Weight Loss Drugs & Medicare

Updated: July 8, 2026

It can be very frustrating when a medication you take is not covered by Medicare Part D. One of the hardest categories to deal with on Medicare lately is weight loss drugs, especially GLP-1 medications such as Wegovy, Zepbound, Ozempic, and Mounjaro.

The Social Security Act generally excludes drugs used for weight loss from Medicare Part D coverage, even when weight loss is medically important. However, some GLP-1 medications can be covered by Medicare Part D when they are prescribed for a medically accepted use other than weight loss, such as type 2 diabetes, certain cardiovascular risk reduction indications, moderate-to-severe obstructive sleep apnea, or noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver scarring.

Medicare has also launched a temporary program called the Medicare GLP-1 Bridge that may allow some Part D beneficiaries to get certain GLP-1 weight management drugs for a $50 monthly copay.

Table of Contents

• Medicare GLP-1 Bridge Program
• Key Dates
• What Drugs Are Included?
• Who May Be Eligible?
• How Much Does It Cost?
• How Does the Program Work?
• When Part D Coverage Applies Instead
• What Happens After 2027?
• Why Doesn't Part D Cover All Weight Loss Drugs?
• Alternative Ways to Obtain Weight Loss Drugs
• Formulary Exceptions
• Helpful Sources

Medicare GLP-1 Bridge Program: Some Weight Loss Drugs for a $50 Copay

Source: CMS Medicare GLP-1 Bridge

Starting July 1, 2026, CMS is running a temporary demonstration program called the Medicare GLP-1 Bridge. The program provides eligible Medicare Part D beneficiaries with access to certain GLP-1 drugs for weight management.

The Bridge program is not the same thing as normal Part D coverage. It operates outside the standard Part D benefit. CMS uses a central processor to handle prior authorization, claims, and pharmacy payment for Bridge drugs.

Key Dates

• Program start date: July 1, 2026
• Current planned end date: December 31, 2027
• BALANCE Medicare launch: Not launching in Medicare in 2027

What Drugs Are Included?

CMS currently lists the following drugs for the Medicare GLP-1 Bridge when prescribed for weight management:

• Foundayo® tablets
• Wegovy® injection
• Wegovy® tablets
• Wegovy® HD injection
• Zepbound® KwikPen®

Who May Be Eligible?

To qualify for the Medicare GLP-1 Bridge, a person generally must:

• Have Medicare drug coverage, such as a standalone Part D plan or Medicare Advantage plan with drug coverage
• Be at least 18 years old
• Have a prescription from a medical provider
• Use the drug to reduce excess body weight and maintain weight reduction, along with ongoing lifestyle modification such as structured nutrition and physical activity, unless physical activity is not clinically appropriate
• Meet CMS clinical criteria at the time GLP-1 therapy was started
• Receive prior authorization through the Medicare GLP-1 Bridge process

Current CMS Clinical Criteria

CMS says a beneficiary may meet the Bridge clinical criteria if, at the time GLP-1 therapy was initiated, the beneficiary had one of the following:

• BMI of 35 or higher; or
• BMI of 30 or higher plus heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or above; or
• BMI of 27 or higher plus prediabetes, previous myocardial infarction, previous stroke, or symptomatic peripheral artery disease.

If a person started GLP-1 therapy before July 1, 2026, CMS looks at whether the person met the clinical criteria when therapy began, not just the BMI at the time the Bridge prior authorization is submitted.

How Much Does It Cost?

Eligible beneficiaries pay a $50 monthly copay for eligible GLP-1 drugs furnished through the Medicare GLP-1 Bridge.

Because Bridge coverage is outside the standard Part D benefit:

• The Part D deductible does not apply
• The $50 copay does not count toward TrOOP, which means it does not help a person move through Part D benefit phases
• The cost does not count toward the annual Part D out-of-pocket cap
• Low-Income Subsidy/Extra Help does not reduce the $50 Bridge copay

How Does the Program Work?

The Medicare GLP-1 Bridge is handled through a CMS central processor instead of the person's regular Part D plan.

