Does Medicare Cover Weight Loss Drugs? (Wegovy, Zepbound)

What This Means

Medicare now covers weight loss drugs for the first time. For decades, federal law specifically excluded weight loss medications from Medicare Part D coverage. That exclusion — written into the Medicare Modernization Act of 2003 — has not been repealed. But starting July 1, 2026, CMS is running a demonstration program called the Medicare GLP-1 Bridge that covers two weight loss drugs: Wegovy (semaglutide injection and tablets) and Zepbound (tirzepatide). The drugs must be prescribed to reduce excess body weight and maintain weight reduction in combination with lifestyle modification.

The Bridge program operates outside of your normal Part D benefit. That means it is not run by your Part D plan. Instead, prior authorization goes through a central CMS processor (administered by Humana). You still need to be enrolled in a Part D plan to qualify, but the Bridge itself is a separate CMS program. The cost is a flat $50 copay per prescription — regardless of the drug’s retail price or where you are in your Part D benefit phases.

This program is temporary. The GLP-1 Bridge runs from July 1 through December 31, 2026. After that, coverage of these weight loss drugs will only continue if you enroll in a Part D plan that participates in a new model called BALANCE, starting in January 2027. Not every plan will participate. If you start one of these medications during the Bridge period, plan ahead for what comes next — we cover the transition in detail below.

Who Qualifies

To be eligible for the Medicare GLP-1 Bridge, you must be enrolled in a Part D plan (either a standalone PDP or a Medicare Advantage plan with Part D) for 2026, and you must be age 18 or older. You must also meet one of the following BMI-based criteria.

Your doctor will need to document your BMI and any qualifying conditions as part of the prior authorization process. If you are not sure whether you meet the criteria, talk to your doctor — they can review your medical history and determine your eligibility.

What It Costs

You will pay a $50 copay per prescription. That is the same whether you get Wegovy or Zepbound, and it does not change based on where you are in your Part D benefit year.

There are important limitations to understand about this $50 copay:

• It does not count toward your Part D deductible. You still need to meet your regular Part D deductible separately for your other medications.
• It does not count toward the $2,100 annual out-of-pocket cap. The $50 you pay for each GLP-1 Bridge prescription will not bring you closer to the Part D out-of-pocket maximum. It is entirely separate spending.
• Extra Help (Low-Income Subsidy) does not apply. Even if you qualify for Extra Help, which normally reduces or eliminates copays on Part D drugs, the $50 Bridge copay is not reduced. You will pay the full $50.

The $50 copay is a fixed cost set by CMS for this demonstration program. It is not subject to the normal Part D cost-sharing rules.

How to Get It

1. Talk to your doctor. Tell your doctor you are interested in Wegovy or Zepbound for weight loss under the Medicare GLP-1 Bridge. Your doctor will evaluate whether you meet the BMI and health condition requirements and whether one of these medications is appropriate for you. The prescription must be for weight loss with lifestyle modification.
2. Your doctor submits a prior authorization to CMS. This is different from a normal Part D prior authorization. Your doctor’s office will submit the request to CMS’s central processor — not to your Part D plan. The prior authorization confirms your BMI, qualifying conditions, and that the drug is being prescribed for the right purpose. Your doctor’s office will handle this paperwork.
3. Fill your prescription at any pharmacy. Once the prior authorization is approved, you can take your prescription to any pharmacy. You will pay the $50 copay at the counter. The pharmacy will process the claim through the Bridge program, not through your regular Part D plan.

One important exception: If the drug you need is already coverable under your Part D plan for a different medical reason, the Bridge does not apply. For example, semaglutide is also sold as Ozempic for type 2 diabetes, and tirzepatide is also sold as Mounjaro for type 2 diabetes. If your doctor prescribes these drugs for diabetes (or another Part D-covered condition), you would get them through your regular Part D benefit with your plan’s normal cost-sharing. The Bridge is specifically for Wegovy and Zepbound prescribed for weight loss.

What Happens After December 2026

The GLP-1 Bridge ends on December 31, 2026. It is a temporary program, and there is no guarantee it will be extended.

Starting in January 2027, Medicare coverage of weight loss GLP-1 drugs will only be available through Part D plans that voluntarily participate in a new CMS model called BALANCE. Plan participation is not required — some plans will join, and some will not. If your current Part D plan does not participate in BALANCE, you will lose coverage for these weight loss drugs on January 1, 2027.

Here is what you should do to prepare:

• Pay attention during the 2027 open enrollment period (October 15 through December 7, 2026). This is when you can switch Part D plans for the following year. By that time, CMS should have information available about which plans are participating in BALANCE.
• You may need to switch plans. If your current plan is not joining BALANCE and you want to continue your weight loss medication, you will need to enroll in a plan that is participating. Switching plans may affect your coverage for other drugs, so review the new plan’s formulary carefully.
• Talk to your doctor before the Bridge ends. If you start Wegovy or Zepbound during the Bridge period, have a conversation with your doctor about your plan for continued coverage in 2027.

CMS will provide more details about the BALANCE Model and participating plans as the transition approaches.

Important Limitations

• Only Wegovy and Zepbound are covered. The Bridge does not cover other GLP-1 medications like Ozempic, Mounjaro, or Saxenda. Ozempic and Mounjaro are the diabetes-approved versions of the same active ingredients — they may be covered under your regular Part D benefit when prescribed for diabetes.
• The drug must be prescribed for weight loss. If your doctor prescribes the medication for a condition already covered by Part D (such as type 2 diabetes), use your regular Part D benefit instead — the Bridge does not apply.
• The $50 copay does not count toward your Part D deductible or the $2,100 out-of-pocket cap. This spending is entirely separate from your normal Part D benefit.
• Extra Help (Low-Income Subsidy) does not reduce the $50 copay. You pay the full $50 regardless of your income level.
• The program is temporary. Coverage under the Bridge runs July 1 through December 31, 2026 only. Continued coverage requires enrolling in a BALANCE Model plan for 2027.
• Prior authorization goes to CMS, not your Part D plan. Your doctor must submit the prior authorization to CMS’s central processor (administered by Humana), not to your Part D plan’s pharmacy benefit manager.
• Weight loss drugs are still excluded from Part D by statute. The Bridge is a CMS demonstration program. Federal law has not changed — the Medicare Modernization Act of 2003 exclusion remains in place. The Bridge works around it, not through it.

Sources

• CMS: Medicare GLP-1 Bridge — official program page
• KFF: What Medicare’s Temporary Program Covering GLP-1s for Obesity Means for Beneficiaries — eligibility and cost details
• KFF: What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid — post-Bridge transition
• CMS: BALANCE Model — the 2027 model that replaces the Bridge

Frequently Asked Questions