Who qualifies, as a table
You must have Part D, be 18 or older, and meet one of these when you start GLP-1 therapy.
| BMI | Also needed |
|---|---|
| 35 or higher | Nothing else |
| 30 or higher | At least one of: Diastolic heart failure (also called heart failure with preserved ejection fraction); Uncontrolled high blood pressure (also called hypertension); Chronic kidney disease at stage 3a or higher |
| 27 or higher | At least one of: Prediabetes; A previous heart attack (also called myocardial infarction) or stroke; Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms |
| Any BMI | Not eligible with: type 2 diabetes, moderate-to-severe sleep apnea, fatty liver disease, or if your Part D plan already covers a GLP-1 for you (your Part D plan might cover your GLP-1s instead) |
What it covers and costs
| Drug | Form covered | Your copay |
|---|---|---|
| Wegovy | injection or tablet | $50 a month |
| Foundayo | tablet | $50 a month |
| Zepbound | KwikPen only (not single-dose vials or pens) | $50 a month |
A month means a 28 or 30-day supply depending on the drug. The copay sits outside your Part D plan: it doesn’t count towards the deductible or out-of-pocket limit, Extra Help can’t lower it, and the Medicare Prescription Payment Plan can’t spread it. Prior authorization, once approved, lasts through December 31, 2027 unless you change GLP-1s.
What counts as Medicare drug coverage
- A standalone Medicare drug plan (PDP)
- A Medicare Advantage (MA) coordinated care plan with drug coverage (including HMO, HMOPOS, and Local and Regional PPO plans) (MA-PD)
- A Special Needs Plan (SNP)
- An Employer/union group waiver plan (EGWP)
- The Limited Income Newly Eligible Transition (LI NET) program
The rules in medicare.gov’s own words
Quoted from medicare.gov/coverage/weight-loss-drugs, read Oct 3, 2026
Which drugs
“Starting July 1, 2026, Medicare covers these GLP-1 drugs: Foundayo® (tablet) · Wegovy® (injection or tablet) · Zepbound® (KwikPen® only. The program doesn’t cover single-dose Zepbound® vials or pens).”
Who it is for
“This temporary program is available nationwide (including all states and U.S. territories) to certain people with Medicare drug coverage (Part D)”
Who's eligible
“You must be 18 or older and meet one of these requirements when you start GLP-1 therapy: You have a body mass index (BMI) of 35 or higher. You have a BMI of 30 or higher and you have at least one of these conditions: Diastolic heart failure (also called heart failure with preserved ejection fraction) · Uncontrolled high blood pressure (also called hypertension) · Chronic kidney disease at stage 3a or higher. You have a BMI of 27 or higher and have at least one of these conditions: Prediabetes · A previous heart attack (also called myocardial infarction) or stroke · Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms”
Who isn't
“You aren't eligible if you: Already get GLP-1 drugs covered through your Medicare Part D plan. Have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (but your Part D plan might cover your GLP-1s).”
What it costs
“You’ll pay a $50 copayment to the pharmacy for a one-month supply (either 28 or 30 days, depending on drug).”
What the copay doesn't do
“Doesn’t count towards your yearly Medicare drug plan deductible or out-of-pocket limit ... Can’t be lowered by programs like Extra Help”
What your prescriber does
“Your provider must certify that you're using the GLP-1 drug as part of a lifestyle program that focuses on diet and exercise.”
How long approval lasts
“Your prior authorization is valid (including for refills and dose changes) through December 31, 2027, unless you change GLP-1s.”
Questions people ask
Who qualifies for the Medicare GLP-1 Bridge?
People with Medicare drug coverage (Part D) who are 18 or older and meet one BMI rule when they start: a BMI of 35 or higher; a BMI of 30 or higher with diastolic heart failure, uncontrolled high blood pressure or chronic kidney disease at stage 3a or higher; or a BMI of 27 or higher with prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease (medicare.gov, read Oct 3, 2026).
What does the Medicare GLP-1 Bridge cost?
You’ll pay a $50 copayment to the pharmacy for a one-month supply (either 28 or 30 days, depending on drug). medicare.gov adds that the copay doesn't count towards your Part D deductible or out-of-pocket limit and can't be lowered by Extra Help.
Which drugs does the Bridge cover?
Wegovy (injection or tablet), Foundayo (tablet) and Zepbound in the KwikPen only. medicare.gov says the program doesn't cover single-dose Zepbound vials or pens.
Who isn't eligible?
You aren't eligible if you: Already get GLP-1 drugs covered through your Medicare Part D plan. Have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (but your Part D plan might cover your GLP-1s).
Can I use a manufacturer savings card on Medicare instead?
No. The Lilly and Novo savings cards exclude government beneficiaries, which includes Medicare. On Medicare the routes are the Bridge, your Part D plan's own coverage, or paying cash.
How long does approval last?
Your prior authorization is valid (including for refills and dose changes) through December 31, 2027, unless you change GLP-1s.
Where to go next
- Does Medicare cover GLP-1s? Part D, the Bridge and what you pay
- Not on Medicare: check what your insurer publishes
- Paying cash: every GLP-1 price, cheapest first
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