Does Medicare Cover Wegovy or Ozempic? What You'll Actually Pay
Medicare still cannot cover Wegovy or Ozempic for weight loss, but the Medicare GLP-1 Bridge offers a $50 monthly copay on certain GLP-1s from July 1, 2026 through December 31, 2027. Ozempic is not on the Bridge drug list, though Part D plans can cover it for diabetes.
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No, Medicare cannot pay for Wegovy or Ozempic when they are used for weight loss. Federal law has barred Medicare Part D from covering drugs taken specifically for weight loss since the benefit began [1][9]. Part D plans can cover GLP-1 drugs only for a medically accepted FDA-approved indication other than obesity, such as type 2 diabetes, cardiovascular disease risk reduction, or sleep apnea [1].
The big change is a separate program called the Medicare GLP-1 Bridge. It gives eligible Part D enrollees a $50 monthly copay on certain GLP-1 drugs from July 1, 2026 through December 31, 2027 [2][3][8]. Wegovy is on the Bridge drug list. Ozempic is not, though a Part D plan may still cover Ozempic for type 2 diabetes [3].
Why can’t Medicare cover weight-loss drugs?
Part D plans must cover at least two drugs in each therapeutic category and class, but the law has excluded drugs used for weight loss from the outset of the benefit [1]. That exclusion is still in force regardless of any demonstration programs running now [1][9].
Medicaid works differently. States can choose whether to cover weight-loss drugs, while coverage for other indications like diabetes, cardiovascular disease, and sleep apnea is required [1][9]. As of January 2026, 13 state Medicaid programs covered GLP-1s for obesity under fee-for-service, down from 16 states in 2025 [1][9].
Even with the exclusion in place, GLP-1 use in Medicare has grown fast. In 2024, Medicare had 21.8 million GLP-1 claims and $27.5 billion in gross spending, not counting rebates [1].
What is the Medicare GLP-1 Bridge?
The Bridge is a short-term demonstration run by CMS that operates outside the normal Part D coverage and payment flow [2]. Because it sits outside Part D, plan sponsors bear no financial risk and do not have to opt in for their enrollees to gain access [1][2]. In 2026, a single central processor handles prior authorization, claims adjudication, and payment to pharmacies [2].
CMS is running the Bridge under Section 402(a)(1)(A) of the Social Security Amendments of 1967, which was made applicable to Part D by section 1860D-42(b) of the Social Security Act [1][2]. The program was originally scheduled to run only from July through December 2026, but CMS extended it through December 31, 2027 [1][2]. It is available nationwide, including all states and U.S. territories [3].
For questions, call 1-800-MEDICARE (1-800-633-4227), or TTY 1-877-486-2048. Eligibility information is at Medicare.gov/glp1bridge [2].
Which GLP-1 drugs does the Bridge cover?
Medicare.gov lists three covered options under the Bridge [3]:
| Drug | Covered under the Bridge? |
|---|---|
| Foundayo (tablet) | Yes [3] |
| Wegovy (injection or tablet) | Yes [3] |
| Zepbound (KwikPen only) | Yes, KwikPen only; single-dose vials and pens are excluded [3] |
| Ozempic | No, not on the Bridge drug list [3] |
So if the question is whether Medicare covers Wegovy for weight loss, the answer through the Bridge is yes, at a $50 monthly copay for eligible enrollees [3][8]. If the question is whether Medicare covers Ozempic for weight loss, the answer is no, because Ozempic is not on the Bridge list and the statutory weight-loss exclusion still applies to Part D [1][3].
Who qualifies for the $50 copay?
The Bridge requires enrollees to be 18 or older and to have Medicare drug coverage, which can include a standalone Part D plan (PDP), a Medicare Advantage plan with drug coverage (HMO, HMOPOS, local or regional PPO), a Special Needs Plan (SNP), an employer or union group waiver plan (EGWP), or the Limited Income Newly Eligible Transition (LI NET) program [3].
The program also requires one of these health criteria when GLP-1 therapy starts [3]:
- BMI of 35 or higher, with no additional condition needed [3]
- BMI of 30 or higher, plus at least one of: diastolic heart failure (heart failure with preserved ejection fraction), uncontrolled high blood pressure, or chronic kidney disease at stage 3a or higher [3]
- BMI of 27 or higher, plus at least one of: prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease [3]
The program excludes people who already get GLP-1 drugs covered through their Part D plan [3]. It also excludes people with type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, because their Part D plan might cover their GLP-1s for those conditions instead [3].
How does a Bridge prescription get filled?
The process works like this, according to Medicare.gov [3]:
- A doctor or other provider sends a prescription for a covered GLP-1 drug to the pharmacy and completes a prior authorization when requested [3].
- The provider certifies that the GLP-1 is being used as part of a lifestyle program focused on diet and exercise [3].
- The pharmacy may ask for the patient’s Medicare Number or the last 4 digits of their Social Security Number to process the prescription [3].
