Since 1 July 2026 a temporary Medicare program lets eligible Part D members get Wegovy, Zepbound in the KwikPen or Foundayo for a $50 monthly copay. It runs through 31 December 2027. Here is who qualifies, what is covered and how it compares with paying cash.
The short version, from Medicare.gov and CMS:
The Medicare GLP-1 Bridge is a short-term CMS demonstration that works outside the normal Part D benefit. CMS says the program was extended to the end of 2027, and that a central processor handles prior authorization, claims and pharmacy payment.
You must be 18 or older and have Medicare drug coverage through a standalone Part D plan, a Medicare Advantage plan with drug coverage (HMO, HMO point-of-service, or local or regional PPO), a special needs plan, an employer group plan or LI NET. The clinical test is checked when you start GLP-1 therapy, and Medicare.gov sets three tiers:
| Your BMI | You also need |
|---|---|
| 35 or higher | Nothing further |
| 30 or higher | One of: diastolic heart failure, uncontrolled hypertension, or chronic kidney disease stage 3a or higher |
| 27 or higher | One of: prediabetes, a prior heart attack or stroke, or peripheral artery disease with symptoms |
You are not eligible if your Part D plan already covers GLP-1 drugs for you, or if you have type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease. Medicare.gov adds that a Part D plan might still cover GLP-1s for those conditions, so a no here is not a no everywhere. Your prescriber has to certify that you are using the drug as part of a lifestyle program focused on diet and exercise.
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| Covered | Not covered by the Bridge |
|---|---|
| Foundayo (tablet) | Zepbound single-dose vials and pens |
| Wegovy (injection or tablet) | Any product not on the list |
| Zepbound KwikPen |
Medicare.gov lists no specific doses, so ask your prescriber and pharmacy whether your dose is covered. The $50 does not count toward your Part D deductible or out-of-pocket limit, does not appear on your Part D Explanation of Benefits or Medicare Summary Notice, cannot be lowered by Extra Help and cannot be spread across months through the Medicare Prescription Payment Plan.
Medicare.gov describes no separate enrollment step and says you will receive a letter by mail confirming coverage. To check eligibility or prior authorization status, call 1-800-MEDICARE.
How we built this page: we read the CMS Medicare GLP-1 Bridge page and the Medicare.gov GLP-1 Bridge page on 31 October 2026 and recorded the dates, the copay, the eligibility tiers, the exclusions, the drug list and the process as they state them. Where a page says nothing, such as specific doses, we say so. Self-pay prices come from our own pages built from NovoCare and LillyDirect. We did not enrol anyone or contact a plan, and the subtraction is our arithmetic. Program rules can change; this page is information, not medical or coverage advice.
Medicare.gov states a $50 monthly copayment, paid at the pharmacy, for a one-month supply (28 or 30 days, depending on the drug), read 31 October 2026.
Medicare.gov says you need Part D drug coverage through a standalone plan, a Medicare Advantage plan with drug coverage, a special needs plan, an employer group plan or LI NET, and you must be 18 or older. The clinical test is checked when you start: BMI of 35 or higher; or BMI of 30 or higher with diastolic heart failure, uncontrolled hypertension or chronic kidney disease stage 3a or higher; or BMI of 27 or higher with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease.
Medicare.gov lists people who already get GLP-1 drugs covered through their Part D plan and people with type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease. It adds that a Part D plan might still cover GLP-1s for those conditions.
Medicare.gov lists Foundayo tablets, Wegovy (injection or tablet) and Zepbound in the KwikPen only; Zepbound single-dose vials and pens are not covered. The page does not list specific doses.
No. Medicare.gov says the copayment does not count toward your Part D deductible or out-of-pocket limit, Extra Help cannot lower it, and it cannot be spread across months through the Medicare Prescription Payment Plan.
CMS says the Bridge runs from 1 July 2026 through 31 December 2027, after being extended to the end of 2027. Medicare.gov says prior authorization is valid through 31 December 2027, including refills and dose changes, unless you change GLP-1 drugs.
Medicare.gov describes no separate enrollment step. Your prescriber sends the prescription to your pharmacy, a prior authorization is completed when requested, and you receive a letter by mail confirming coverage. You can call 1-800-MEDICARE to check eligibility or prior authorization status.
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