Medicare GLP-1 Bridge program

For years, Medicare has NOT covered medications used strictly for weight loss because of a long-standing federal law. That part has not changed.

What HAS changed is the new temporary Medicare GLP-1 Bridge program.

Beginning July 1, 2026, eligible Medicare beneficiaries may gain access to certain GLP-1 medications for obesity treatment for $50 per month. Currently included medications are Wegovy, Zepbound KwikPen, and Foundayo.

This temporary CMS demonstration program is scheduled to run through December 31, 2027.

Important:

• The program operates outside normal Part D coverage.
• Costs will NOT count toward your Part D deductible or TrOOP limits.
• Prior authorization and strict eligibility criteria will apply.
• Not all GLP-1 drugs or formulations are included.

Documentation matters.

For a beneficiary to qualify, their provider must submit a prior authorization request that attests the beneficiary is being prescribed the drug to reduce excess body weight and ongoing maintenance of weight reduction and that they fall into one of three categories related to BMI and other clinical diagnostic criteria.

Clinical eligibility criteria as of today:

• Age: 18 or older.
• BMI 35+: Body Mass Index of 35 or greater.
• BMI 30+ with comorbidities: BMI of 30 or greater combined with at least one condition, such as diastolic heart failure, uncontrolled hypertension, or chronic kidney disease (Stage 3a or higher).
• BMI 27+ with comorbidities: BMI of 27 or greater combined with pre-diabetes, a previous myocardial infarction (heart attack), stroke, or symptomatic peripheral artery disease.

If you may qualify, do not wait.

This is a temporary pilot program designed to collect data and test whether broader Medicare obesity-drug coverage is feasible long term. Rules, eligibility, and participating plans could change as the program evolves.

Think of this as a temporary window of opportunity, not a guaranteed permanent Medicare benefit.

We will continue to monitor CMS updates closely as additional guidance is expected to be released in late June.

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