For the first time in history, Medicare will cover weight-loss medications. The Medicare GLP-1 Bridge launches July 1, 2026, offering eligible Part D beneficiaries Wegovy, Foundayo, and Zepbound at a flat $50/month copay. Here's everything you need to do before July 1 to be ready.
What's Covered
| Medication | Manufacturer | Format | Covered? | Notes |
|---|---|---|---|---|
| Wegovy (injection) | Novo Nordisk | Weekly injection | ✅ All doses | Including HD 7.2mg |
| Wegovy (oral tablet) | Novo Nordisk | Daily pill | ✅ All doses | New oral form |
| Foundayo (orforglipron) | Eli Lilly | Daily pill | ✅ All doses | Approved Apr 2026 |
| Zepbound KwikPen | Eli Lilly | Weekly injection | ✅ KwikPen only | Vials NOT covered |
| Ozempic | Novo Nordisk | Weekly injection | ❌ Not for weight loss | Diabetes coverage only |
| Mounjaro | Eli Lilly | Weekly injection | ❌ Not for weight loss | Diabetes coverage only |
| Compounded GLP-1s | Various | Injectable | ❌ Not covered | Brand-name only |
Eligibility Requirements
To qualify for the Medicare GLP-1 Bridge, you must meet all of the following:
- Enrolled in Medicare Part D — through a standalone PDP or Medicare Advantage plan with drug coverage (MAPD)
- BMI ≥35 — documented by your healthcare provider
- OR BMI ≥27 with at least one weight-related comorbidity (hypertension, type 2 diabetes, dyslipidemia, cardiovascular disease, obstructive sleep apnea)
- Prescription from a licensed provider specifically for weight reduction and maintenance
- Prior authorization from your Part D plan
Your Pre-July 1 Checklist
1. Confirm your BMI documentation (do this NOW)
Schedule an appointment with your primary care provider before June 15. Get your BMI, weight, and any comorbidities documented in your medical record. This documentation will be needed for prior authorization. If your BMI is between 27 and 35, make sure relevant comorbidities are clearly noted.
2. Talk to your doctor about which medication
All three covered medications have different profiles. Wegovy injection is the most-studied for weight loss (STEP and SELECT trials). Foundayo is the most convenient (oral, any time, no food restrictions). Zepbound KwikPen delivers the highest weight loss (20.2% in SURMOUNT-5). Your provider should help you choose based on your medical history and preferences.
3. Contact your Part D plan
Call the number on your Medicare Part D card and ask about the GLP-1 Bridge program. Confirm that your plan is participating, ask about the prior authorization process, and request the required forms. The Bridge operates separately from normal Part D benefits — your plan won't bear financial risk — but enrollment mechanics may vary.
4. Get prior authorization started
Prior authorization can take 1-4 weeks. If your doctor submits the PA request in mid-June, you'll have coverage ready for a July fill. Don't wait until July 1 to start this process.
5. Choose your pharmacy
The Bridge program should be accessible through most pharmacies that process Part D claims. Confirm with your pharmacy that they can fill Bridge prescriptions before July 1.
What If You Don't Qualify?
If your BMI is below the threshold, or if prior authorization is denied, these options remain available:
After the Bridge: The BALANCE Model
The GLP-1 Bridge is temporary — it runs July 1, 2026 through December 31, 2027. After that, the longer-term BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model takes over. The BALANCE Model will include the Bridge medications plus Ozempic, Rybelsus, and Mounjaro, and adds required lifestyle supports alongside medication coverage. Details are still being finalized, but the transition is designed to be seamless for patients already on Bridge medications.