up your prescription.
To get access to these weight loss medications, you must be enrolled in a Medicare Part D drug plan. Eligibility for the medications is based mainly on body weight and health status. People with a BMI (body mass index) of 27 or higher and a condition such as heart disease or prediabetes, among others may qualify. A BMI of 35 or higher will automatically qualify. Most people using these drugs will need to increase dosage in order to maintain weight loss. The bridge program is unique in that it offers predictable $50 copayments that don’t go up as dosage increases.
Like many pilot programs, there are trade-offs. The $50 copay won’t count toward the Part D deductible, nor does it count toward the $2100 annual-out-of-pocket cap on prescription drug costs. If you receive a low-income subsidy, known as the Medicare Extra Help program, you cannot use that assistance for the drugs covered by the GLP-1 Bridge program. If you are already taking one of the listed medications for qualifying conditions, i.e. Type 2 diabetes, cardiovascular disease risk reduction or sleep apnea, you will continue coverage through your regular Part D plan.
If you are already on a GLP-1 for weight loss, you may qualify for the Bridge program. Your doctor will need to attest that you met the clinical criteria when you first started the medication. For example, you started a GLP-1 in September 2024 with a BMI of 37, but in July 2026 you’ve lost weight and now have a BMI of 34, your doctor should attest in the prior authorization request that you met the BMI criteria of 35 or over when the GLP-1 therapy started.
New-to-Medicare enrollees should understand their options when considering drug coverage. A knowledgeable Medicare agent can help you make an informed decision.
Any content, resident submissions, guest columns, advertisements, and advertorials are not necessarily endorsed by or represent the views of Best Version Media LLC (BVM) or any municipality, homeowners associations, businesses, or organizations that this publication serves. BVM is not responsible for the reliability, suitability, or timeliness of any content submitted, inclusive of materials generated or composed through artificial intelligence (AI). All content submitted is done so at the sole discretion of the submitting party.