The basic process is:

1. The beneficiary talks with their health care provider about whether a GLP-1 medication is clinically appropriate.
2. The prescription is submitted at the pharmacy using the Bridge program information.
3. CMS says there must be a denied pharmacy claim submitted to the Bridge BIN and PCN before the prescriber submits the prior authorization request.
4. The prescribing clinician submits the prior authorization electronically through CoverMyMeds or by fax.
5. If approved, the beneficiary receives a letter letting them know the GLP-1 drug is covered under the Medicare GLP-1 Bridge.

CMS says a Bridge prior authorization is valid, including for refills and dose changes, through December 31, 2027, unless the beneficiary changes GLP-1 drugs.

When Part D Coverage Applies Instead

The Bridge program is for eligible beneficiaries using an included GLP-1 drug for weight management. If the GLP-1 is being prescribed for a Part D-coverable diagnosis, the request should go through the person's Part D plan instead.

CMS specifically notes that the following indications are eligible for Part D coverage and are not handled through the Bridge program:

• Type 2 diabetes
• Moderate-to-severe obstructive sleep apnea
• Noncirrhotic MASH with moderate to advanced liver scarring
• Reducing the risk of major adverse cardiovascular events in adults with established cardiovascular disease, when the drug has that approved indication

What Happens After 2027?

This is the part that changed.

CMS originally described the Medicare GLP-1 Bridge as a temporary pathway that would lead into a broader long-term model called BALANCE. However, CMS now says the BALANCE Model is not launching in Medicare in 2027.

Instead, CMS has extended the Medicare GLP-1 Bridge through December 31, 2027. CMS says this extension allows the agency to collect additional data on GLP-1 use and share that data with Part D plan sponsors ahead of a potential future implementation of BALANCE in Part D.

That means there is no guaranteed permanent Medicare GLP-1 weight loss benefit after the Bridge program ends. Medicare beneficiaries should understand that access after December 31, 2027 is uncertain unless CMS, Congress, manufacturers, or Part D sponsors create another pathway.

Why Doesn't a Medicare Part D Plan Cover Weight Loss Medications for Every FDA-Approved Purpose?

Medications approved by the FDA for purposes other than weight loss can be covered by Part D plans, but that does not guarantee that every Part D plan will include every medication on its formulary. A formulary is the list of medications covered by a specific Part D plan.

Medicare Part D plans must cover "substantially all" drugs in six protected categories and classes:

• Anticonvulsants: drugs to treat seizures and other seizure disorders
• Antidepressants: medications for depression and other mental health conditions
• Antineoplastics: cancer medications
• Antipsychotics: drugs for mental illnesses such as schizophrenia
• Antiretrovirals: medications used to treat HIV/AIDS
• Immunosuppressants: drugs to prevent organ transplant rejection

Outside of those six protected categories and classes, Medicare Part D plans generally must cover at least two drugs in the most commonly prescribed categories and classes. That does not mean every drug in every category must be covered.

GLP-1 drugs prescribed only for weight loss are still generally excluded from normal Medicare Part D coverage. The Medicare GLP-1 Bridge is a separate temporary demonstration program for certain eligible beneficiaries and certain included medications.

For more background, see Diane Omdahl's Forbes article: Medicare Part D Coverage Of Wegovy: Three Stumbling Blocks.

Alternative Ways to Obtain Weight Loss Drugs

Formulary Exceptions for Drugs Not Covered by Part D Plans

If you need a medication that your drug plan does not cover, your physician can request a formulary exception.

This may allow you to:

• Obtain a Part D drug that is not included on your plan's formulary; or
• Obtain a formulary drug without a utilization management restriction, such as step therapy, prior authorization, or quantity limits.

The physician's supporting statement must explain why the requested drug is medically necessary to treat a covered condition and why covered alternatives would not be as effective or would cause adverse effects.

If the plan sponsor denies the request, there is an appeal process.

Helpful Sources

• CMS: Medicare GLP-1 Bridge
• CMS: Medicare GLP-1 Bridge Information for Providers
• Medicare.gov: Weight Loss Drugs
• CMS: BALANCE Model
• CMS: Medicare GLP-1 Bridge Prior Authorization Request Form
• Diane Omdahl, Forbes: Medicare Part D Coverage Of Wegovy: Three Stumbling Blocks
• CMS: Coverage Exceptions