Medicare GLP-1 Bridge (2026-2027): Who Qualifies and How It Works
If you are on Medicare and have heard about a GLP-1 program with a flat monthly copay, it is real. CMS calls it the Medicare GLP-1 Bridge. It started July 1, 2026, it is temporary, and its rules are narrower than many headlines suggest. Here is what CMS and Medicare.gov say as of 2026-10-16, and how to find out whether it applies to you.
Transformation Health is an independent guide, not a provider, and is not affiliated with CMS or Medicare: we do not prescribe, sell medication, or work with insurance. This content is for general education and is not medical advice. Talk with a licensed provider about your situation.
The short answer
Medicare Part D still does not cover GLP-1 medications for weight loss alone. The Part D statute lets drug plans exclude drugs “when used for anorexia, weight loss, or weight gain,” and as of 2026-10-16 that exclusion is still in the law.[7]
The Bridge is a separate, temporary route. As of 2026-10-16, CMS says it gives eligible Medicare Part D beneficiaries access to certain GLP-1 drugs between July 1, 2026 and December 31, 2027, and that it “will operate outside of the Medicare Part D benefit’s coverage and payment flow."[1] Eligible enrollees pay a flat copay for each monthly fill.[1]
Three things decide whether it applies to you:
- Your drug coverage. You need an eligible type of Part D plan.[3]
- Your health history. You need to meet one of three BMI-based criteria when you start GLP-1 therapy, and not have certain diagnoses that Part D already covers.[2]
- Why the drug is prescribed. It has to be prescribed for weight management, not for another covered use.[2]
How the Bridge works
The Bridge is not a change to your Part D plan. Your plan’s formulary, tiers, and deductible are not involved, and your plan does not have to opt in.[1] CMS says it uses a single central processor for prior authorization, claims, and payment to pharmacies. That processor is Humana, acting in its role as administrator of another Medicare program called the Limited Income Newly Eligible Transition (LI NET) program.[2] That is a job Humana does for CMS; it does not make the Bridge a Humana plan benefit.
Here is how CMS describes the money side, as of 2026-10-16:
| Question | What CMS says (as of 2026-10-16) |
|---|---|
| What do you pay? | A flat copay per monthly fill, the same in every phase of the Part D benefit[1][2] |
| Does the Part D deductible apply? | No[1] |
| Does the copay count toward Part D out-of-pocket costs? | No part of it counts toward your true out-of-pocket costs (TrOOP)[1] |
| Does Extra Help (the low-income subsidy) lower it? | No[1] |
| Can coupons or discount programs lower it? | No. The Bridge is the primary payer, does not coordinate with other payers, and does not accept coupons or discounts[3] |
| How much can you fill at once? | One monthly supply (28 or 30 days) per fill; no 60- or 90-day fills and no partial fills[3] |
| Are pen needles covered? | No. Pen needles for the Zepbound KwikPen are bought separately[3] |
The Extra Help point surprises people. Because the Bridge is not a Part D benefit, the subsidy that normally lowers drug costs for people with limited income does not apply, so everyone in the program pays the same copay.[1]
Which drugs are included
As of 2026-10-16, CMS says an eligible drug is one of these products “when used to reduce excess body weight and maintain weight reduction”:[2]
- Foundayo (tablets), all formulations
- Wegovy (injection and tablets), all formulations
- Zepbound, KwikPen formulation only. The single-dose vials and single-dose pens are not included.
CMS lists the specific National Drug Codes on its Part D plan page and says the list may change during the program.[2] Other GLP-1 products are not on the list, and neither is compounded semaglutide or tirzepatide.
Wegovy and Zepbound both carry a boxed warning about the risk of thyroid C-cell tumors.[8][9] Each of these medications has prescribing information with warnings and side effects to review with your prescriber.
