Medicare does cover GLP-1 pills, through two separate paths. For weight loss, a temporary program called the Medicare GLP-1 Bridge covers the daily Foundayo tablet and the Wegovy tablet for a flat $50 monthly copay through December 31, 2027. For type 2 diabetes, standard Medicare Part D has long covered the oral semaglutide pill Rybelsus, and its negotiated price drops sharply on January 1, 2027.
GLP-1 Pills Covered for Weight Loss
Federal law has prohibited Medicare from paying for drugs prescribed solely for weight loss since Part D was created in 2003. CMS worked around that exclusion by launching the Medicare GLP-1 Bridge on July 1, 2026, a nationwide demonstration authorized under Section 402 of the Social Security Amendments of 1967. The program sits outside the normal Part D benefit, which is why its costs behave differently from a regular prescription (more on that below).
Two of the three drugs eligible under the Bridge are pills:
- Foundayo (orforglipron) is a once-daily tablet from Eli Lilly, FDA-approved in April 2026. It can be taken at any time of day, with or without food or water.
- Wegovy (semaglutide) is available as a daily 25 mg tablet, approved by the FDA in December 2025. The pill has to be taken first thing in the morning on an empty stomach with no more than four ounces of water, and you must wait at least 30 minutes before eating or drinking anything else.
The third covered drug, Zepbound (tirzepatide), is only covered in its KwikPen injectable form under the Bridge. Single-dose vials and pens of Zepbound are not covered.
What You Pay
The copay is $50 for a 30-day supply of any eligible drug, paid at the pharmacy. That $50 does not count toward your Part D deductible, your annual out-of-pocket maximum, or true out-of-pocket spending. Low-Income Subsidy benefits and the Medicare Prescription Payment Plan do not apply to Bridge prescriptions, and manufacturer coupons cannot be stacked on top of the Bridge price either.
Who Qualifies
You must be enrolled in a standalone Part D plan or a Medicare Advantage plan that includes drug coverage, be at least 18, and meet one of these combinations:
- BMI of 35 or higher, with no additional condition required.
- BMI of 30 or higher, plus heart failure with preserved ejection fraction, uncontrolled high blood pressure despite two medications, or chronic kidney disease at stage 3a or above.
- BMI of 27 or higher, plus prediabetes, a history of heart attack or stroke, or symptomatic peripheral artery disease.
Three conditions disqualify you from the Bridge specifically: type 2 diabetes, moderate-to-severe sleep apnea, and fatty liver disease (MASH). CMS directs people with those conditions to their regular Part D plan, which may already cover a GLP-1 for that indication.
How to Get a Prescription Filled
There is no enrollment website and no sign-up through your Part D plan. Your prescriber submits a prior authorization request and the prescription directly to a central processor run by Humana, which CMS selected because it already runs the Limited Income Newly Eligible Transition program. The pharmacy then bills the central processor. Once the first fill is approved, refills do not require a new prior authorization unless you switch to a different covered drug, and the authorization is valid through December 31, 2027. Your provider must attest that the drug is being prescribed alongside structured nutrition and physical activity, consistent with the FDA label.
GLP-1 Pills Covered for Diabetes
Rybelsus, an oral semaglutide tablet, is covered under standard Medicare Part D when it is prescribed for type 2 diabetes. Coverage depends on your plan’s formulary, and plans commonly require prior authorization or step therapy. You pay your plan’s regular cost-sharing, and anything you spend counts toward the Part D annual out-of-pocket cap of $2,100 in 2026. Once you reach that cap, your cost for covered drugs drops to zero for the rest of the year.
Starting January 1, 2027, Rybelsus and Ozempic will cost significantly less. Under the Medicare Drug Price Negotiation Program, CMS set a maximum fair price of roughly $274 for a 30-day supply of either drug, a 71 percent discount from the 2024 list price of $959. About 2.3 million Part D enrollees used these drugs in 2024.
Other Non-Diabetes Uses Covered Through Part D
Some GLP-1 prescriptions that are not strictly for weight loss or diabetes also go through your regular Part D plan rather than the Bridge. Wegovy can be covered to reduce the risk of major cardiovascular events in adults with established heart disease who are overweight or obese. Zepbound can be covered for moderate-to-severe obstructive sleep apnea in adults with obesity. These prescriptions follow your plan’s normal formulary and prior authorization rules.
What Happens When the Bridge Ends
The Bridge was originally set to end on December 31, 2026, and CMS extended it by one year to December 31, 2027. CMS had planned to hand coverage off to a longer-term initiative called the BALANCE Model, which would have integrated weight-loss GLP-1 coverage directly into Part D plans starting in January 2027, but CMS delayed the Medicare portion of BALANCE in April 2026 after private insurers pushed back.
CMS has not announced what will replace the Bridge when it expires. Unless a new demonstration is created or Congress lifts the statutory exclusion on weight-loss drug coverage, Medicare beneficiaries could lose access to GLP-1 pills for weight loss at the start of 2028. Coverage of Rybelsus and other GLP-1s prescribed for type 2 diabetes is not affected by the Bridge’s expiration.