Who qualifies for the Medicare GLP-1 Bridge?
Medicare Part D enrollees aged 18 or older are eligible, says CMS, if when they start they have a BMI of at least 35; or at least 30 with certain heart, blood-pressure or kidney conditions; or at least 27 with prediabetes or a past heart attack, stroke or artery disease. It costs $50 a month.
- Meeting these criteria makes you eligible for this Medicare payment program. It doesn’t mean a GLP‑1 is right for you; that is your prescriber’s decision.
- Criteria are from CMS’s June 2026 prescriber sheet and Medicare.gov, checked October 12, 2026.
What are the BMI and health criteria?
CMS lists 3 routes in, and you need only 1 of them at the time you start the medicine, along with being at least 18.1
- BMI 35 or more on its own.
- BMI 30 or more plus heart failure with preserved ejection fraction, uncontrolled high blood pressure (a top number above 140 or a bottom number above 90 despite taking 2 blood-pressure medicines), or chronic kidney disease stage 3a or worse.
- BMI 27 or more plus prediabetes, a previous heart attack, a previous stroke, or peripheral artery disease with symptoms.1
For a sense of scale: at 5 ft 7 in (170 cm), a BMI of 35 is about 224 lb (101 kg), and a BMI of 30 is about 192 lb (87 kg). That is our arithmetic. The medicine must be prescribed to reduce weight, not for another approved use.1
In lb and inches, with the CDC categories. Free, no sign-up.
Who can’t use the Bridge?
You can’t use it if you have type 2 diabetes, moderate-to-severe sleep apnea or MASH (a fatty liver disease), or if you already get a GLP‑1 through your Part D plan.1,2
Those people go through their own Part D plan instead.1 Most people with Part D are eligible, CMS says, but not those in private fee-for-service plans, cost plans, PACE and some other plan types, unless they also have a standalone drug plan.1
Extra Help (the Low-Income Subsidy) doesn’t lower the $50 copay, and the copay doesn’t count toward your Part D out-of-pocket cap.4
How do you apply?
You don’t fill in a form yourself: your prescriber sends the prescription and then completes a prior authorization when the pharmacy asks for one.2
CMS tells prescribers to add an obesity diagnosis code and the words “SEND TO BRIDGE FOR WEIGHT MANAGEMENT” to the prescription. The pharmacy then sends the prior authorization request, usually within 24 to 72 hours, and a decision comes within 72 hours of submission, with a letter mailed to you.1
After the first approval, refills don’t need a new one unless you switch to a different GLP‑1. Only 28- or 30-day fills are covered.1 Your prescriber must also certify that you use the medicine as part of a lifestyle program focused on diet and exercise.2 The covered medicines are Foundayo, Wegovy injection and tablets, and the Zepbound KwikPen, from July 1, 2026 to December 31, 2027.2,3 To check, use Medicare.gov/glp1bridge or call 1-800-MEDICARE (1-800-633-4227).2 More in Does Medicare cover Zepbound or Wegovy? and in Guide 6.
Read the full picture
Related questions
Sources
- Centers for Medicare & Medicaid Services (CMS). Medicare GLP-1 Bridge: information for prescribers. CMS Product No. 12235, June 2026. cms.gov (PDF)
- Medicare.gov. Medicare GLP-1 Bridge: who qualifies, covered drugs, $50 monthly copayment, how to check (1-800-MEDICARE). Checked Oct 12, 2026. medicare.gov
- CMS. Medicare GLP-1 Bridge (program page): “between July 1, 2026, and December 31, 2027”; $50 copay; operates “outside of the Medicare Part D benefit”. Last modified Jul 13, 2026. cms.gov
- KFF. What to know about the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge. Updated May 11, 2026. kff.org
Last checked Oct 12, 2026 · Next review due Apr 12, 2027 · Report an error
How this answer was made. Written by the GLP Guidebook team from the sources above, all checked on Oct 12, 2026. It’s general information, not medical advice. Talk to a doctor, pharmacist or other licensed prescriber before starting, stopping or changing any medicine. In an emergency, call 911. How we write