Who qualifies
As of 2026-10-16, CMS says a prescriber must submit a prior authorization request attesting that you meet these criteria.[2]
First, the use. You are prescribed the drug to reduce excess body weight and maintain weight reduction, together with current and ongoing lifestyle changes, including structured nutrition and physical activity, consistent with the FDA label.[2]
Second, age and BMI. You are 18 or older and meet one of three criteria at the time you start GLP-1 therapy:[2]
| BMI when you start GLP-1 therapy | Also needed (CMS criteria as of 2026-10-16) |
|---|---|
| 35 or higher | Nothing else |
| 30 or higher | At least one of: heart failure with preserved ejection fraction; uncontrolled high blood pressure (systolic above 140 or diastolic above 90 despite two blood pressure medications); chronic kidney disease stage 3a or above |
| 27 or higher | At least one of: prediabetes (as defined by American Diabetes Association guidelines); a previous heart attack; a previous stroke; symptomatic peripheral artery disease |
The timing detail matters if you already take a GLP-1. CMS says you must meet the criteria when you started GLP-1 therapy, including if you started before joining Part D or before the Bridge launched. CMS gives the example of someone who started at a BMI of 37 and has a BMI of 34 at the time of the request: the prescriber attests to the starting BMI.[4]
Third, your plan type. As of 2026-10-16, CMS says you must be enrolled in one of these:[3]
- A standalone Medicare drug plan (PDP)
- A Medicare Advantage coordinated care plan with drug coverage (HMO, HMO-POS, or Local or Regional PPO)
- A Special Needs Plan (SNP), an employer or union group waiver plan (EGWP), or the LI NET program
People enrolled in private fee-for-service plans, section 1876 cost plans, section 1833 health care prepayment plans, PACE, fallback plans, and religious fraternal benefit plans are not eligible unless they also have a standalone Part D plan. People with both Medicare and Medicaid can use the Bridge if they are in an eligible Part D plan type and meet the criteria.[3] If your drug coverage comes from somewhere other than Part D, for example TRICARE For Life without a Part D plan, these CMS rules mean the Bridge does not apply to you.
The Bridge is available in all states and U.S. territories.[3]
Who is not eligible, even with a qualifying BMI
People with a diagnosis Part D already covers. As of 2026-10-16, CMS says type 2 diabetes, moderate to severe obstructive sleep apnea, and noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis are uses eligible for Part D coverage. People with these diagnoses are not eligible for the Bridge, even if they meet the clinical criteria, and even if their Part D plan does not cover a GLP-1 for that condition.[2]
People who already got a GLP-1 through Part D. CMS says anyone who received a GLP-1 through their Part D plan in 2026 is not eligible for the Bridge in 2026, including through supplemental weight management coverage. CMS checks its own data for fills of Zepbound, Mounjaro, Foundayo, Rybelsus, Ozempic, Wegovy, Saxenda, Victoza, and Trulicity. It has not yet decided what lookback period it will use in 2027.[2]
Prescriptions for a covered heart or sleep apnea use. CMS says a GLP-1 prescribed for a use the basic Part D benefit can cover, such as Zepbound for moderate to severe obstructive sleep apnea in adults with obesity, or Wegovy to reduce the risk of major cardiovascular events in adults with established cardiovascular disease, does not qualify for the Bridge, whether or not the drug is on the plan’s formulary. Those requests go through the Part D plan’s own formulary exception process.[2]
This one overlaps with the BMI 27 row above. CMS says the Bridge request does not ask the prescriber to attest that you do not have cardiovascular disease, but it does ask the prescriber to attest that the drug is for weight management. If the drug is prescribed to reduce cardiovascular risk, even if it is also for weight, CMS says the prescription goes to the Part D plan.[2] Our page on Medicare Part D and GLP-1 coverage covers that route.
