Key takeaways:
The Medicare GLP-1 Bridge program is a pilot project that allows Medicare Part D prescription plan enrollees to access certain glucagon-like peptide-1 (GLP-1) medications for weight loss with a $50 monthly copay.
The Medicare GLP-1 Bridge program begins on July 1, 2026 and is set to end on December 31, 2027.
The following GLP-1 medications will be available through this program: Foundayo (orforglipron), Wegovy (semaglutide) pills and injections, and Zepbound (tirzepatide) KwikPens. Zepbound single-use pens and vials are not included.
Historically, Medicare did not cover medications solely for weight loss. For Medicare enrollees interested in glucagon-like peptide-1 (GLP-1) and similar medications, this meant facing hundreds of dollars in out-of-pocket costs every month.
But that changes in July 2026 with a new pilot program that will offer Medicare prescription plan enrollees access to weight-loss medications for a $50 monthly copay.
For prescribers, there are particular instructions to follow to help your Part D patients access GLP-1s at this price. Here’s what you need to know about the Medicare GLP-1 Bridge program, including who qualifies and which medications are covered.
What is the Medicare GLP-1 Bridge program?
The Medicare GLP-1 Bridge program is a short-term initiative for Medicare Part D prescription plan enrollees to access certain incretin mimetics for weight loss and pay $50 a month. The pilot program is initially planned as an 18-month project starting July 1, 2026 and ending December 31, 2027.
This program offers a chance for Part D enrollees, particularly older adults, to access medications for weight loss that have long been out of reach for many because of cost.
It’s important to note that the $50 copays do not count toward the annual Part D deductible, which can be up to $615 in 2026. These payments also won’t count toward yearly Part D out-of-pocket spending cap, which is $2,100 in 2026.
What drugs will be covered under the Medicare GLP-1 Bridge program?
Only certain medications will be covered under the Medicare GLP-1 Bridge program. They include all formulations of the following medications:
Zepbound single-use pens and vials are not included in the program. The Bridge program also does not include other GLP-1s for other indications like Type 2 diabetes.
Who will be eligible for the Medicare GLP-1 Bridge program?
Medicare Part D enrollees are eligible if they:
Meet Medicare GLP-1 Bridge program clinical criteria (more below)
Are enrolled in a standalone prescription drug plan
Have a prescription for a GLP-1 medication to reduce excess body weight and maintain weight loss
Note that enrollees must have Medicare Part D to participate, but the Medicare GLP-1 Bridge program is the primary payer — not the prescription insurance plan.
Additional coupons and discounts are not allowed. Individuals without Medicare Part D or other prescription coverage may benefit from savings programs like the GoodRx for Weight Loss subscription program.
Medicare GLP-1 Bridge program clinical criteria
Prescribers are required to submit a prior authorization form for each enrollee attesting to their eligibility.
Enrollees must meet the following requirements at the time of therapy initiation:
18 years of age or older
Have received a prescription for the medication to reduce excess body weight and maintain weight reduction (not for any other indication)
A body mass index (BMI) of 35 or higher OR
A BMI of 30 or higher and a diagnosis of one or more of the following: heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or above OR
A BMI of 27 or higher and a diagnosis of one or more of the following: prediabetes, previous heart attack, previous stroke, or symptomatic peripheral artery disease (PAD)
GLP-1s for other conditions are covered by Part D plans, but they aren't eligible for the Bridge program — or the $50 copay — even if the clinical criteria are met.
Eligible Part D prescription plans
Patients must be enrolled in a standalone Part D plan or a standard Medicare Advantage plan that offers Part D coverage. Enrollees who have Special Needs Plans (SNPs), employer/union group waiver plans, and limited-income newly eligible transition program plans can also participate.
Those who are dually eligible for Medicare and Medicaid and also meet the prior authorization criteria can access GLP-1s through the Bridge program.
People with other types of Medicare coverage, such as enrollment in the Program of All-Inclusive Care for the Elderly (PACE) are not eligible for the Bridge program unless they also have a standalone Part D plan.
Excluded GLP-1 indications
If your patient has a diagnosis of any of the following, they are not eligible for the Medicare GLP-1 Bridge program:
Type 2 diabetes
Obstructive sleep apnea (OSA)
Metabolic dysfunction-associated steatohepatitis (MASH)
Medicare Part D plans cover GLP-1 medications for these conditions. But the Bridge program will not cover them, even when clinical criteria are met.
