Might you qualify for the Medicare GLP-1 Bridge?
A quick check against CMS's published criteria. It is not a decision: that comes from the prior authorization your provider submits. Nothing you enter leaves this page.
You may qualify.
- Next step:
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 - What you would pay:
You’ll pay a $50 copayment to the pharmacy for a one-month supply (either 28 or 30 days, depending on drug).
medicare.gov, Sep 27, 2026 - How long it takes:
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 - It covers:
an eligible GLP-1 drug is any of the following products when used to reduce excess body weight and maintain weight reduction: Foundayo®, Wegovy® (injection and tablets), and Zepbound® (KwikPen®).
cms.gov, Sep 27, 2026
This goes through your Part D plan, not the Bridge.
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
Not through 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 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
This plan type is not part of the Bridge.
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
You need Medicare drug coverage first.
If you get Medicare drug coverage, you may become eligible.
medicare.gov, Sep 27, 2026
The Bridge is for people 18 and older.
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
From these answers, the BMI criteria are not met.
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, 2026has 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, 2026or (C) chronic kidney disease stage 3a or above
cms.gov, Sep 27, 2026has 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
Paying cash instead: the makers' self-pay prices.
Enter your age to check.
Enter your height and weight, or your BMI, to check.
This checks CMS's published criteria only. 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 Full rules: Medicare GLP-1 Bridge.