How to use the Bridge, step by step
There is no consumer application. As of 2026-10-16, CMS and Medicare.gov describe the process this way:[4][5]
1. Check whether you might qualify. Medicare.gov has a short set of questions about your drug coverage, past GLP-1 use, diagnoses, age, and BMI.[5] You can also call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) with questions about eligibility.[1][5] If you are not sure whether your plan type counts, your State Health Insurance Assistance Program (SHIP) can also help.[3]
2. Talk with your prescriber. Bring the table above. The question is whether your BMI when you started (or will start) GLP-1 therapy, and your documented diagnoses, fit one of the three criteria, and whether you have any of the excluding diagnoses. A licensed provider decides whether a prescription is appropriate. Your prescriber does not need to be enrolled in Medicare, but cannot be on Medicare’s Preclusion List.[4]
3. The prescription goes to a pharmacy first. CMS says the prescriber sends the prescription to the pharmacy and waits for the pharmacy to request prior authorization; a request sent before the pharmacy submits a Bridge claim returns a “patient not found” error. A Part D denial is not required first.[4] Pharmacies do not need to sign up to take part.[3] Your pharmacy may ask for your Medicare Number or the last four digits of your Social Security number to process the claim.[3][5]
4. Your prescriber completes the prior authorization. CMS says the pharmacy usually sends the request to the prescriber within 24 to 72 hours, and the prescriber submits it electronically or by fax. The prescriber attests under penalty of perjury that the information is accurate, and CMS may check Medicare data, for example for a type 2 diabetes diagnosis.[4]
5. You get a decision. CMS says the approval or denial is mailed to you and sent to your prescriber within 72 hours of submission.[4] If approved, you pay the flat copay at the pharmacy for each monthly fill.[3]
After approval. CMS says approvals are valid through December 31, 2027, and refills and dose changes do not need a new prior authorization unless you switch to a different covered GLP-1.[3][5] Two things can end it early: filling a GLP-1 through your Part D plan, or moving to an ineligible plan type. In either case the pharmacy gets a rejection at your next refill.[3] CMS says pharmacies can use a vacation override, but there are no overrides for lost or stolen medication.[3]
If the Bridge says no
There is no appeal within the Bridge. As of 2026-10-16, CMS says there is no appeals process under the Bridge. If information on the request was wrong, or there is new information, your prescriber can resubmit the prior authorization form.[4]
Part D appeal rights are unchanged. For a use Part D can cover, CMS says the Bridge does not change your appeal rights, including exception requests, with your Part D plan.[2] Our page on what to do when insurance denies your GLP-1 walks through reading a denial, and our prior authorization guide covers the documentation these requests usually need.
If you do not qualify at all. Part D generally cannot cover a GLP-1 for weight loss alone, and an appeal cannot change a federal exclusion.[7] The remaining options are outside Medicare:
- Manufacturer self-pay options. Novo Nordisk and Eli Lilly each publish self-pay terms, and the terms change. Manufacturer savings cards for people with commercial insurance generally exclude Medicare enrollees. Our page on GLP-1 savings programs compares the options.
- Cash-pay telehealth programs. Some prescribe brand-name medications and some prescribe compounded medications. Compounded medications are not FDA-approved. The FDA does not review them for safety, effectiveness, or quality, and they are not the same as brand-name products.[10] Our page on compounded GLP-1 without insurance explains how that route works.
Prices vary by program, medication, and dose. Compare the total cost: medication, dose increases, visits, labs, shipping, membership fees, and cancellation terms. At most telehealth programs, a licensed provider reviews your health history and decides whether a prescription is appropriate.
Transformation Health does not accept payment from providers. How we make money.
What CMS says about the end date
As of 2026-10-16, CMS says the Bridge runs through December 31, 2027.[1] CMS describes the Bridge on the same page as its BALANCE Model, and says the BALANCE Model is not launching in Medicare in 2027, and that the Bridge was extended through December 31, 2027 so CMS can collect more GLP-1 use data to share with Part D plans “ahead of potential implementation of BALANCE in Part D."[2][6] The Medicaid side of BALANCE is separate; our BALANCE model guide explains it.
The CMS pages we checked do not describe a program after December 31, 2027. If you start a GLP-1 through the Bridge, it is worth asking your prescriber now what the plan would be after that date, and checking CMS or 1-800-MEDICARE for updates.
How to check your own situation
For the Bridge, contact Medicare. Call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) or use the eligibility questions on Medicare.gov.[5] Ask whether your plan type is eligible and, after a request, the status of your prior authorization.
