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Medicare's GLP-1 Bridge, explained

By the Everlon founding team · · How we write and review health content

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.

Check it before you pay out of pocket.

Does Medicare cover GLP-1s?

Sometimes. It depends on why the medicine is prescribed.

For type 2 diabetes and a few other conditions, yes, through Part D. CMS says type 2 diabetes, moderate to severe obstructive sleep apnea, and noncirrhotic MASH with moderate to advanced liver scarring are indications "eligible for Part D coverage." Whether your plan covers a particular drug, and on what terms, depends on its formulary.

For weight loss alone, not through regular Part D. Federal law excludes from Part D "agents when used for anorexia, weight loss, or weight gain." In CMS's words, "Since the inception of the Part D program, CMS has interpreted the statutory exclusion of 'agents when used for weight loss' to mean that a drug, when used for weight loss, is excluded from the definition of a covered Part D drug." CMS proposed in November 2024 to reinterpret that exclusion for people with obesity. In April 2025 it announced it was "not finalizing" the proposal.

What changed in 2026: the Bridge. Since July 1, 2026, the Medicare GLP-1 Bridge has let eligible people with Part D coverage get certain brand-name GLP-1s for weight management for a $50 copay for each one-month supply. It is a CMS demonstration that operates "outside of the Medicare Part D benefit's coverage and payment flow," and it runs through December 31, 2027. On its BALANCE model page, CMS sums up the problem plainly: "currently Medicare and Medicaid generally do not cover these drugs for the weight loss indication." CMS has delayed the Part D part of that model, so for now the Bridge is the route through 2027.

Two limits worth knowing. CMS says a beneficiary who has received a GLP-1 through Part D in 2026 is not eligible for the Bridge. And if you have one of the conditions above, the Bridge isn't for you: your Part D plan may cover a GLP-1 for that condition instead. The Bridge covers only the brand-name products on CMS's list; compounded semaglutide and tirzepatide are not on it.

The rest of this page explains what the Bridge covers, who qualifies and how to get it.

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 programs or a telehealth program. The Bridge pays nothing toward either.

Everlon is a cash-pay program: semaglutide is $179 for your first 4-week supply, then $249 every 4 weeks, if prescribed, and tirzepatide is $229 for your first 4-week supply, then $299 every 4 weeks, 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.

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

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 or CMS.

Where to go next

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Compounded medications are prepared by a state-licensed 503A compounding pharmacy and are not FDA-approved. The FDA does not review compounded drugs for safety, effectiveness, or quality before they are dispensed.

Individual results vary. Treatment is prescribed only when clinically appropriate, and a prescription is never guaranteed. This article is for education and is not a substitute for professional medical advice, diagnosis, or treatment. If this is a medical emergency, call 911.

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