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By The RX Index Editorial TeamLast verified: May 28, 2026Sources: CMS, KFF, AHA, FDA — re-checked monthly

CMS BALANCE Model Foundayo: Who Really Gets $50 a Month (2026)

Disclosure: Some links on this page are affiliate links. If you purchase through these links, we may earn a commission at no extra cost to you.

Bottom line before you scroll

If you have Medicare: Foundayo’s $50-a-month path is the Medicare GLP-1 Bridge — a temporary federal program running July 1, 2026 through December 31, 2027. It is not the BALANCE Model’s Medicare Part D plan. CMS delayed that part, and it is not launching in 2027.

If you have Medicaid: Foundayo can be covered under the BALANCE Model, but only in states that choose to join. Your answer depends entirely on your state.

If you searched CMS BALANCE Model Foundayo, you probably heard the same headline everyone did: the new weight-loss pill might cost about $50 a month through Medicare. The price is real. The catch is that many people are watching the wrong program to get it — and end up waiting on coverage that was never coming.

The RX Index is a pricing intelligence and comparison resource for GLP-1 telehealth providers. This page may contain affiliate links, and we may earn a commission if you choose certain providers — at no cost to you. The coverage rules, eligibility criteria, and prices below are checked against primary sources (linked throughout and listed at the bottom). This is general information, not medical advice.

Check my Foundayo coverage path →

Free 60-second quiz. No sign-up \u2014 we\u2019ll point you to your exact route.

Your Foundayo coverage routes at a glance

Find your coverage type on the left and read across. No other page puts all six routes side by side with the real prices.

Your coverage	Covers Foundayo?	When	What you’d likely pay	What to check
Medicare GLP-1 Bridge	Yes, if you qualify	July 1, 2026 – Dec 31, 2027	$50/month	Plan type, prior-auth form, your BMI/diagnosis tier
BALANCE Model — Medicare Part D	Not the live route	Delayed; not 2027	N/A in 2027	Don’t wait on this — use the Bridge
BALANCE Model — Medicaid	Maybe \u2014 state by state	Rolling, as early as May 2026	State-set; usually $0 or small copay if covered	Whether your state joined; state drug list; managed-care rules
Regular Medicare Part D	Usually not for weight loss	Now	Plan-dependent	Your diagnosis and your plan’s formulary
Commercial (private) insurance	Varies by plan	Now	As low as $25/month	Formulary, prior auth, savings-card terms
Self-pay / cash	Yes, with a prescription	Now	$149–$349/month by dose	Your dose and where you fill it

Sources: CMS Medicare GLP-1 Bridge; CMS BALANCE Model; Eli Lilly. Last verified May 28, 2026.

CMS BALANCE Model Foundayo: does it cover Medicare or Medicaid?

Foundayo is on CMS’s covered list, but the program you actually use depends on your insurance. For people on Medicaid, Foundayo can be covered under the BALANCE Model in states that join. For people on Medicare, the program that delivers the $50 price is the separate Medicare GLP-1 Bridge — not the BALANCE Model’s Medicare Part D plan, which CMS delayed.

Here’s the part nobody explains clearly. “BALANCE Model” and “Medicare GLP-1 Bridge” are two different programs, and the news tangled them together.

BALANCE Model

CMS’s bigger, longer-term plan to lower GLP-1 costs. Has a Medicaid side (rolling out now) and a Medicare side (delayed — not 2027).

Medicare GLP-1 Bridge

Shorter, temporary program. Gives eligible Medicare members Foundayo for $50/month starting July 1, 2026. This is the live route for Medicare.

CMS named the Bridge a “bridge” because it was meant to carry Medicare members until the BALANCE Model’s Medicare plan kicked in. Then that Medicare plan got delayed — so the Bridge is the whole show for Medicare through the end of 2027.

⚠️ The honest catch — and why it’s not bad news

The CMS BALANCE Model will not be your $50 Foundayo route if you’re on Medicare in 2027. On April 21, 2026, CMS delayed the Medicare Part D part of BALANCE, “pending further evaluation and data collection.” It is not launching in 2027.

The good news: you still get the $50 price. CMS extended the Medicare GLP-1 Bridge through December 31, 2027, so eligible members pay the same $50 a month. You just have to ask for the Bridge by name — not BALANCE.

