Medicare GLP-1 Coverage: The Bridge Program, Eligibility
Medicare Part D covers GLP-1s for type 2 diabetes but not for weight loss alone. The Medicare GLP-1 Bridge covers Wegovy, Zepbound and Foundayo for weight loss at $50 a month from July 1, 2026 to December 31, 2027, if you meet its BMI rules.
- Medicare GLP-1 Bridge copay
- $50 a month
- Bridge runs
- July 1, 2026 to December 31, 2027
- GLP-1 in the Bridge
- Some
- Part D for weight loss alone
- Not covered
Half-life and weight loss overview
In days, half-life tells how long the body needs to remove half a dose. This comes from section 12.3 in each FDA label.
Percentage of body weight. Trials, doses and lengths differ. Check each result against the placebo listed on its own page.
Does Medicare cover GLP-1?
| Medicine | Approved for | Part D covers | In the $50 Bridge |
|---|---|---|---|
 Ozempic | Type 2 diabetes, along with heart risk and kidney disease linked to type 2 diabetes | Diabetes and heart-risk uses | No |
 Wegovy | Weight loss, heart risk and MASH liver disease | Heart risk or sleep apnea uses only | Yes |
 Mounjaro | Type 2 diabetes and heart risk | Diabetes and heart-risk uses | No |
 Zepbound | Weight loss and sleep apnea | Heart risk or sleep apnea uses only | Yes |
 Foundayo | Weight loss | Not for weight loss | Yes |
 Rybelsus | Type 2 diabetes and heart risk | Diabetes and heart-risk uses | No |
 Trulicity | Type 2 diabetes and heart risk | Diabetes and heart-risk uses | No |
 Saxenda | Weight loss | Not for weight loss | No |
 Victoza | Type 2 diabetes and heart risk | Diabetes and heart-risk uses | No |
- Weight loss only under Part D
- Part D coverage is possible when you have diabetes or cardiovascular disease
- Your plan may cover it for type 2 diabetes, sleep apnea, or fatty liver
Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.
The published policy
- Bridge starts: July 1, 2026
- Bridge ends: December 31, 2027
- The monthly copay for the Medicare GLP-1 Bridge is $50
- Foundayo, Wegovy, Zepbound KwikPen are Bridge drugs
- Vials and single-dose pens are excluded from the Bridge
- These costs do not count toward your Part D deductible
Check the policy yourself: medicare.gov.
Sources: humana.com, medicare.gov, CMS.
Prior authorization checklist
- By itself, BMI qualifies at a BMI of 35 or higher. No condition is needed
- When heart failure, uncontrolled blood pressure or CKD 3a+ is present, a BMI of 30 or higher qualifies, per
- A lower BMI can qualify at BMI 27 or higher if you have prediabetes, a previous heart attack, stroke, or PAD
- The approval step is prior authorization
- Records: your measured height and weight, weight-related conditions, and the diet and activity plan you have tried
- Your prescriber, not you, submits the prior authorization
Source: medicare.gov.
If denied: the appeal
| Denial reason | What to send or ask |
|---|---|
| Criteria not met | Have your prescriber send a new submission with your measured BMI and all weight-related conditions in your chart. The threshold is a BMI of 35, or 27 if a weight-related condition is present. |
| The drug is not on the plan's list | Request a formulary exception, and ask which GLP-1 the plan prefers |
- Ask your Part D plan for a coverage determination, or for an exception if its list omits the drug
- If the answer is no, request a redetermination from the plan. Your prescriber can also provide a supporting statement.
- If that does not work, the appeal goes to a reviewer who is independent and outside the plan.
State and plan variation
Medicare Advantage plans with drug coverage follow the same rules Humana, for example, sets the Bridge copay at $50 for each 30-day supply
Each Part D plan establishes its own list of drugs and copay tiers
When you have both Medicare and Medicaid, Medicaid rules for your state apply as well: Does Medicaid Cover GLP-1? Criteria, Copay, How to Appeal
Source: humana.com.
Other choices when coverage says no
| Medicine | Lowest self-pay | Manufacturer offer if your plan does not cover it | Patient assistance |
|---|---|---|---|
| Ozempic | $149 a month | Not listed | Free if approved |
| Wegovy | $149 a month | Not listed | Not listed |
| Mounjaro | Not listed | $499 a month | Not listed |
| Zepbound | $299 a month | $299 a month | Not listed |
| Foundayo | $149 a month | Not listed | Not listed |
| Trulicity | Not listed | Not listed | Free for up to 12 months |
Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.