Foundayo joins Medicare GLP-1 Bridge as CMS limits Zepbound coverage to the KwikPen
Foundayo is now covered under the Medicare GLP-1 Bridge, but two people taking tirzepatide can get different answers depending on which Zepbound device their prescription names.
CMS added all formulations of Foundayo (orforglipron) to the Medicare GLP-1 Bridge's list of covered products on April 6, 2026, and stated in the same update that among Zepbound (tirzepatide) products only the KwikPen qualifies [1]. Foundayo received FDA approval on April 1, 2026, for reducing excess body weight and maintaining weight reduction long term in adults with obesity, or adults with overweight who also have at least one weight-related condition, in combination with a reduced-calorie diet and increased physical activity [2].
The Bridge is a short-term CMS demonstration that gives eligible Medicare Part D beneficiaries access to selected GLP-1 drugs from July 1, 2026 through December 31, 2027 [1]. Because it runs outside the Part D payment flow, Part D sponsors take on no risk for the drugs and do not have to opt in for beneficiaries to take part; CMS will use one central processor in 2026 to handle prior authorization, claims, and payment to pharmacies [1]. The program's end date was pushed to the close of 2027 after the BALANCE Model did not launch that year [1].
What is covered
Beginning July 1, 2026, the Bridge will cover all formulations of Foundayo, all formulations of Wegovy (injection and tablets), and the KwikPen version of Zepbound [1]. The single-dose vial and single-dose pen versions of Zepbound are not included [1]. CMS listed National Drug Codes for each covered product and says the product and code list may change during the demonstration [1].
Pen needles for the Zepbound KwikPen fall outside the Bridge. CMS says they should not be billed to the Bridge or to a patient's Part D plan, and that patients can buy them separately [1].
Who can use it
A prescriber must send a prior authorization request attesting that the drug is prescribed to reduce excess body weight and maintain weight reduction, together with ongoing lifestyle modification, and that the beneficiary met one of these thresholds when GLP-1 therapy began: age 18 or older with a BMI of at least 35; a BMI of at least 30 along with heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or higher; or a BMI of at least 27 along with pre-diabetes, a prior heart attack, a prior stroke, or symptomatic peripheral artery disease [1].
Plan type also matters. Standalone prescription drug plans and Medicare Advantage coordinated care plans that offer drug coverage qualify, as do Special Needs Plans, employer and union group waiver plans, and the Limited Income Newly Eligible Transition program. Private fee-for-service plans, section 1876 cost contracts, section 1833 health care prepayment plans, PACE organizations, fallback plans, and religious fraternal benefit plans do not, unless the person is also enrolled in a standalone prescription drug plan [1].
People whose GLP-1 prescription is for type 2 diabetes, moderate to severe obstructive sleep apnea, or noncirrhotic metabolic dysfunction-associated steatohepatitis get the drug through their Part D plan and cannot use the Bridge for it, even if they meet the Bridge's weight criteria. The $50 copay applies to Bridge prescriptions written for weight management [1].
Why it matters for patients
For people taking tirzepatide, Bridge coverage depends on the package, not just the molecule. A prescription written for the KwikPen can qualify; one written for the single-dose pen or the single-dose vials cannot [1]. CMS has not said whether that distinction will be revisited.
The clinical rules look backward. Eligibility is judged on the BMI a patient had when they started GLP-1 therapy, not their current BMI. CMS gives the example of a person who began treatment in September 2024 with a BMI of 37 and now has a BMI of 34; the prescriber should attest to the earlier figure [1]. Patients who no longer meet a threshold today may still qualify.
Because the covered-product list can be updated during the demonstration [1], the list in effect at a given time may not be the list that applied earlier.
What happens next
The Bridge begins July 1, 2026 and ends December 31, 2027 [1]. Prescriber questions go to the Bridge Call Center at 855-273-0102, Monday through Friday, 8am to 7pm ET [1]. Whether private insurers or state programs will follow the same covered-product list has not been reported.
Sources
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