Full background: Why the CMS BALANCE Model was delayed →

Find my Foundayo route →

Medicare, Medicaid, or private \u2014 get your answer before you call your doctor.

BALANCE Model vs. the Medicare GLP-1 Bridge: what’s the difference?

The Medicare GLP-1 Bridge gives eligible Medicare members Foundayo for $50 a month from July 1, 2026 through December 31, 2027. The BALANCE Model is a separate, longer program that covers Foundayo for Medicaid in participating states, and was meant for Medicare Part D in 2027 — but that Medicare piece was delayed. For a Medicare member today, the Bridge is the program that matters.

	Medicare GLP-1 Bridge	BALANCE Model
What it is	A short, temporary federal program	A bigger, longer-term CMS program
Status	Live July 1, 2026 → Dec 31, 2027	Medicaid: rolling out from May 2026. Medicare Part D: delayed — not 2027
Who it’s for	Medicare Part D members (including most Medicare Advantage drug plans)	Medicaid members in states that join; (later) Medicare Part D
Your cost for Foundayo	$50/month	State-set for Medicaid; not yet set for any future Medicare version
Covers Foundayo?	Yes \u2014 all forms	Yes for Medicaid in participating states
Other drugs covered	Foundayo, Wegovy, Zepbound KwikPen	Adds Mounjaro, Ozempic, and Rybelsus too
Who runs it	CMS, through Humana	State Medicaid programs now; future Medicare version not set

For the full breakdown across every GLP-1 — not just Foundayo: CMS BALANCE Model GLP-1 guide →

What happens after December 31, 2027?

Honestly? It’s not settled yet. The Bridge is temporary. CMS may bring the BALANCE Model to Medicare later, but it hasn’t locked in how people will keep their Foundayo coverage once the Bridge ends. We’re watching this closely and will update this page the moment CMS says more. For now, the smart move is to use the $50 Bridge while it’s here.

Do you qualify for $50 Foundayo? (Medicare GLP-1 Bridge rules)

To get Foundayo for $50 a month through the Bridge, you need a Medicare Part D plan, a prescription for weight management, an approved prior-authorization form from your doctor, and you must meet one of three BMI-and-condition rules set by CMS. The simplest: a BMI of 35 or higher qualifies on its own.

Think of it as four gates. You need all four.

The right plan.

You’re in a Medicare Part D drug plan — either a standalone drug plan (PDP) or a Medicare Advantage plan that includes drugs (MA-PD).

The right reason.

Foundayo is prescribed to help you lose weight and keep it off, alongside healthier eating and more activity.

The right numbers.

Your BMI and health history fit one of the three routes below.

The paperwork.

Your doctor sends the prior-authorization form to CMS’s processor — not to your plan. (More on that below.)

The three ways to qualify (CMS clinical rules)

BMI is body mass index — a number that compares your weight to your height. You only need to meet one route.

Route	Age	BMI	Plus one of these conditions
1	18+	BMI 35 or higher	None needed — BMI alone qualifies
2	18+	BMI 30 or higher	Heart failure with preserved ejection fraction · uncontrolled high blood pressure (top number over 140 or bottom number over 90, even while taking two blood-pressure medicines) · chronic kidney disease, stage 3a or worse
3	18+	BMI 27 or higher	Prediabetes · a past heart attack · a past stroke · symptomatic peripheral artery disease (poor blood flow in the legs that causes symptoms)

One detail that trips people up: CMS looks at your BMI when you started GLP-1 treatment, not your BMI today. So if you began a GLP-1 a year ago at a BMI of 37 and you’re now down to 33, your doctor can confirm you met the BMI-35 rule at the start. That counts — even if you started before July 1, 2026, or before you had Part D.

Which Medicare plans count?

Most do. CMS includes standalone Part D drug plans and Medicare Advantage drug plans (HMOs, PPOs), plus Special Needs Plans, employer/union group plans, and the Limited Income program. People who are dually eligible (on both Medicare and Medicaid) can use it too, as long as they’re in an eligible plan and meet the rules. A few plan types are left out — like PACE programs and certain cost plans — unless you also carry a standalone drug plan.

Looks like you might qualify? Don’t waste the first doctor visit on coverage confusion. We’ll build your personalized action plan, including what to bring to your appointment.

See full Bridge eligibility guide →

How much will Foundayo cost — and what does the $50 really cover?