- A letter arrives in the mail confirming the drug is covered under the Bridge [3].
The prior authorization stays valid through December 31, 2027, including refills and dose changes, unless the GLP-1 is switched to a different one [3]. Fraud can be reported to 1-800-MEDICARE [3].
Does the $50 copay count toward the Part D out-of-pocket cap?
No. Bridge drugs are furnished outside the Part D benefit, so the Part D deductible does not apply, and no part of the $50 copay counts toward true out-of-pocket (TrOOP) costs [2]. There is also no low-income subsidy (Extra Help) applied for LIS beneficiaries under the Bridge [2].
For drugs that are covered under a regular Part D plan, the 2026 out-of-pocket cap is $2,100. Once that much is spent on covered medications in 2026, the catastrophic phase begins and the plan pays 100% of covered drug costs for the rest of the year [4]. The maximum Part D deductible in 2026 is $615, though some plans have no deductible [4].
Affordability is a real issue for many people. In KFF polling, 56% of GLP-1 users said the drugs were difficult to afford, including one in four who called them “very difficult” to afford [1].
What is the $274 negotiated price for Ozempic and Wegovy?
Separately from the Bridge, semaglutide (Ozempic, Rybelsus, and Wegovy) was selected for Medicare drug price negotiation. CMS and Novo Nordisk agreed on a maximum fair price (MFP) of $274 per 30-day supply for calendar year 2027, a 71% discount from the 2024 list price of $959 per 30-day supply [5]. The negotiated prices take effect January 1, 2027 [5][7].
Package-level prices show how the MFP varies by product: $276.78 for one Ozempic 4mg/3mL pen, $276.78 for 30 Rybelsus 7mg tablets, and $385.63 for four Wegovy 2.4mg/0.75mL pens [5].
In 2024, about 2,282,000 Part D enrollees used the semaglutide group, accounting for $15.16 billion in Part D gross covered drug costs [5]. The semaglutide group was one of 15 drugs in the second negotiation cycle; those 15 drugs together accounted for 5.3 million Part D users, $42.5 billion in gross covered costs, and $1.7 billion in beneficiary out-of-pocket spending in 2024 [5][7]. CMS projects beneficiaries will save about $685 million in out-of-pocket costs under the defined standard benefit when the negotiated prices take effect [7].
One thing the MFP is not: it is the price Medicare and Part D plans pay, not the copay an enrollee pays at the pharmacy [5].
What about the $245 most-favored-nation price?
On November 6, 2025, the White House announced deals with Eli Lilly and Novo Nordisk that set the Medicare price for Ozempic, Wegovy, Mounjaro, and Zepbound at $245, and stated that Medicare beneficiaries would pay a $50 per month copay [6].
The same announcement listed TrumpRx prices: Ozempic and Wegovy falling from $1,000 and $1,350 per month to $350, and Zepbound and orforglipron (if approved) falling from $1,086 per month to an average of $346 [6]. If the FDA approves the Wegovy pill or similar oral GLP-1s, the initial dose would be priced at $150 per month through TrumpRx [6].
| Price | Amount | What it is |
|---|---|---|
| $959 | 2024 list price (WAC) per 30-day supply of the semaglutide group [5] | Manufacturer list price |
| $274 | Negotiated MFP per 30-day supply, effective January 1, 2027 [5] | Price Medicare and plans pay, not a copay [5] |
| $245 | Medicare price under the November 6, 2025 MFN deals [6] | Price for Ozempic, Wegovy, Mounjaro, and Zepbound |
| $50 | Bridge copay [2][3][8] | Monthly copay for eligible Part D enrollees |
The $274 MFP is higher than the $245 MFN price announced weeks earlier [7]. According to news reports, CMS has confirmed that the MFN prices for covered GLP-1 drugs are expected to supersede the IRA negotiated prices because of the terms and timelines of the deals [7].
What happened to the BALANCE model?
CMS had planned a larger program called BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth), a Center for Medicare and Medicaid Innovation model originally scheduled to run in Medicare from January 2027 through December 2031 [1]. April 20, 2026 was the deadline for Part D sponsors to apply [1].
On April 21, 2026, CMS announced an indefinite delay of BALANCE in Medicare Part D, along with the extension of the Bridge through 2027 [1]. The delay is indefinite on the record; CMS has not canceled the model outright [1]. Earlier milestones included a January 8, 2026 manufacturer application deadline and a pre-implementation period from January 12 to February 5, 2026 [1].
The Medicaid portion of BALANCE is proceeding. It launches May 1, 2026, with rolling implementation through January 1, 2027, and runs through December 31, 2031. State Medicaid agencies had until July 31, 2026 to apply [1].
CMS said the Bridge extension also lets the agency collect GLP-1 utilization data to share with Part D sponsors ahead of potential BALANCE implementation in Part D [2].
What happens after December 31, 2027?
