💡 Bottom Line
Starting July 1, 2026, Medicare will cover Wegovy, Zepbound (KwikPen), and Foundayo for weight loss at a flat $50/month copay. This is the first time Medicare has ever covered prescription weight loss drugs. The program runs through December 31, 2026, then transitions to the BALANCE Model in 2027.
For more than 20 years, Medicare was prohibited from covering weight loss medications. That changes on July 1, 2026, when the Medicare GLP-1 Bridge launches — giving millions of Medicare beneficiaries access to GLP-1 medications at $50 per month.
Here's everything you need to know to get enrolled.
What's Covered
| Medication | Formats Covered | Monthly Copay |
|---|---|---|
| Wegovy (semaglutide) | Injection and oral tablet | $50 |
| Zepbound (tirzepatide) | KwikPen only (not vials) | $50 |
| Foundayo (orforglipron) | Oral tablet | $50 |
⚠️ Important: What's NOT Covered
Zepbound single-dose vials and single-dose pens are not covered under the Bridge. Only the KwikPen formulation qualifies. Compounded GLP-1 medications are not covered. Ozempic and Mounjaro (the diabetes formulations) are already covered under standard Part D for diabetes — the Bridge specifically adds coverage for weight loss.
Who Qualifies
To qualify for the Medicare GLP-1 Bridge, you must meet all of these criteria:
- Enrolled in Medicare Part D — either a standalone prescription drug plan (PDP) or a Medicare Advantage plan with drug coverage (MA-PD)
- BMI of 35 or higher (no additional conditions required), OR
- BMI of 27 or higher with at least one qualifying condition: heart failure, hypertension, chronic kidney disease, prediabetes, or history of cardiovascular events
- Prescribed the medication for weight loss alongside diet and exercise
How It Works
- Talk to your doctor now. Don't wait until July — discuss your eligibility and get your BMI documented.
- Your doctor submits prior authorization to a central CMS processor (not your Part D plan).
- Once approved, fill your prescription at any pharmacy. No special pharmacy required.
- Pay $50/month copay at the pharmacy counter.
📌 Important Detail
The $50 copay does NOT count toward your Part D deductible or the $2,100 annual out-of-pocket cap. The Bridge operates outside the normal Part D benefit structure. This means your GLP-1 spending won't help you reach the catastrophic coverage threshold for other medications.
Timeline
| Date | What Happens |
|---|---|
| Now – June 2026 | No Medicare coverage for weight loss GLP-1s. Prepare documentation with your doctor. |
| July 1, 2026 | Medicare GLP-1 Bridge launches. Wegovy, Zepbound KwikPen, and Foundayo at $50/mo. |
| Oct 15 – Dec 7, 2026 | Medicare Open Enrollment. Check if your plan joins the BALANCE Model for 2027. |
| Dec 31, 2026 | Bridge program ends. |
| Jan 1, 2027 | BALANCE Model begins for participating Part D plans. IRA-negotiated prices take effect ($274/mo for Wegovy/Ozempic). |
What If You Don't Qualify for Medicare?
If you're not on Medicare, these cash-pay options are available now without any insurance:
| Provider | Starting Price | Details |
|---|---|---|
| Sesame Care | from $199 | Check Price → Paid link |
Key Takeaways
- Medicare GLP-1 Bridge: $50/month for Wegovy, Zepbound KwikPen, and Foundayo starting July 1, 2026
- Eligibility: BMI ≥35, or BMI ≥27 with qualifying conditions (heart failure, hypertension, CKD, prediabetes, CV history)
- Doctor submits prior auth to CMS — not your Part D plan
- Bridge runs July–December 2026; BALANCE Model continues coverage in 2027
- Check during Open Enrollment (Oct–Dec) that your plan joins BALANCE for 2027
Compare All GLP-1 Prices
See today's lowest verified prices from vetted telehealth providers.
Compare Prices →Paid link · Compounded medications are not FDA-approved.