Medicare does cover weight-loss drugs for many beneficiaries right now, but only through a temporary program called the Medicare GLP-1 Bridge, which launched July 1, 2026 and runs through December 31, 2027. If you qualify, you pay a flat $50 per month for Wegovy, Zepbound, or Foundayo. Outside this program, the 2003 statute that bars Part D from covering drugs prescribed for weight loss is still in force.1AARP. Does Medicare Cover Ozempic Weight Loss Drugs
What the Bridge Covers and What You Pay
Three drugs are on the Bridge formulary, all prescribed for weight reduction alongside diet and exercise:
- Wegovy (semaglutide), as an injection or tablet, from Novo Nordisk.
- Zepbound (tirzepatide), in the KwikPen formulation only, from Eli Lilly.
- Foundayo (orforglipron), a once-daily pill approved by the FDA in April 2026 and also made by Eli Lilly. It is the first oral small-molecule GLP-1 that can be taken at any time without food or water restrictions.2Eli Lilly. FDA Approves Lilly’s Foundayo (Orforglipron)
The copay is $50 per one-month supply. It does not change based on which drug you take, your dose, or where you are in your Part D year.3CMS. Medicare GLP-1 Bridge
A few things to know about that $50. It does not count toward your Part D deductible or your annual out-of-pocket maximum. It will not show up on your Part D Explanation of Benefits. Extra Help does not lower it. The Medicare Prescription Payment Plan does not apply. And you cannot stack a manufacturer coupon or discount card on top.4Medicare.gov. Weight Loss Drugs
Who Qualifies for the GLP-1 Bridge
You have to be at least 18 and enrolled in a standalone Part D plan or a Medicare Advantage plan that includes drug coverage. Special Needs Plans and employer group waiver plans also qualify. If you are in a PACE organization, a private fee-for-service plan, or certain cost-contract plans, you are not eligible unless you also carry a separate standalone Part D plan.5CMS. Medicare GLP-1 Bridge – Information for Providers
The clinical criteria are tiered by body mass index at the time your doctor starts the prescription:
- BMI of 35 or higher: no additional condition required.
- BMI of 30 to 34.99: you also need heart failure with preserved ejection fraction, uncontrolled high blood pressure above 140/90 despite two medications, or chronic kidney disease at stage 3a or above.
- BMI of 27 to 29.99: you also need prediabetes, a history of heart attack or stroke, or symptomatic peripheral artery disease.
There is one exclusion worth reading carefully. If you have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, you cannot use the Bridge. Those conditions already have GLP-1 drugs available through standard Part D, and CMS wants that care to stay in your regular plan.4Medicare.gov. Weight Loss Drugs
How to Get a Prescription Through the Bridge
You do not sign up for the Bridge yourself. Your doctor submits a prior authorization request and the prescription to a single central processor, Humana, which runs the program for CMS. Once it is approved, you get a confirmation letter and can fill the prescription at a participating pharmacy. Refills and dose adjustments do not require a new authorization through the end of 2027, as long as you stay on the same drug.6Medicare.gov. Medicare GLP-1 Bridge: GLP-1 Drugs for $50 a Month
When a GLP-1 Is Covered Through Regular Part D
If you are prescribed a GLP-1 for something other than weight loss, your regular Part D plan may already cover it, and the Bridge does not apply. Ozempic and Rybelsus are commonly covered for type 2 diabetes. Wegovy has a separate FDA approval for reducing cardiovascular risk in adults with heart disease who are overweight or obese, and some Part D plans cover it for that use. Zepbound is approved for moderate-to-severe obstructive sleep apnea.7Wellcare. Does Medicare Cover Weight Loss Drugs
Coverage of these indications varies by plan. Each formulary is different, and plans may require prior authorization or step therapy. When Wegovy is covered for cardiovascular risk, it usually sits on a specialty tier, where coinsurance of 25% to 33% of the list price can translate into $325 to $430 per month before you hit the annual out-of-pocket cap.8KFF. A New Use for Wegovy Opens the Door to Medicare Coverage for Millions CMS has said it will watch Part D plans to make sure they do not push beneficiaries with coverable indications out of their regular plan and into the Bridge to save money.9CMS. Medicare GLP-1 Bridge – Information for Part D Plans
Other Weight-Management Coverage Under Medicare
Medicare pays for more than just drugs. Part B covers obesity screening and intensive behavioral therapy for beneficiaries with a BMI of 30 or higher at no cost to you. These visits include nutritional assessment and counseling, but they must be delivered by a primary care provider; referrals to a registered dietitian are not covered under this benefit.10National Council on Aging. Obesity Treatment and Medicare: A Guide to Understanding Coverage
Medicare also covers bariatric surgery for beneficiaries with a BMI of 35 or higher who have at least one obesity-related health condition and documented unsuccessful attempts at weight loss through diet or exercise. Covered procedures include sleeve gastrectomy, Roux-en-Y gastric bypass, and adjustable gastric banding. Open sleeve gastrectomy and gastric balloons are not covered.11Medicare.gov. Bariatric Surgery Some Medicare Advantage plans add supplemental benefits like gym memberships.
What Happens After December 31, 2027
The Bridge is scheduled to end on that date. CMS originally built it as a six-month bridge to a longer-running arrangement called the BALANCE Model, under which Part D plans would voluntarily cover weight-loss drugs. That model has been delayed for Medicare after insurers resisted participation, and CMS extended the Bridge to fill the gap.12STAT News. Medicare Weight Loss Drugs GLP-1 Bridge Program May Be Hard to End13Obesity Medicine Association. CMS Announces Changes to Medicare Coverage of GLP-1 Medications for 2027
If the BALANCE Model launches, participating Part D plans would cap cost-sharing on GLP-1s for obesity at $50 per month in enhanced and employer plans, or $125 per month in basic plans, with the copay dropping to zero once a beneficiary hits the annual out-of-pocket maximum ($2,400 in 2027).14KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid For now, the model is only announced for Medicare, and its launch depends on how many plans sign up. If neither Congress nor a permanent rule changes the underlying law, the statutory ban on Medicare covering drugs prescribed for weight loss resumes once the Bridge expires.