The Bridge is currently scheduled to end on December 31, 2027 [2][8]. BALANCE in Medicare Part D is delayed indefinitely, not canceled on the record [1]. And the statutory exclusion on weight-loss drugs remains law regardless of what happens with either demonstration [1][9].
What if you have Medicare but don’t qualify for the Bridge?
Medicare.gov points to several options [3]:
- Check whether the company that makes a drug offers help paying for it, using the pharmaceutical assistance tool in Medicare plan compare [3].
- Find out if a state offers help with drug costs [3].
- Compare mail-order pharmacy prices, which are sometimes cheaper [3].
- Look at the Medicare Prescription Payment Plan, which spreads out-of-pocket costs for plan-covered drugs across the year instead of paying up front at the pharmacy [3][4]. It is voluntary, costs nothing to join, requires annual signup, charges no interest or fees on late payments, and enrollment is open at any time in 2026 [4].
- Visit TrumpRx.gov to compare cash prices. Drugs cannot be bought directly from TrumpRx, and TrumpRx and other discount cards are not creditable coverage, so spending through them does not count toward the Medicare deductible or out-of-pocket maximum [3].
People with Medicare but no drug coverage may become eligible for the Bridge after enrolling in a Part D plan during allowed enrollment periods [3]. Open enrollment runs October 15 through December 7 each year, and plans send an Annual Notice of Change by September 30 that shows the next year’s coverage [4].
Sources
- KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge. May 11, 2026.
- Centers for Medicare & Medicaid Services. Medicare GLP-1 Bridge.
- Medicare.gov. Weight loss drugs.
- GoodRx. Medicare Part D Out-of-Pocket Limit is $2,100 in 2026.
- Centers for Medicare & Medicaid Services. Fact Sheet: Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2027. June 2023.
- The White House. Fact Sheet: President Donald J. Trump Announces Major Developments in Bringing Most-Favored-Nation Pricing to American Patients. November 6, 2025.
- NCPA. CMS announces MFPs for 15 drugs to be added to Medicare Drug Price Negotiation Program in 2027. December 2, 2025.
- Centers for Medicare & Medicaid Services. Coming Soon: CMS to Provide $50 Monthly Access to GLP-1 Medications for Medicare Beneficiaries. May 6, 2026.
- KFF. Medicaid Coverage of and Spending on GLP-1s. January 16, 2026.
Frequently asked questions
Is Ozempic covered for weight loss under the Medicare GLP-1 Bridge?
No. Ozempic is not on the Medicare.gov Bridge drug list, which includes only Foundayo, Wegovy, and Zepbound KwikPen. The statutory exclusion on Part D coverage of weight-loss drugs also still applies. A Part D plan may cover Ozempic for a non-obesity indication such as type 2 diabetes.
Will a Part D plan still cover Ozempic for type 2 diabetes?
Yes, that remains possible. Part D plans can cover GLP-1s used for a medically accepted FDA-approved indication other than obesity, such as type 2 diabetes, cardiovascular disease risk reduction, or sleep apnea. In 2024, about 2,282,000 Part D enrollees used the semaglutide group of drugs.
What does Wegovy cost on Medicare in 2026?
For eligible Part D enrollees under the Bridge, Wegovy carries a $50 monthly copay from July 1, 2026 through December 31, 2027. Wegovy is not covered under Part D for weight loss itself because of the statutory exclusion. The $274 negotiated price effective January 1, 2027 is what Medicare and plans pay, not a patient copay.
Does the $50 copay count toward the $2,100 Part D out-of-pocket cap?
No. Bridge drugs are provided outside the Part D benefit, so the Part D deductible does not apply and no part of the $50 copay counts toward true out-of-pocket costs. The $2,100 cap applies to drugs covered under a Part D plan, after which the plan pays 100% for the rest of 2026.
Does Extra Help lower the $50 GLP-1 copay?
No. CMS states there is no low-income subsidy provided for LIS beneficiaries under the Bridge, so the copay is $50 regardless of Extra Help status. The Part D deductible also does not apply to Bridge drugs.
Do Zepbound vials qualify for the Bridge?
No. The Bridge covers Zepbound KwikPen only, and does not cover single-dose Zepbound vials or pens. The other covered drugs are Foundayo tablets and Wegovy, in injection or tablet form.
What BMI do you need to qualify for the Bridge?
A BMI of 35 or higher qualifies with no additional condition. A BMI of 30 or higher qualifies with diastolic heart failure, uncontrolled hypertension, or stage 3a or higher chronic kidney disease. A BMI of 27 or higher qualifies with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease.
Does sleep apnea or fatty liver disease disqualify you from the Bridge?
Yes. Medicare.gov states you are not eligible if you have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, because your Part D plan might cover your GLP-1s for those conditions instead. You are also ineligible if you already get GLP-1s covered through your Part D plan.
This article summarizes FDA labeling, published research and company information current as of September 14, 2026. It is not medical advice and does not replace a conversation with your own healthcare provider. How we research and verify.