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GLP-1 Weight-Loss Drug Demonstration Begins July 2026
Starting in July 2026, some people with Medicare will be eligible for Medicare coverage of certain weight-loss medications through the new Medicare GLP‑1 Bridge Program.
Background
Under federal law, Medicare Part D plans cannot cover medications prescribed for weight loss, among several other “excluded” categories of drugs and indications. Medications that are FDA-approved for both weight loss and other indications may only be covered by Part D plans for non-weight loss indications.
GLP-1 drugs, which include medications used to treat type 2 diabetes, obesity, cardiovascular disease, and other conditions, have greatly increased in popularity in recent years due to their demonstrated effectiveness. But the federal exclusion limits Medicare coverage of these drugs.
Changing the law to permit or require Medicare Part D plans to cover medications for weight loss would require Congress to act.
Changing the law to permit or require Medicare Part D plans to cover medications for weight loss would require Congress to act. But the Centers for Medicare & Medicaid Services (CMS) has the authority to test coverage changes through Center for Medicare and Medicaid Innovation (CMMI) models and other statutory demonstration authorities.
New Test Models Announced
To work within these parameters, originally CMS announced two models to test expanded access to GLP-1 medications for people with Medicare: the GLP-1 Bridge Program and the Better Approaches to Lifestyle and Nutrition for Comprehensive Health (BALANCE) model.
The GLP-1 Bridge Program is a time-limited program that will provide eligible Medicare beneficiaries with access to certain GLP-1 drugs outside of the Part D benefit.
The BALANCE model would have allowed Part D plans to opt into the program to provide coverage for GLP-1 drugs for weight loss for their enrollees.
The BALANCE Model will be delayed indefinitely and the GLP-1 Bridge will be extended through 2027.
In its initial announcements, CMS indicated that the GLP-1 Bridge program would run from July 1, 2026, through the end of the year, with the BALANCE Model beginning in January 2027. But CMS announced in May 2026 that the Part D portion of the BALANCE Model will be delayed indefinitely and that the GLP-1 Bridge will be extended through December 31, 2027.
What Is the Medicare GLP‑1 Bridge Program?
The GLP‑1 Bridge Program will give eligible Medicare beneficiaries temporary access to certain weight‑loss drugs. The program will start July 1, 2026, and end December 31, 2027.
In the Bridge Program:
- Approved GLP-1 medications will be provided through a special program. Importantly, this is not the regular Part D drug plan.
- The Part D plan does not have to sign up for this program or participate
- A central system run by Medicare will handle approvals, process claims, and pay pharmacies.
What Medications Are Included?
Three GLP-1 medications will be covered under the Medicare GLP-1 Bridge Program:
- Wegovy (both injections and tablets)
- Zepbound (KwikPen)
- Foundayo
Who Is Eligible?
To be eligible, a person must:
- Be 18 or older
- Need the GLP-1 medication for weight loss and keeping weight off, meaning a person must meet one of these weight and health criteria to be eligible:
- BMI of 35 or higher
- BMI of 30 or higher and have certain health conditions, such as:
- Heart failure
- Uncontrolled hypertension
- Chronic kidney disease
- BMI of 27 or higher and have other health risks, such as:
- Pre-diabetes
- Heart attack
- Peripheral artery disease
- Have Medicare with prescription drug coverage either through a standalone Part D plan or a Medicare Advantage plan that includes drug coverage
- Have prior authorization/approval from the Bridge Program.
How Much Will the GLP-1 Medications Cost?
Under the GLP-1 Bridge Program, people will pay a fixed $50 monthly copayment. The Bridge Program is separate from regular Medicare Part D drug coverage. This means the $50 copay will not count toward the deductible or out-of-pocket limit. Cost assistance programs like Extra Help cannot be used, and the $50 copay stays the same, no matter what stage of Part D applies.
These financial factors make it vital for interested Medicare enrollees to thoroughly weigh the pros and cons of using the Bridge Program to access these medications.
For More Information
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25 Comments on “GLP-1 Weight-Loss Drug Demonstration Begins July 2026”
John Dwyer
June 4, 2026 at 7:45 pmI receive my Wegovy from NovoCare specialty pharmacy around the 20th of each month. If I am approved for Bridge project Wii they bill me $50 instead of $349.
Tek Shrewsbury
June 5, 2026 at 10:56 amThat is a separate program and you need to stop that and have to doctor use the bridge program. They are also waiting for final details as well as the pharmacies.
Click the link for details from official source and track it as they make progress.
https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge
Saul Shapiro
June 4, 2026 at 9:16 pm“Have prior authorization/approval from the Bridge Program.” How do I obtain that prior authorization? My physician has prescribed it for me based on the eligibility requirements above. It’s gone through the usual channels from pharmacy to Medicare Advantage to (at this point) nowhere. Is that the proper route, pending the start of the program?