How the program works
If you have determined that a patient meets the criteria above, you can help them access one of the program’s covered GLP-1 medications. Here’s what you need to know:
Send the prescription (28-day or 30-day supply) to the pharmacy, including an obesity diagnosis code (E66). Include a request to submit the claim to the Medicare GLP-1 Bridge program — not to the patient’s Part D plan.
Wait for Medicare to confirm eligibility.
Once confirmed, the pharmacy will ask you to send the prior authorization form electronically or by fax. Paper forms will not be accepted.
Within 72 hours you should receive an approval or denial through the electronic prior authorization (ePA) portal run by the Centers for Medicare & Medicaid Services (CMS). The patient should also receive a response by mail.
If authorization is denied, you can resubmit the prior authorization.
If approved, your patient can now purchase the medication at the price of $50 for a 28- or 30-day supply.
Subsequent fills do not require prior authorization. But switching from one covered medication to another in the program does require another prior authorization.
Prescribers are not required to be enrolled in Medicare but can’t be on the preclusion list of healthcare professionals banned from receiving Medicare payments.
What happens when the Medicare GLP-1 Bridge program ends?
It’s unclear what will happen if the Medicare GLP-1 Bridge program ends as scheduled on December 31, 2027 without another option for enrollees.
CMS originally proposed the program as part of a two-step plan to expand Medicare coverage of GLP-1s for obesity. The Medicare GLP-1 Bridge program was the first step.
The second stage — a 5-year program called BALANCE, which was set to launch in January 2027 for Medicare enrollees to continue low-cost coverage for weight-loss medications more permanently — has been paused. CMS has reported to Part D plans that BALANCE may be implemented, so there’s a chance the longer-term program could be revived.
Counseling patients on what to do after Bridge ends
If the end date for the Medicare GLP-1 Bridge program remains December 31, 2027, and patients wish to continue their medication in 2028 for an approved purpose, they may need to switch Part D plans for the 2028 coverage year.
They can do this during Medicare open enrollment in the fall of 2027. Those with a Medicare Advantage plan can also make Part D changes during the first three months of 2028 during the Medicare Advantage open enrollment season.
At that time, they will need to ensure their desired medication will be included in whatever Medicare program covers GLP-1s for weight loss — or that the medication is covered by their prescription plan to treat another condition.
Due to the current uncertainty of the program’s future, it’s a good idea to discuss long-term considerations with patients now. They are likely to be apprehensive about what could happen after the Bridge program ends, so having a plan in place will be helpful. Health benefits of GLP-1s hinge on adherence, but GoodRx research shows that cost and access to these medications can affect treatment duration.
The bottom line
The Medicare GLP-1 Bridge Program is a new way for Medicare Part D prescription plan enrollees to access certain glucagon-like peptide-1 (GLP-1) medications for weight loss at a $50 monthly copay. The program starts July 1, 2026 and is scheduled to end on December 31, 2027. It covers Foundayo (orforglipron), Wegovy (semaglutide) pills and injections, and Zepbound (tirzepatide) KwikPens.
To qualify, patients must be enrolled in certain Part D plans, meet clinical criteria, and have a prescription for an included GLP-1 medication for the purpose of weight loss.
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References
CMS.gov. (n.d.). Medicare GLP-1 Bridge prior authorization request form. Centers for Medicare & Medicaid Services.
CMS.gov. (2025). Preclusion list. Centers for Medicare & Medicaid Services.
CMS.gov. (2026). BALANCE (Better approaches to lifestyle and nutrition for comprehensive health) model. Centers for Medicare & Medicaid Services.
CMS.gov. (2026). Coming soon: CMS to provide $50 monthly access to GLP-1 medications for Medicare beneficiaries. Centers for Medicare & Medicaid Services.
CMS.gov. (2026). Medicare GLP-1 Bridge. Centers for Medicare & Medicaid Services.
CMS.gov. (2026). Medicare GLP-1 Bridge: Information for Medicare beneficiaries. Centers for Medicare & Medicaid Services.
CMS.gov. (2026). Medicare GLP-1 Bridge: Information for Part D plans. Centers for Medicare & Medicaid Services.
CMS.gov. (2026). Medicare GLP-1 Bridge: Information for pharmacies. Centers for Medicare & Medicaid Services.
CMS.gov. (2026). Medicare GLP-1 Bridge: Information for prescribers. Centers for Medicare & Medicaid Services.
CMS.gov. (2026). Medicare GLP-1 Bridge: Information for providers. Centers for Medicare & Medicaid Services.
Freed, M., et al. (2026). What to know about the BALANCE model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge. KFF.
Goldman, M. (2026). Trump admin shifts course on Medicare GLP-1 coverage. Axios.
