For decades, a legal exclusion has blocked Medicare Part D from covering drugs used for “anorexia, weight loss, or weight gain.” That single sentence is the reason a Medicare beneficiary with a BMI of 38 could not get Wegovy through their drug plan unless they also had established cardiovascular disease.

Starting July 2026, Medicare will cover GLP-1s for weight loss for some beneficiaries. CMS is laucnhing a program called the Medicare GLP-1 Bridge which gives eligible beneficiaries access to GLP-1 drugs for for a $50 monthly copay.

The Bridge is a workaround, since it operates outside the Part D benefit, runs on CMS’s demonstration authority, and expires on December 31, 2027. This post covers what the Bridge is, who qualifies, how it interacts with Medicare’s existing GLP-1 coverage for cardiovascular risk reduction, and how it connects to the BALANCE Model.

Five pathways for GLP-1 coverage under Medicare in 2026. The Bridge is the only one that covers GLP-1s prescribed purely for weight loss.

What is the Medicare GLP-1 Bridge?

The Medicare GLP-1 Bridge is a short-term CMS demonstration which runs from July 1, 2026 to December 31, 2027. Eligible Part D beneficiaries pay $50 per monthly supply for select GLP-1 medications prescribed for weight management. Participating manufacturers provide the drugs at a net price of $245 per month.

Medicare will cover Wegovy (semaglutide), Foundayo (orforglipron), and the KwikPen formulation of Zepbound (tirzepatide). The single-dose vial and single-dose pen formulations of Zepbound are not included.

Who qualifies for the Medicare GLP-1 Bridge?

A beneficiary must be at least 18 years old and meet one of three BMI thresholds based on coexisting conditions. The prescription must be for weight reduction and weight maintenance in combination with lifestyle modification (structured nutrition and physical activity), consistent with the FDA-approved label.

BMI is measured the time of GLP-1 initiation, not the time of the prior authorization request. A beneficiary who started semaglutide in 2024 with a BMI of 37 still qualifies in July 2026, even if their BMI has since dropped to 32.

Medical providers have to submit a prior authorization request and the prescription. Interestingly enough, the provider does not need to be enrolled in Medicare, but must not be on the Preclusion List.

How does the Bridge interact with Medicare’s existing GLP-1 coverage?

The Bridge does not replace existing Part D coverage, but rather adds to it. Standard Medicare Part D covers Wegovery for cardiovascular risk reduction and Zepbound for moderate-to-severe obstructive sleep apnea. If you fit into those categories, you’ll go through the Part D standard formulary process. CMS has said it will monitor plans to make sure they do not shift these prescriptions to the Bridge to offload cost.

When does Medicare cover GLP-1s for cardiovascular risk factors?

Medicare GLP-1 coverage has steadily expanded since 2024. There are now three pathways for cardiometabolic indications:

1. Type 2 diabetes. Ozempic, Mounjaro, and Rybelsus have been covered under Medicare Part D when prescribed for diabetes. Tier and prior authorization vary by plan.
2. Established cardiovascular disease. Following the SELECT trial, Part D plans can cover Wegovy for adults with prior MI, stroke, or PAD who are overweight or obese. About 3.6 million Medicare beneficiaries potentially qualify.
3. Cardiovascular risk factors without established disease. This is the gap the Bridge addresses. A beneficiary with a BMI of 32 and uncontrolled hypertension, or a BMI of 28 with pre-diabetes and a prior stroke, previously had no straightforward path to GLP-1 coverage. The Bridge gives them one for the next 18 months.

The Bridge criteria look like a deliberate map of cardiovascular and metabolic risk. The qualifying diagnoses (HFpEF, uncontrolled hypertension, CKD, pre-diabetes, prior MI, prior stroke, PAD) are the conditions where GLP-1 trials have shown direct benefit or strong biological plausibility for benefit.

How much will GLP-1s cost under the Bridge?

Beneficiaries pay $50 per monthly supply. That copay is fixed regardless of which Part D benefit phase the beneficiary is in. It does not count toward Part D’s $2,100 annual out-of-pocket cap. Low-income cost-sharing subsidies do not apply to the copay either.

Behind the scenes, participating manufacturers provide the drugs at a net price of $245 per month. Pharmacies are reimbursed at wholesale acquisition cost less the $50 copay, plus a dispensing fee. Manufacturer coupons and patient assistance programs cannot be applied to Bridge claims.

For context, cash prices for Wegovy and Zepbound typically run between $1,000 and $1,400 per month. The Bridge is a major shift in access for Medicare beneficiaries who would otherwise be priced out.

Monthly out-of-pocket cost for a Medicare beneficiary, by coverage pathway. The Bridge does not count toward Part D’s $2,100 OOP cap; standard Part D tier copays do.

How does the Bridge relate to the BALANCE Model?

CMS announced the BALANCE Model (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) in December 2025. The original plan: BALANCE would launch in Medicare Part D in January 2027, and the Bridge would cover the gap between July 2026 and that launch. CMS has since indicated that BALANCE will not launch in Medicare Part D in 2027 as originally planned. The Bridge has been extended through December 31, 2027 instead. CMS will collect utilization data from the Bridge to share with Part D plan sponsors ahead of a potential future BALANCE implementation. So as of May 2026, the Bridge is the only confirmed pathway for Medicare to cover GLP-1s for weight loss. And that pathway has an expiration date.

How does the Bridge interact with Medicare drug price negotiation?

Ozempic, Rybelsus, and Wegovy were selected in the second round of Medicare drug price negotiation. The negotiated Maximum Fair Price takes effect January 1, 2027. The Bridge and the negotiation program are separate. In 2026, none of the Bridge drugs are subject to an MFP. CMS has said it will release more detail on how the two programs interact during the 2027 demonstration period.

How can a patient access the Bridge?

Beneficiaries do not apply directly. A medical provider submits a prior authorization request to the central processor. The provider attests that the beneficiary meets the BMI and diagnosis criteria at the time of GLP-1 initiation, and is using the drug alongside structured nutrition and physical activity. CMS will publish detailed prior authorization procedures in Spring 2026.

Pharmacies do not need to opt in. Pharmacies submit claims electronically through Humana.

Key references

This post is part of our series on Medicare coverage for cardiovascular health. See also: Medicare coverage of cardiovascular medications and the ACCESS model.