Medicare Rights Center
June 5, 2026 at 12:58 pmThe prior authorization process for the Bridge Program has not yet been made fully available. More information should be coming this month, and prior authorizations will be accepted and processed starting July 1, 2026. See “How can a medical provider refer a beneficiary to the Medicare GLP-1 Bridge?” for more currently available information. http://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-medicare-beneficiaries
If you have further questions, especially after more information is available, we encourage you to call your local State Health Insurance Assistance Program (whose number can be found at http://www.shiphelp.org) or Medicare Rights’ free, national helpline 800-333-4114.
Christina
June 10, 2026 at 6:01 pmI think there was a recent update to a page on the CMS Bridge site area. No one is going to get this on July 1! Steps I have taken: 1) I have an Rx for one of covered drugs, Zepbound Kwikpen, on file at the hospital pharmacy; 2) I have supplied the hospital pharmacy the special BIN and PCN numbers from the Medicare Bridge site 3) I have supplied my Medicare A/B number to the pharmacy. I will wait till 3 AM or later on July 1 and submit my Rx via the pharmacy app. The rejection is expected. It will trigger a message to the pharmacy that a PA is required. Unclear if the pharmacy or Medicare/Humana contractor generates the PA form to go to my physician. Will track that. Warns it could take up to 72 hours, and Jul 1 is just before the long holiday weekend. 4) I am pursuing an endocrinology referral. I was told, since I already receive hospital charity care (< 250% FPL, higher at Hartford Health, and a $60K+ asset test for one), using a provider EMPLOYED by the hospital network, if they write the script, the charity care will cover the $50. I am not given up my *affiliated* PCP over this, which is why I am trying the endocrinology route.
Evelyn McKinnon
June 22, 2026 at 4:59 pmHow and when can I sign up. I meet the BMI and have predibetes and hypertension.
Evelyn McKinnon
June 22, 2026 at 5:01 pmHow and when can I sign up. I meet the criteria.
Medicare Rights Center
June 24, 2026 at 3:59 pmAfter a doctor confirms your eligibility, starting July 1 they will be able to submit a prior authorization request and prescribe one of the GLP-1 drugs covered by the Bridge program. You do not need to sign up for a separate program outside of Medicare Part D.
E Jensen
June 11, 2026 at 4:20 pmMy husband is retired military so our drug coverage is provided through TriCare. Will TriCare recipients qualify similar to Medicare Advantage plans?
Medicare Rights Center
June 16, 2026 at 9:47 amThe Medicare GLP-1 Bridge Program only applies to people with Medicare Part D drug coverage. TRICARE for Life (TFL) recipients may have coverage from both TFL and Medicare Part D as outlined in the page below. Whether it makes sense to have both is a case-by-case matter. If you need support evaluating your options, we encourage you to call our free, national helpline 800-333-4114 or your local State Health Insurance Assistance Program (SHIP) whose number can be found at http://www.shiphelp.org https://www.medicareinteractive.org/understanding-medicare/coordinating-medicare-with-other-insurance/military-retiree-insurance-and-medicare/tfl-drug-coverage-and-part-d
Marlene Lenz
June 30, 2026 at 9:53 pmThis is discrimination against Veterans and their spouses. Tricare for Life is a wrap around program that includes drug coverage. It should be considered a Part D insurance. I’ve paid over $5000. Out of pocket for my Zepbound and people on Medicaid and Medical are getting it for free. I’m completely disgusted.
Paula
June 18, 2026 at 5:09 amI was on Zepbound for one year. Tricare paid for. I then turned 65 yrs old and that is the age I had to switch to Tricare for life, with Medicare A and B which now TFL doesn’t cover my Zepbound anymore. Studied up somewhat on the new bridge program for TFL enrollees..
Questions… I’m gaining weight since off shot for a few months but I’m not high body mass now like begining of taking shots Will I be approve for my weight maintenance because Zepbound wasn’t approved in those months span?
Also…. Am I reading the right info that TFL Medicare part D must have Body mass % and also other health issues to be paid for ? The tricare alone (not TFL) paid for my Zepbound for weight loss only. Should be the same approval with either tricare or TFL or TFL w med D
Also… is it actually Medicare part D I need to enroll in or some other new special “Medicare Bridge” program im missing?
Thank you!
Medicare Rights Center
June 18, 2026 at 10:17 amWe highly encourage you to call our free, national helpline at 800-333-4114 to discuss your coverage options in a more private way, or to contact your local State Health Insurance Assistance Program (SHIP) whose number can be found at http://www.shiphelp.org.
Some general answers–which may or may not apply to your specific circumstance:
The BMI at the start of the GLP-1 therapy is the BMI they go off of (just make sure to have your doctor verify this). If your BMI at the start of the therapy is below a certain threshold and you are not experiencing other risks or conditions, it may not be enough on its own to be eligible for the Bridge Program.
