Medicare and GLP-1: What's Covered in 2026

For years, Medicare beneficiaries were locked out of GLP-1 weight loss treatment. Federal law explicitly prohibited Medicare Part D from covering drugs used solely for weight loss. That's changing in 2026 — and the implications are enormous for the roughly 65 million Americans enrolled in Medicare.

The Medicare GLP-1 Bridge Program

Launching July 1, 2026, the Medicare GLP-1 Bridge is a short-term demonstration program that will, for the first time, provide Medicare coverage of GLP-1 medications specifically for weight management. Here are the details:

What It Costs

$50 per month for a 30-day supply. That's the total out-of-pocket cost — no additional copays, coinsurance, or deductible applies. The $50 copay does not count toward your Part D out-of-pocket cap because the Bridge operates outside the normal Part D benefit structure.

Which Drugs Are Covered

• Wegovy (semaglutide) — both injectable and oral formulations
• Zepbound (tirzepatide) — KwikPen formulation
• Foundayo — oral GLP-1 formulation

Notably excluded: Ozempic and Mounjaro. These medications are FDA-approved for diabetes, not weight loss, and remain covered under standard Part D for diabetes indications.

How Long It Lasts

July 1, 2026 through December 31, 2027. The Bridge is designed as a transition to the BALANCE Model, a longer-term Medicare program launching in 2027 that will expand GLP-1 access through Part D itself.

Who Qualifies

Plan Eligibility

You must be enrolled in a standalone Prescription Drug Plan (PDP) or a Medicare Advantage plan that includes drug coverage (MA-PD). Most Medicare beneficiaries with Part D coverage are eligible. Excluded: beneficiaries in private fee-for-service plans, employer/union group waiver plans (EGWPs), PACE organizations, and certain other non-standard plan types.

Clinical Eligibility (Three Pathways)

• Pathway 1 — BMI ≥35: Qualifies with BMI alone. No additional conditions required.
• Pathway 2 — BMI ≥30 with specific comorbidities: Heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or higher.
• Pathway 3 — BMI ≥27 with specific conditions: Pre-diabetes, prior myocardial infarction, prior stroke, or symptomatic peripheral artery disease.

How to Enroll

1. Discuss GLP-1 therapy with your doctor (PCP, endocrinologist, or obesity medicine specialist)
2. Your prescriber submits a prior authorization request to the Bridge's central processor (not to your Part D plan)
3. The central processor reviews clinical eligibility
4. Once approved, fill your prescription at any participating pharmacy (pharmacies automatically participate)
5. Pay the $50 copay at the pharmacy counter

What Medicare Part D Already Covers (Without the Bridge)

Separate from the Bridge, standard Part D plans may already cover certain GLP-1 medications for non-weight-loss indications:

• Ozempic: Covered for type 2 diabetes management under many Part D formularies
• Mounjaro: Covered for type 2 diabetes (formulary dependent)
• Wegovy: Covered for cardiovascular risk reduction in patients with established heart disease and obesity (since the SELECT trial FDA indication)

What the Bridge Does NOT Cover

• Compounded GLP-1 medications (only FDA-approved brand-name formulations)
• GLP-1 medications prescribed solely for diabetes (use standard Part D for that)
• Manufacturer coupons cannot be applied to reduce the $50 copay further

What Comes After: The BALANCE Model (2027)

The Bridge is a temporary program. Starting January 2027, the BALANCE Model will integrate GLP-1 coverage directly into Medicare Part D. Under BALANCE, Part D plans themselves will be responsible for covering anti-obesity medications — a fundamental shift from the Bridge's government-funded model. Details on patient cost-sharing under BALANCE are still being finalized.

For Medicaid, the BALANCE Model allows states to opt into GLP-1 coverage starting as early as May 2026. States choosing to participate can offer GLP-1 medications through their Medicaid programs with federal financial support.