Medicare's GLP-1 Bridge, explained

The Medicare GLP-1 Bridge is a short-term CMS demonstration that lets eligible people with Medicare drug coverage get certain brand-name GLP-1 medications for weight management for a $50 copay a month. It started on July 1, 2026 and runs through December 31, 2027. Here is what it covers, who qualifies, what it costs and how to get it, from CMS and Medicare.gov only.

If you qualify, the Bridge will almost certainly cost you less than any cash price, brand or compounded. Check it before you pay out of pocket.

What it covers

• The drugs: Foundayo™, Wegovy® (injection or tablets) and Zepbound® in the KwikPen® form. Zepbound® single-dose vials and single-dose pens are not included.
• The reason for the prescription: weight management only. A prescription written to reduce the risk of major cardiovascular events goes through your regular Part D plan instead.
• Not covered: compounded medications, and pen needles.

What it costs

• $50 for a one-month supply (28 or 30 days, depending on the drug), paid at the pharmacy. Only one-month fills are covered.
• No deductible, and the $50 is the same at every stage of your Part D benefit. CMS says "the Part D deductible will not apply" and that the copay "would remain the same, regardless of the phase of the Part D benefit".
• It sits outside your Part D costs. CMS says "no part of the $50 copay counts towards the beneficiary's TrOOP costs" (true out-of-pocket costs). Medicare.gov says the copay "Can't be lowered by programs like Extra Help" and "Can't be spread across multiple months using the Medicare Prescription Payment Plan."

Who qualifies

Your coverage. You need Medicare drug coverage through a standalone Part D plan or a Medicare Advantage plan with drug coverage (HMO, HMO-POS, or local or regional PPO). Special Needs Plans, employer or union group plans and the LI NET program take part. People with both Medicare and Medicaid can take part if their plan type qualifies. Some plan types can't, including private fee-for-service plans, cost plans and PACE, unless you also have a standalone Part D plan. The Bridge is available in every state and U.S. territory.

The clinical criteria. CMS sets them, and your prescriber attests to them when asking for approval. You must be 18 or older, and at the start of GLP-1 treatment meet one of three combinations of body mass index (BMI) and diagnosed conditions that CMS lists on its provider page. The prescription must be paired with ongoing lifestyle changes, including structured nutrition and physical activity.

Who can't use it. People with type 2 diabetes, moderate to severe obstructive sleep apnea or noncirrhotic MASH are not eligible, even if they meet the other criteria; their coverage runs through their Part D plan. And CMS says "a beneficiary who has received a GLP-1 through Part D in CY 2026 is not eligible for the Medicare GLP-1 Bridge."

Whether you meet the criteria is for your prescriber to assess, not something to work out from a list.

How to get it

1. Talk to your prescriber. They send the prescription to a pharmacy. CMS suggests noting that it is for weight management and should go to the Bridge.
2. The pharmacy submits the claim to the Bridge. The first claim is denied until prior authorization is in place, and the pharmacy asks your prescriber for it, usually within 24 to 72 hours.
3. Your prescriber requests prior authorization, electronically or by fax. Only the prescriber can submit it. CMS decides within 72 hours of submission.
4. You get a letter from Medicare when it is approved.
5. Pick up your medicine at the pharmacy and pay $50 for a one-month supply.

You don't need a denial from your Part D plan first. An approval lasts through December 31, 2027, including refills and dose changes, unless you switch to a different GLP-1. There is no appeals process. In CMS's words, "A prescriber may resubmit the prior authorization form if they initially entered incorrect information or have updated or additional information to include."

The dates

• July 1, 2026: the Bridge started.
• December 31, 2027: the Bridge ends. CMS extended it after delaying the Part D part of its follow-on BALANCE model, which has no Part D start date yet.

If you don't qualify

Your options are the manufacturers' self-pay prices, through TrumpRx.gov, NovoCare Pharmacy or LillyDirect, or a telehealth program. The Bridge pays nothing toward either. See our 2026 price guide for the current self-pay prices.

Everlon is a cash-pay program: semaglutide is $129 first month, then $249/mo from month 2, if prescribed, and tirzepatide is $315/mo, if prescribed. The medication is compounded by a state-licensed 503A pharmacy. Compounded medications are not FDA-approved, and they are not covered by the Bridge. If you qualify for the Bridge, it is very likely the better deal.

FAQ

Does the Medicare GLP-1 Bridge cover Ozempic®? No. It covers Foundayo™, Wegovy® (injection or tablets) and Zepbound® KwikPen® for weight management. People with type 2 diabetes are not eligible for the Bridge; their GLP-1 coverage runs through their Part D plan.

Is the $50 per month or per fill? Per one-month supply of 28 or 30 days. Only one-month fills are covered.

Do I need prior authorization? Yes, on the first fill and whenever you change GLP-1s. Your prescriber submits it after the pharmacy's first claim.

Does the Bridge cover compounded semaglutide or tirzepatide? No. It covers specific brand-name products only.

Is a prescription guaranteed? Never. A licensed prescriber decides whether a medication is appropriate for you.

Sources

• Medicare GLP-1 Bridge — CMS, accessed 2026-09-25
• Medicare GLP-1 Bridge: information for providers — CMS, accessed 2026-09-25
• Medicare GLP-1 Bridge: information for Part D plans — CMS, accessed 2026-09-25
• Medicare GLP-1 Bridge: information for pharmacies — CMS, accessed 2026-09-25
• Weight loss drugs — Medicare.gov, accessed 2026-09-25
• Medicare GLP-1 Bridge — Medicare.gov, accessed 2026-09-25
• Medicare GLP-1 Bridge: GLP-1 drugs for $50 a month (June 2026) — Medicare.gov, accessed 2026-09-25
• Medicare GLP-1 Bridge prior authorization request form — CMS, accessed 2026-09-25
• Medicare GLP-1 Bridge: expectations and FAQs for Part D sponsors (June 10, 2026) — CMS, accessed 2026-09-25
• Status update on the Bridge demonstration and the BALANCE model in Part D for 2027 (April 21, 2026) — CMS, accessed 2026-09-25
• CMS launches Medicare GLP-1 Bridge (July 1, 2026) — CMS, accessed 2026-09-25

Ozempic® and Wegovy® are registered trademarks of Novo Nordisk A/S. Zepbound® and KwikPen® are registered trademarks, and Foundayo™ is a trademark, of Eli Lilly and Company. Medicare is a program of the U.S. Centers for Medicare & Medicaid Services. Everlon is not affiliated with or endorsed by Novo Nordisk, Eli Lilly, CMS or TrumpRx.gov.