The Medicare Bridge Program does not require you to enroll or opt in separately from Medicare Part D. That said, if you have TFL but not Medicare Part D, you may not have access to the program. Again, we encourage you to call our helpline to discuss your coverage options.
Sources: “Does a beneficiary need to meet the Medicare GLP-1 Bridge clinical criteria at the time of the prior authorization request, or at the time they first initiated GLP-1 therapy?” “What do beneficiaries need to do now if interested in the Medicare GLP-1 Bridge?” and “Are TRICARE For Life beneficiaries eligible to receive GLP-1 drugs furnished via the Medicare GLP-1 Bridge?” on https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-medicare-beneficiaries
Richard Weil
June 21, 2026 at 9:45 amIt would be interesting to know why the delay. Why wasn’t this addressesd in the article? Why will it take 18 more months to start BALANCE. It wouldn’t have anything to do with our current government, would it? Sadly, Medicare beneficiaries, some percent on fixed incomes, who worked all their lives and paid their taxes, and may desperately need these drugs, must wait, and suffer. We don’t do elder care humanely in this country.
Susan Kline
June 22, 2026 at 3:17 pmWhere does one find an on line provider that will work with this and also doesn’t charge a monthly fee or dues would be great too?. I quit smoking gained weight, I broke my left foot and had a total knee replacement gained more weight and have copd and it is so hard for to get off the weight I have gained my doctor doesn’t listen to me. I printed everything out and he refused to hear me out.
Medicare Rights Center
June 22, 2026 at 5:17 pmHi there–we encourage you to keep your health and insurance coverage information private online. You can turn to resources such as Medicare.gov (if you have Original Medicare) or to your plan’s provider directory (if you have a Medicare Advantage plan) to find doctors.
Medicare Rights Center
June 26, 2026 at 10:55 amPlease refrain from sharing personal health information in the comments. For questions about your personal medical eligibility for the GLP-1 Bridge Program for weight loss, discuss with your doctor. For questions about medically qualifying diagnoses to access these drugs for purposes other than weight loss, discuss with your doctor. Your insurance my have different criteria for how to access these drugs for non-weight loss purposes, in which case you may reach out to your plan.
Bob
June 28, 2026 at 5:10 pmIt seems quite odd to me that the GLP – one program would not cover diabetes patients who could use this as a sugar reduction tool. Diabetes has what I would think is a more significant potential for long-term damage. Is anyone aware whether or not diabetes folks will be eligible?
Medicare Rights Center
June 29, 2026 at 9:58 amThis particular GLP-1 Program is specific to weight-loss indications, because drugs prescribed for weight management generally cannot be covered by Part D plans under federal law. This program was established to test how a category of drugs for weight management becoming available under Medicare might impact beneficiaries and the Medicare program.
GLP-1 drugs will continue to be available for other purposes, such as managing Type 2 diabetes, through Part D plans. If a GLP-1 is prescribed for another eligible medical condition, it will be covered according to the Part D plan’s rules.
See: “Are beneficiaries eligible for the Medicare GLP-1 Bridge if they are prescribed a GLP-1 for a condition other than weight management?” at https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-providers
Addie
July 1, 2026 at 12:13 pmIs there a place we can send “complaints” regarding what could be considered discrimination, unfairness, or inequality? Many of us who have a disqualifying condition (sleep apnea, diabetes etc.) can not afford the Part D copay for GLP-1, so we still can’t obtain it. It sounds like some Tricare for Life members are in the same boat.
Diane
July 3, 2026 at 7:09 pmMy doctor filled out the form for the bridge program for me. Still waiting for pharmacy to approve it. Seems like it is taking along time to get approved. I have called both the doctors office and the pharmacy multiple times. Can’t figure out the delay. So frustrating
Lori Hatten
July 6, 2026 at 8:49 amI meet all requirements for the Bridge Program. Medica has denied me for this and is requiring a 3 month dietary restriction to be approved. Can they do this?
Medicare Rights Center
July 6, 2026 at 4:26 pmWe highly encourage you to call our free, national helpline at 800-333-4114 to discuss your coverage eligibility and options in a more private way, or to contact your local State Health Insurance Assistance Program (SHIP) whose number can be found at http://www.shiphelp.org.
Kristine Rocanella
July 6, 2026 at 11:48 amIf you have the word diabetes anywhere on your chart, (even if not diagnosed with it) you are not eligible. That’s what i was told by my doctor’s office today. So, they weaved in something so you can’t get it. So like the government to keep me from getting healthy
Julie
July 8, 2026 at 9:36 amI had an appointment with my endocrinologist on June 30. July 1, she filled out the GLP-1 Bridge forms. July 2, got a text from CVS saying my Rx was ready with a copay of $50. Did my first injection on July 6. I’m so excited to get started on this!