For your Part D or Medicare Advantage plan, call member services. Use the number on your plan card. Ask whether your plan covers the GLP-1 your prescriber is considering for a use Part D can cover, such as type 2 diabetes, sleep apnea, or cardiovascular risk reduction, and what prior authorization or a formulary exception requires. Your plan does not run the Bridge, so its member services line may not have Bridge answers.
The full insurance coverage overview can help you weigh the options side by side.
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Get StartedCitations
[1] Centers for Medicare and Medicaid Services. “Medicare GLP-1 Bridge.” Page last modified 07/13/2026. Accessed 2026-10-16. https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge
[2] Centers for Medicare and Medicaid Services. “Medicare GLP-1 Bridge: Information for Part D Plans.” Page last modified 08/06/2026. Accessed 2026-10-16. https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-part-d-plans
[3] Centers for Medicare and Medicaid Services. “Medicare GLP-1 Bridge: Information for Pharmacies.” Page last modified 08/17/2026. Accessed 2026-10-16. https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-pharmacies
[4] Centers for Medicare and Medicaid Services. “Medicare GLP-1 Bridge: Information for Providers.” Page last modified 08/06/2026. Accessed 2026-10-16. https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-providers
[5] Medicare.gov. “Weight loss drugs” (Medicare GLP-1 Bridge beneficiary page; medicare.gov/glp1bridge redirects here). Accessed 2026-10-16. https://www.medicare.gov/coverage/weight-loss-drugs
[6] Centers for Medicare and Medicaid Services. “BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model.” Page last modified 09/29/2026. Accessed 2026-10-16. https://www.cms.gov/priorities/innovation/innovation-models/balance
[7] 42 U.S.C. 1395w-102(e)(2)(A) (definition of covered Part D drug; exclusions), incorporating 42 U.S.C. 1396r-8(d)(2)(A). Accessed 2026-10-16. https://www.law.cornell.edu/uscode/text/42/1395w-102
[8] Novo Nordisk. WEGOVY (semaglutide) injection and tablets, prescribing information. U.S. Food and Drug Administration. Revised 06/2026. Accessed 2026-10-16. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215256s025lbl.pdf
[9] Eli Lilly and Company. ZEPBOUND (tirzepatide) injection, prescribing information. U.S. Food and Drug Administration. Revised 08/2026. Accessed 2026-10-16. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/217806Orig1s041correctedlbl.pdf
[10] U.S. Food and Drug Administration. “Compounding and the FDA: Questions and Answers.” Accessed 2026-10-16. https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers
Important disclosures
Information on this page is current as of 2026-10-16, is general and educational, and changes frequently. It is not legal or benefits advice and does not determine your eligibility for any federal program. Eligibility for the Medicare GLP-1 Bridge is decided through CMS’s prior authorization process, not by this page or by Transformation Health. To verify your situation, call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) or the member services number on your Part D or Medicare Advantage plan card.
Important: This content is for general education and is not medical advice. Talk with a licensed provider about your situation. transformationhealth.com is a website operated by Amerigo Health LLC. Transformation Health is an independent publisher. It does not provide medical care, prescribe, or sell medication, and does not give medical advice. A licensed provider decides whether a prescription is appropriate. Compounded medications are not FDA-approved. The FDA does not review them for safety, effectiveness, or quality, and they are not the same as brand-name products. Compounded semaglutide and tirzepatide are not the same as brand-name products such as Wegovy or Zepbound and may differ in formulation, purity, and potency. Wegovy, Ozempic, Rybelsus, Saxenda, and Victoza are trademarks of Novo Nordisk A/S. Zepbound, KwikPen, Foundayo, Mounjaro, and Trulicity are trademarks of Eli Lilly and Company. Medicare is a program of the U.S. Centers for Medicare and Medicaid Services; Humana is a trademark of its owner. Transformation Health is not affiliated with or endorsed by CMS, Medicare, Humana, Novo Nordisk, or Eli Lilly. Transformation Health does not accept payment from providers. How we make money.