Medicare GLP-1 Bridge: $50 a month, who qualifies and how to get it
From July 1, 2026 to December 31, 2027, Medicare's GLP-1 Bridge covers Wegovy, Foundayo and the Zepbound KwikPen for a $50 copay a month, if you qualify. cms.gov, Sep 27, 2026
- You pay
- $50 a month medicare.gov
- Runs
- Jul 1, 2026 to Dec 31, 2027
- Where
- Every state and US territory medicare.gov
Which medications it covers
- Foundayo tablets.
Starting July 1, 2026, Medicare covers these GLP-1 drugs: Foundayo® (tablet)
medicare.gov, Sep 27, 2026 - Wegovy, as the injection or the tablet. Zepbound only as the KwikPen: not single-dose vials or single-dose pens.
Wegovy® (injection or tablet) Zepbound® (KwikPen® only. The program doesn’t cover single-dose Zepbound® vials or pens).
medicare.gov, Sep 27, 2026
Who qualifies
Three things together: the right kind of Medicare drug coverage, using the medication for weight, and the clinical criteria below.
- You need a standalone Part D plan, or a Medicare Advantage plan with drug coverage (HMO, HMOPOS, local or regional PPO), in 2026.
must be enrolled in a standalone prescription drug plan (PDP) or Medicare Advantage (MA) coordinated care plan (i.e., HMO, HMOPOS, and Local and Regional PPO plans) that offers prescription drug coverage (MA-PD plans) in CY 2026.
cms.gov, Sep 27, 2026 - Special Needs Plans, employer or union group plans and LI NET count too.
Part D beneficiaries in Special Needs Plans (SNPs), employer/union group waiver plans (EGWPs), and the Limited Income Newly Eligible Transition (LI NET) program are eligible to participate.
cms.gov, Sep 27, 2026 - Private fee-for-service, cost plans, PACE and a few other plan types do not, unless you also have a standalone Part D plan.
Beneficiaries enrolled in private fee-for-service plans, section 1876 cost contract plans, section 1833 health care prepayment plans, PACE organizations, fallback plans, and religious fraternal benefit plans are not eligible to participate, unless also enrolled in a standalone PDP, as applicable.
cms.gov, Sep 27, 2026 - Age 18 or older with a BMI of 35 or more when you started the GLP-1, or
The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to thirty-five (≥35) at the time of initiation of GLP-1 therapy
cms.gov, Sep 27, 2026 - a BMI of 30 or more with heart failure with preserved ejection fraction or uncontrolled high blood pressure,
has a BMI greater than or equal to thirty (≥30) at the time of initiating GLP-1 therapy with a diagnosis of one or more of the following: (A) heart failure with preserved ejection fraction, (B) uncontrolled hypertension
cms.gov, Sep 27, 2026 - or with chronic kidney disease stage 3a or above, or
or (C) chronic kidney disease stage 3a or above
cms.gov, Sep 27, 2026 - a BMI of 27 or more with prediabetes, a past heart attack, a past stroke or symptomatic peripheral artery disease.
has a BMI greater than or equal to twenty-seven (≥27) at the time of initiating GLP-1 therapy with a diagnosis of one or more of the following: (A) pre-diabetes (as defined by American Diabetes Association guidelines), (B) previous myocardial infarction, (C) previous stroke, or (D) symptomatic peripheral artery disease.
cms.gov, Sep 27, 2026 - The criteria are judged at the time you started GLP-1 therapy.
Eligible beneficiaries must meet the clinical criteria at the time of GLP-1 therapy initiation.
cms.gov, Sep 27, 2026 - Your provider has to certify you are using it as part of a diet and exercise program.
Your provider must certify that you're using the GLP-1 drug as part of a lifestyle program that focuses on diet and exercise.
medicare.gov, Sep 27, 2026
Who goes through their Part D plan instead
- Type 2 diabetes, moderate to severe sleep apnea and MASH are covered through Part D plans.
Type 2 diabetes, moderate to severe obstructive sleep apnea, and noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) indications are eligible for Part D coverage.
cms.gov, Sep 27, 2026 - With one of those diagnoses you cannot use the Bridge, even if you meet its other criteria.
Beneficiaries with these diagnoses are eligible to receive GLP-1s through their Part D plan and therefore are ineligible to receive them through the Medicare GLP-1 Bridge, even if they otherwise meet the Medicare GLP-1 Bridge clinical criteria.
cms.gov, Sep 27, 2026 - A prescription to lower the risk of heart attack or stroke also goes to the Part D plan.
If the drug is being prescribed in order to reduce the risk of major adverse cardiovascular events (regardless of whether the drug is also prescribed in order to reduce excess weight and maintain weight reduction), that prescription should be routed to the Part D plan.
cms.gov, Sep 27, 2026 - If your Part D plan already filled a GLP-1 for you in 2026, you cannot use the Bridge in 2026.
If the beneficiary has previously filled a prescription for a GLP-1 through their Part D plan in 2026, they are not eligible for coverage through Medicare GLP-1 Bridge in 2026
cms.gov, Sep 27, 2026 - If your drug plan already pays for your GLP-1, you can keep getting it through the plan.
