Medicare GLP-1 Bridge launches July 1 with Wegovy prescriptions flat

The Medicare GLP-1 Bridge, a CMS program that gives eligible Medicare Part D beneficiaries access to certain GLP-1 drugs for weight loss, began July 1, 2026, and is scheduled to run through Dec. 31, 2027 ^[2]. Weekly prescriptions for Wegovy (semaglutide) have been relatively flat since the program started, according to Jefferies analysts ^[1].

The Bridge is the Medicare portion of a larger CMS Innovation Center test called BALANCE, short for Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth. Under the model, CMS negotiates drug prices and coverage terms directly with GLP-1 manufacturers on behalf of state Medicaid agencies and Part D plan sponsors ^[2]. The program offers coverage for certain weight-loss medications, including Eli Lilly's Foundayo (orforglipron), for a $50 copayment per month ^[1].

The drugs named in BALANCE are all formulations of Mounjaro, Ozempic, Rybelsus and Wegovy, the KwikPen formulation of Zepbound, and Foundayo ^[2]. They are included for currently covered uses such as type 2 diabetes as well as for weight management ^[2]. Patients are subject to qualifications set in the negotiations between CMS and manufacturers, which can include prior authorization requirements; CMS says the model "will not guarantee coverage for any individual" ^[2]. CMS has not disclosed how many beneficiaries have enrolled in the Bridge.

What the prescription numbers show

In the most recent reporting week, the Wegovy pill reached about 183,000 total prescriptions, up from roughly 181,000 the week before, while Foundayo climbed nearly 8% to 47.5K, according to IQVIA data cited by Citi ^[1]. Total Wegovy prescriptions, including the original injectable, rose 2.7% sequentially to 513.5K in the week reported Sept. 4, and Zepbound scripts rose 1.6% to a little fewer than 772,000 ^[1].

In an Aug. 21 note, Jefferies analysts observed that Wegovy has been relatively flat since the Medicare GLP-1 Bridge program began July 1 ^[1].

Citi analysts said total GLP-1 prescriptions rose 5.4% over the prior four weeks, compared with a 6.8% decline in the same period a year earlier. They attributed the 12-percentage-point swing to the expansion of oral GLP-1 therapies, which they said is likely broadening access to the class and drawing in new patients ^[1]. Lilly's tirzepatide holds nearly 57% of the total GLP-1 market, up from about 49.5% a year earlier, while Novo's semaglutide has stayed relatively flat at 37%, the analysts added ^[1]. They also cautioned that IQVIA may be missing some Foundayo prescriptions written through telehealth channels ^[1].

Why it matters for patients

For people with Medicare Part D, the Bridge is the first route to coverage of these medicines for weight loss, which Medicare and Medicaid generally did not cover for that use before ^[2]. The $50 monthly copayment applies to certain weight-loss drugs under the program, including Foundayo ^[1]. Which drugs a given patient can get, and under what conditions, depends on the eligibility terms CMS negotiated with each manufacturer, and prior authorization may be required ^[2].

The Medicaid side of BALANCE is separate. States can join beginning in May 2026 through Jan. 1, 2027, and Medicaid coverage depends on participation by both manufacturers and states ^[2]. Medicaid participants also receive a lifestyle support program provided by the manufacturer at no cost ^[2].

What happens next

• Jan. 1, 2027: Deadline for state Medicaid agencies to join the BALANCE model ^[2].
• Dec. 31, 2027: Scheduled end of the Medicare GLP-1 Bridge, which CMS says has been extended through that date ^[2].
• CMS says BALANCE will not launch in Medicare in 2027. The agency says it will use the Bridge period to collect additional data on GLP-1 use to share with Part D plan sponsors before possible implementation of BALANCE in Part D ^[2].