Medicare GLP-1 Bridge begins with a $50 copay for Wegovy, Zepbound KwikPen and Foundayo

Medicare's GLP-1 Bridge began on July 1, 2026, giving eligible Part D beneficiaries access to certain GLP-1 drugs for a flat $50 copay for a one-month supply ^[1][4][6]. The demonstration is scheduled to run through December 31, 2027 ^[1][6].

The program exists because federal law bars Medicare Part D from covering drugs used for weight loss, so CMS created a short-term demonstration instead ^[3]. Under it, the drugs are furnished outside the Part D benefit's coverage and payment flow, which means Part D plans carry no financial risk for them and do not have to opt in for their members to use the program ^[6]. CMS says it is using a single central processor in 2026 to manage prior authorization, claims adjudication and payment to pharmacies ^[6].

Three products, one price

Medicare's beneficiary fact sheet names exactly three covered products: Foundayo (orforglipron) tablets, Wegovy (semaglutide) injection or tablets, and Zepbound (tirzepatide) KwikPen only ^[2][4]. The single-dose Zepbound pen and Zepbound vials are not covered ^[2][4]. Ozempic, Mounjaro and Rybelsus do not appear on the covered list ^[2][4]. Medicare lists the active ingredients that count as GLP-1 drugs for this program as semaglutide, tirzepatide, orforglipron, dulaglutide and liraglutide ^[4].

The Zepbound KwikPen is a multi-dose pen that contains all four doses for the month and requires separately sold pen needles ^[5].

Because the drugs sit outside the Part D payment flow, the Part D deductible does not apply, no part of the $50 copay counts toward a beneficiary's true out-of-pocket costs, and no low-income subsidy is provided for beneficiaries who receive one ^[6]. Medicare's fact sheet states that the $50 "doesn't count toward your Medicare drug plan deductible or yearly out-of-pocket limit," and that these drugs are not eligible for the Medicare Prescription Payment Plan ^[4].

Who qualifies

Beneficiaries must be 18 or older and have Medicare Part D drug coverage, including standalone drug plans, Medicare Advantage plans with drug coverage, special needs plans, employer or union group waiver plans, and the LI NET program ^[2]. The program is available nationwide, including all states and U.S. territories ^[2].

They must also meet one of three clinical categories: a body mass index of 35 or higher; a BMI of 30 or higher plus diastolic heart failure, uncontrolled high blood pressure or chronic kidney disease at stage 3a or above; or a BMI of 27 or higher plus prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease ^[2][4].

People who already get a GLP-1 drug covered through their Medicare drug plan are not eligible, and neither are people with type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease, though their Part D plan may already cover a GLP-1 for those conditions ^[2][4].

A provider must send the prescription to a pharmacy and, when requested, complete a prior authorization certifying that the patient is using the drug as part of a lifestyle program focused on diet and exercise ^[2]. Once approved, the authorization covers refills and dose changes through December 31, 2027, unless the patient switches to a different GLP-1 ^[2].

"These treatments are a major medical advancement, but too many seniors are currently unable to access them due to high cost," CMS Administrator Dr. Mehmet Oz said in the May 2026 announcement ^[1]. Chris Klomp, Director of Medicare and Chief Counselor at HHS, said the demonstration is meant to make access "simpler, more predictable, and more consistent across the Medicare program" ^[1].

Why it matters for patients

KFF polling cited in a May 2026 analysis found that about 56% of GLP-1 users said the drugs were difficult to afford, including one in four who said they were "very difficult" to afford ^[3]. For a patient who qualifies, the Bridge replaces an unpredictable retail price with a fixed $50 per month.

The trade-offs are structural. Because the $50 does not count toward true out-of-pocket costs, it will not help a patient reach the annual Part D out-of-pocket cap ^[4][6]. Eligibility is narrow and product-specific, so someone stable on a covered GLP-1 through their Part D plan generally cannot move into the program ^[2][4]. Medicare reports 21.8 million claims and $27.5 billion in gross GLP-1 spending under Medicare in 2024, figures that do not reflect manufacturer rebates ^[3].

What happens next

The Bridge was originally scheduled to run only from July to December 2026 and was extended through the end of 2027 ^[3]. CMS says the extension lets it collect more data on GLP-1 use to share with Part D plan sponsors ahead of a possible launch of the BALANCE Model in Part D, which has been indefinitely delayed ^[6]. BALANCE continues for state Medicaid agencies through December 2031 ^[3]. Separately, the GLP-1 semaglutide was selected for Medicare drug price negotiation in 2025, with a negotiated price set to take effect in 2027 ^[3]. What happens to Bridge coverage after December 31, 2027 has not been announced ^[1][6].