Medicare GLP-1 Bridge Program

Medicare has launched a new program to help eligible patients access FDA-approved weight loss GLP-1 medications at a significantly reduced cost. The Medicare GLP-1 Bridge Program runs from July 1, 2026 through December 31, 2027 and offers eligible Medicare Part D beneficiaries access to covered medications for a flat $50 per month copay.

The medications covered under this program are Wegovy (semaglutide), Zepbound (tirzepatide, KwikPen only), and Foundayo (semaglutide). Ozempic and Mounjaro are not covered under the Bridge Program, as their approved indications for Type 2 diabetes are processed through standard Medicare Part D instead.

Who is eligible?

To qualify, you must be enrolled in an eligible Medicare Part D plan and meet clinical criteria. Eligible plan types include standalone Medicare Part D Prescription Drug Plans, Medicare Advantage plans with drug coverage, Special Needs Plans, the LI NET program, and employer or union group waiver plans. Patients enrolled in PACE, private fee-for-service, or religious fraternal benefit plans are not eligible unless they are also enrolled in a standalone Part D plan.

Clinically, you must be 18 or older and have a prescription for weight loss or obesity paired with a structured nutrition and physical activity plan. Eligibility is determined based on your BMI and qualifying condition at the time GLP-1 therapy was initiated — not today. If you started therapy in the past and have since lost weight, you may still qualify based on your historical BMI.

If you are taking a GLP-1 for a condition such as diabetes, sleep apnea, or cardiovascular disease, you may not be eligible for the Bridge for that indication. Coverage in those cases would continue through your standard Part D plan.

How much does it cost?

The copay is $50 flat for a 30-day supply, regardless of dose or how long you have been on the medication. This $50 does not count toward your Part D deductible or annual out-of-pocket maximum. If you currently receive the Low-Income Subsidy (Extra Help), please note that this benefit does not apply to Bridge claims — you will pay $50 under this program rather than your usual reduced copay. Coupons and manufacturer discount programs cannot be applied to Bridge claims.

How the program works

The Bridge Program operates separately from your standard Medicare Part D benefit. Prior authorization requests, pharmacy claims, and coverage decisions are handled through the Bridge Program's designated pathway rather than through your regular Medicare Part D plan. Your pharmacy will need to use Bridge-specific billing information, not your regular Medicare card. If you do not have your Medicare card on hand, your pharmacy can look up your information using the last four digits of your Social Security number.

How your Advocate can help

Your Advocate is here to support you through every step of this process. They can help verify your eligibility, coordinate with your physician, track your prior authorization, and work through any issues that come up at the pharmacy. If you are not sure whether you qualify, your Advocate is the best place to start.

If you are not eligible for the Bridge Program, there may still be options available to you. Your Advocate can help explore alternative coverage pathways and financial assistance programs.

If you have questions or would like to learn more, please reach out to our support team and we will be happy to help.