Does Medicare cover Wegovy or Zepbound? The $50 Medicare GLP‑1 Bridge explained

Why doesn’t Medicare normally cover weight-loss drugs?

Federal law bars Medicare drug plans from covering medicines used for weight loss, so Part D plans can only cover GLP‑1s for other approved uses.³

KFF, a health-policy research group, puts it plainly: Medicare is “prohibited by law from covering medications when used specifically for weight loss”.³

Part D plans can cover the same medicines when they are used for something else on the label. KFF lists type 2 diabetes, lowering heart risk and sleep apnea.³ That is why Medicare plans have long covered Ozempic and Mounjaro for diabetes. They can also cover Wegovy to lower heart risk and Zepbound for sleep apnea: see Zepbound for sleep apnea.

What is the Medicare GLP‑1 Bridge?

It is a short-term Medicare demonstration that pays for certain GLP‑1s for weight at a $50 monthly copay, outside the normal Part D benefit, from July 1, 2026, to December 31, 2027.¹

A demonstration is a time-limited test program. CMS, which runs Medicare, uses one central processor for the Bridge’s approvals, claims and pharmacy payments.⁴

• Covered: Foundayo tablets, Wegovy injection and tablets, and the Zepbound KwikPen. The single-dose Zepbound pen and Zepbound vials are not covered.²
• Cost: $50 for a one-month supply, “no matter your income level”.²
• Outside your plan’s limits: the Part D deductible doesn’t apply, the $50 doesn’t count toward your yearly out-of-pocket cap, and there is no low-income subsidy (Extra Help) on it.¹
• Fills: only 28-day or 30-day fills are covered.⁴

The Bridge was first due to end on December 31, 2026. CMS extended it through 2027 after deciding not to start its longer-term BALANCE Model in Medicare in 2027.³ KFF says it is uncertain how people will keep this coverage after the Bridge ends.³

Who qualifies for the Bridge?

Adults with Part D who aren’t already getting a GLP‑1 through their plan, don’t have type 2 diabetes, sleep apnea or MASH, and meet one of three BMI rules.^2,4

Medicare’s fact sheet lists four requirements, all of which must be met.²

1. 1You have Medicare Part D, through a standalone drug plan or a Medicare Advantage plan with drug coverage. Some special plan types, such as PACE, are excluded.^2,4
2. 2You are not eligible to get a GLP‑1 through your own drug plan. If your plan already pays for one for any reason, you stay with your plan.²
3. 3You don’t have type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease. With these, your Part D plan may already cover a GLP‑1.²
4. 4You are 18 or older and, when you start, meet one BMI rule below.⁴

For a sense of scale: at 5 ft 6 in (168 cm), a BMI of 35 is about 217 lb (98 kg). These are Medicare payment rules, not medical advice about who should take a GLP‑1.

How do you get it through the Bridge?

You don’t apply yourself: your prescriber sends the prescription marked for the Bridge, the pharmacy checks you’re eligible, and your prescriber then completes a prior authorization form.^4,2

A prior authorization (PA) is advance approval from the payer before it will cover a medicine. CMS sets out the steps.⁴

1. 1Your prescriber sends the prescription with an obesity diagnosis code (the E66 family) and the note “SEND TO BRIDGE FOR WEIGHT MANAGEMENT”. Without that note, the pharmacy may send the claim to your Part D plan instead.⁴
2. 2The pharmacy may ask for your Medicare ID number, printed on your card.²
3. 3Medicare checks you’re eligible. The pharmacy then sends your prescriber the PA form, usually within 24 to 72 hours.⁴
4. 4Your prescriber completes it, under penalty of perjury. Medicare may check details such as a diabetes diagnosis against its own records. A decision comes within 72 hours.⁴
5. 5You get a letter from Medicare and pay $50 at the pharmacy. Refills don’t need a new approval if you stay on the same drug, even when the dose changes.²

Switching to a different covered GLP‑1 needs a new PA.⁴ For questions about your plan type, Medicare’s number is 1-800-MEDICARE (1-800-633-4227).²

What if you don’t qualify?

If your plan covers a GLP‑1 for another approved use, that route applies; otherwise the makers’ savings cards don’t help, because they exclude Medicare beneficiaries.^3,11

Novo Nordisk’s savings card terms say “Government beneficiaries excluded”, and Lilly’s exclude anyone in Medicare, Medicare Part D or Medicaid.^11,12 Paying the makers’ cash prices is still possible: see GLP‑1 costs without insurance.

KFF estimated that 3.8 million Part D enrollees met the Bridge’s clinical rules in 2023, out of 47.5 million people with Part D (about 8%, our arithmetic).⁵ The White House said 600,000 seniors used the $50 program in its first two months.¹³ That figure is the administration’s own.

Questions people ask

How we researched this

More from the US blog

USUnited StatesHow much do Wegovy, Zepbound and the GLP‑1 pills cost without insurance in the US?USUnited StatesDoes Medicaid cover Wegovy or Zepbound? Which states cover GLP‑1s for weight, and which dropped themUSUnited StatesZepbound for sleep apnea: who qualifies, and why do insurers cover it differently?