If you’ve been using a GLP-1 drug paid for by your Medicare drug plan you aren’t eligible for the Medicare GLP-1 Bridge, but you can keep getting your GLP-1 drug through your current plan.
medicare.gov, Sep 27, 2026 - Medicare's fact sheet counts as a GLP-1 any product with semaglutide, tirzepatide, orforglipron, dulaglutide or liraglutide.
GLP-1 drugs are defined as products with the following active ingredients: Semaglutide, Tirzepatide, Orforglipron, Dulaglutide, and Liraglutide.
medicare.gov, Sep 28, 2026
How to get it
- Your provider sends the prescription to the pharmacy and completes a prior authorization when asked.
If you’re eligible, your doctor or other health care provider must send a prescription for a covered GLP-1 drug to the pharmacy and when requested, complete a prior authorization.
medicare.gov, Sep 27, 2026 - The pharmacy may ask for your Medicare Number or the last 4 digits of your Social Security Number.
Your pharmacy may ask for your Medicare Number or the last 4 digits of your Social Security Number to help them process your prescription.
medicare.gov, Sep 27, 2026 - Once the pharmacy confirms you are eligible for the Bridge, your doctor submits a form to get Medicare's approval.
After the pharmacy receives confirmation that you are eligible for Medicare GLP-1 Bridge, your doctor will need to submit a form to get approval from Medicare for coverage.
medicare.gov, Sep 28, 2026 - The approval or denial comes within 72 hours.
The prior authorization approval or denial will be mailed to your patient and sent to the prescriber through the ePA portal or by fax within 72 hours of submission.
cms.gov, Sep 27, 2026 - You get a letter in the mail when it is covered.
You'll get a letter in the mail letting you know your GLP-1 drug is covered under Medicare GLP-1 Bridge.
medicare.gov, Sep 27, 2026 - The approval lasts through December 31, 2027, refills and dose changes included, unless you switch GLP-1s.
Your prior authorization is valid (including for refills and dose changes) through December 31, 2027, unless you change GLP-1s.
medicare.gov, Sep 27, 2026 - You can check whether you might qualify on Medicare.gov.
People with Medicare can learn about Medicare GLP-1 Bridge and check if they might qualify at Medicare.gov/glp1bridge.
cms.gov, Sep 27, 2026
What the $50 does not do
- It does not change with your income.
Your cost for these drugs under this program is $50 per month, no matter your income level.
medicare.gov, Sep 28, 2026 - It sits outside Part D: the deductible does not apply, it does not count toward your out-of-pocket total, and Extra Help does not lower it.
This means that the Part D deductible will not apply, no part of the $50 copay counts towards the beneficiary’s TrOOP costs, and there is no low-income subsidy (LIS) provided for LIS beneficiaries.
cms.gov, Sep 27, 2026 - Bridge drugs are not eligible for the Medicare Prescription Payment Plan.
These drugs aren’t eligible for the Medicare Prescription Payment Plan.
medicare.gov, Sep 28, 2026 - Coupons and discount programs cannot be used on it.
Coupons and discount programs may not be applied to Medicare GLP-1 Bridge claims, regardless of funding source.
cms.gov, Sep 27, 2026 - One month at a time: no 60- or 90-day fills.
Sixty or ninety-day fills are not available under the Medicare GLP-1 Bridge.
cms.gov, Sep 27, 2026 - There is no appeals process.
There is no appeals process under Medicare GLP-1 Bridge.
cms.gov, Sep 27, 2026
If you do not qualify
The makers' $25 savings cards exclude Medicare. Paying cash, straight from the maker, starts here (the first 52 weeks with every fee, at the starting dose):
- Foundayo pillLillyDirect, $149 per 30 days at 0.8 mg$1,937Check price at LillyDirect (opens LillyDirect's site)
- Wegovy pillNovoCare Pharmacy, $149 per 30 days at 1.5 mg$1,937Check price at NovoCare Pharmacy (opens NovoCare Pharmacy's site)
- Zepbound injection, vialLillyDirect, $299 per 28 days at 2.5 mg$3,887Check price at LillyDirect (opens LillyDirect's site)
- Zepbound injection, penLillyDirect, $299 per 28 days at 2.5 mg$3,887Check price at LillyDirect (opens LillyDirect's site)
- Wegovy injection, penNovoCare Pharmacy, $349 per 28 days at 0.25 mg ($199 for the first 2 fills)$4,237Check price at NovoCare Pharmacy (opens NovoCare Pharmacy's site)
Savings card on Medicare, drug by drug: Zepbound · Foundayo · Wegovy · Ozempic · Mounjaro. If you do not have Medicare drug coverage now: If you get Medicare drug coverage, you may become eligible.
medicare.gov, Sep 27, 2026
GLPLens is not affiliated with Medicare or CMS and does not give medical advice. Whether you qualify is decided through your provider's prior authorization. Medical disclaimer.