Does Medicare Cover Wegovy? The $50 Bridge, Eligibility, and Part D

Yes, Medicare does cover Wegovy, but how it covers the drug depends on why it’s prescribed. For weight loss, coverage runs through a temporary federal program called the Medicare GLP-1 Bridge, which launched July 1, 2026 and charges eligible beneficiaries a flat $50 for a one-month supply.¹ For adults with established cardiovascular disease who are overweight or obese, Wegovy can be covered through a regular Part D plan to reduce the risk of heart attack and stroke, at standard specialty-tier cost sharing. The two pathways don’t overlap, and each carries its own rules.

The $50 Weight-Loss Pathway

The Medicare GLP-1 Bridge is a nationwide demonstration operated by CMS from July 1, 2026 through December 31, 2027.¹ It sits outside your Part D plan. When your pharmacy fills a Bridge prescription, the claim is routed to a central processor (Humana, under contract with CMS) rather than to your drug plan.²

You pay $50 for each 28- or 30-day supply. That price does not change based on your deductible status or where you are in the Part D benefit.³ Three drugs are covered under the program when prescribed for weight loss:

Wegovy (semaglutide), both the injection and the oral tablet
Zepbound (tirzepatide), the KwikPen formulation only — single-dose vials and single-dose pens are excluded
Foundayo (orforglipron), a once-daily oral tablet approved by the FDA in April 2026⁴

Only single monthly fills are allowed. There are no 60- or 90-day supplies through the Bridge.⁵

What the $50 Does Not Do

The copay is genuinely $50, but it comes with financial limits worth understanding before you commit:

It does not count toward your Part D deductible or the $2,100 annual out-of-pocket cap for 2026.⁶
Extra Help (the Low-Income Subsidy) cannot reduce it further.⁶
The Medicare Prescription Payment Plan, which lets you spread other drug costs across the year, does not apply.⁷
Manufacturer coupons and discount cards cannot be stacked on Bridge prescriptions.⁵

For someone on a fixed income who relies on Extra Help for other prescriptions, $50 every month with no subsidy assistance is a real budget item. The Medicare Rights Center has flagged this as a reason to think carefully before starting.⁸

Who Qualifies for the Bridge

You need Medicare prescription drug coverage — either a standalone Part D plan or a Medicare Advantage plan that includes drug coverage. Special Needs Plans, employer or union group waiver plans, and LI NET participants are also eligible. Beneficiaries in private fee-for-service plans, PACE organizations, or cost contract plans generally aren’t, unless they also carry a standalone Part D plan.⁷

Your prescribing provider must submit a prior authorization confirming that you’re at least 18, that you’re using the drug for weight reduction alongside structured nutrition and physical activity, and that you meet one of these clinical thresholds:¹

BMI of 35 or higher, with no additional diagnosis required
BMI of 30 or higher, plus heart failure with preserved ejection fraction, uncontrolled hypertension (systolic above 140 or diastolic above 90 despite two blood pressure medications), or chronic kidney disease at stage 3a or above
BMI of 27 or higher, plus prediabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease

Once approved, the authorization runs through December 31, 2027. Refills don’t require a new one as long as you stay on the same drug, even if your dose changes.³

Who Is Excluded

If your Part D plan already covers a GLP-1 drug for another condition you have, you cannot use the Bridge for that prescription. This applies specifically to people with type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH (fatty liver disease). Those beneficiaries are directed to work through their Part D plan instead.⁹

How to Fill a Prescription

The steps are straightforward:⁷

Talk to your doctor about whether a GLP-1 medication is appropriate and whether you meet the BMI and health criteria.
Have the prescription sent to your pharmacy.
Give the pharmacy your Medicare ID number so the claim routes to the central processor.
Wait for prior authorization. Your doctor submits the form, and Medicare sends a confirmation letter once coverage is approved.

Pharmacies do not need to opt in. Any pharmacy that submits electronic claims can process Bridge prescriptions using the designated billing code.⁵

Wegovy for Heart Disease: Coverage Through Part D

Wegovy has a second, older coverage path that runs through your regular Part D plan. In March 2024, the FDA approved Wegovy to reduce the risk of heart attack, stroke, and cardiovascular death in adults with established cardiovascular disease who are also overweight or obese. The approval was based on a trial of more than 17,600 participants that showed a 20% reduction in major adverse cardiovascular events compared to placebo.¹⁰

Following that approval, CMS told Part D plans they could add Wegovy to their formularies for cardiovascular risk reduction, because at that point the drug is no longer being prescribed solely for weight loss.¹¹ Plans that cover it may impose prior authorization and step therapy. Because Wegovy’s list price is roughly $1,300 per month, plans typically place it on a specialty tier with 25% to 33% coinsurance, which translates to around $325 to $430 per month out of pocket before you reach the annual Part D spending cap.¹²

If you qualify for Wegovy under the cardiovascular indication through your Part D plan, you cannot also use the Bridge for that prescription. The two pathways are mutually exclusive.

Why the $50 Program Is Temporary

Federal law has excluded weight-loss drugs from Medicare Part D since the benefit was created in 2003. Section 1927(d)(2) of the Social Security Act permits the exclusion of “agents when used for anorexia, weight loss, or weight gain,” and CMS has interpreted that provision to bar Part D plans from covering anti-obesity medications prescribed solely for weight loss.¹³ The Bridge is a demonstration program that operates outside Part D, which is how it sidesteps that exclusion.

The Bridge was originally scheduled to end December 31, 2026, as a stopgap before a broader voluntary program called the BALANCE Model took over on January 1, 2027. The Medicare portion of BALANCE was delayed, and CMS extended the Bridge through December 31, 2027 so that beneficiaries don’t lose access.² Medicare-side implementation of BALANCE is now not expected before 2028.¹⁴ Coverage after December 2027 depends on future federal action, so if you start on Wegovy through the Bridge, it’s worth talking with your prescriber about what happens if the $50 pricing ends.

1
CMS.gov. Medicare GLP-1 Bridge
2
Obesity Medicine Association. CMS Announces Changes to Medicare Coverage of GLP-1 Medications for 2027
3
Medicare.gov. Weight Loss Drugs
4
Eli Lilly Investor Relations. FDA Approves Lilly’s Foundayo (Orforglipron)
5
CMS.gov. Medicare GLP-1 Bridge – Information for Pharmacies
6
KFF. What Medicare’s Temporary Program Covering GLP-1s for Obesity Means for Beneficiaries
7
Medicare.gov. Medicare GLP-1 Bridge – GLP-1 Drugs for $50 a Month
8
Medicare Rights Center. GLP-1 Weight Loss Drug Demonstration Begins July 2026
9
CMS.gov. Medicare GLP-1 Bridge – Information for Part D Plans
10
FDA. FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults With Obesity or Overweight
11
NPR. Wegovy Medicare Part D Weight Loss Drugs
12
KFF. A New Use for Wegovy Opens the Door to Medicare Coverage for Millions of People With Obesity
13
HHS ASPE. Medicare Coverage of Anti-Obesity Medications
14
GWU STOP. Legal and Policy Update