Through the Medicare GLP-1 Bridge, eligible members pay a flat $50 a month for Foundayo, no matter the dose, from July 1, 2026 through December 31, 2027. Behind the scenes, the drugmaker agreed to a net price of $245 a month, but you only pay the $50 copay. Outside the Bridge, Foundayo costs as little as $25 a month with private insurance, or $149–$349 a month paying cash.

$50/mo

Medicare Bridge

Flat, dose-independent. July 2026–Dec 2027.

~$25/mo

Commercial + savings card

With the Foundayo Savings Card and insurance that covers it.

$149–$349/mo

Cash / self-pay

Varies by dose. No insurance required.

Two things people get wrong:

⚠Extra Help won’t lower it. The Low-Income Subsidy program does not apply to the $50 Bridge copay. Your $50 is $50.

⚠It won’t count toward your out-of-pocket cap. Because the Bridge sits outside your normal Part D benefit, the $50 you pay each month does not count toward your yearly Part D out-of-pocket limit.

Deep dive on costs: Medicare GLP-1 Bridge $50 copay guide → · True out-of-pocket costs on the Bridge →

Foundayo self-pay prices, dose by dose

If you’re paying cash — through LillyDirect (sponsored affiliate link, opens in a new tab) (Eli Lilly’s direct pharmacy) or a telehealth provider — here’s what Lilly publishes by dose.

Foundayo dose	Cash price per month
0.8 mg (starting dose)	$149
2.5 mg	$199
5.5 mg	$299
9 mg	$299
14.5 mg	$349 ($299 if you refill within 45 days)
17.2 mg	$349 ($299 if you refill within 45 days)

Source: Eli Lilly / Foundayo. A retail pharmacy with no program applied can charge more. Verify before relying on these prices.

Which Foundayo price actually applies to you?

Your situation	Your likely Foundayo price	Why
Medicare + you qualify for the Bridge	$50/month	Bridge copay (July 2026 – Dec 2027)
Medicaid in a participating state	$0 or a small copay	State Medicaid cost-sharing, if covered
Commercial insurance + savings card	As low as $25/month	Foundayo Savings Card (commercial plans only)
Commercial insurance that doesn’t cover it	Lilly cash-offer pricing	Self-pay offer applies
No insurance / paying cash	$149–$349/month by dose	LillyDirect or telehealth self-pay
Any government program (Medicare, Medicaid, VA, TRICARE)	Savings card not allowed	Use the Bridge (Medicare) or your state (Medicaid) instead

Compare my Foundayo price path →

We\u2019ll line up your options in plain numbers.

What to do before July 1, 2026 (so you’re ready on day one)

You can’t sign yourself up for the Bridge, and you can’t use a coupon — your doctor has to submit the prescription and the prior-authorization form to CMS’s processor. The best thing you can do now is gather the information your doctor and pharmacy will need. Coming prepared can save you weeks.

Your Foundayo Bridge prep card

1Confirm your plan type. Look at your plan card or member site. You want a Part D drug plan, or a Medicare Advantage plan with drug coverage.
2Find your starting BMI. CMS uses your BMI when you began GLP-1 treatment. If you’ve been on a GLP-1 before, your records from back then matter.
3Document any qualifying condition. Heart failure, hard-to-control high blood pressure, kidney disease (stage 3a+), prediabetes, a past heart attack or stroke, or symptomatic poor leg circulation.
4Ask your prescriber which Bridge drug fits you medically. Foundayo is one option. Wegovy and the Zepbound KwikPen are also covered. The choice should be about your health.
5Hand your pharmacy the Bridge details once it’s live. CMS is running the Bridge through Humana as the processor, with a specific billing setup (BIN 028918, PCN MEDDGLP1BR). Claims are electronic only — paper claims and direct member reimbursements won’t be accepted.

For your pharmacist: the six FDA Foundayo product codes (NDCs) on the Bridge drug list are 0002-4178-31 (0.8 mg), 0002-4503-31 (2.5 mg), 0002-4794-31 (5.5 mg), 0002-4803-31 (9 mg), 0002-4839-31 (14.5 mg), and 0002-4953-31 (17.2 mg). Ask the pharmacy to confirm the current CMS payer sheet before they bill.

Does Medicaid cover Foundayo through the BALANCE Model?

Maybe — it depends on your state. Foundayo is on the BALANCE Model’s covered list, and states can join the program on their own timeline, as early as May 1, 2026 through January 1, 2027. If your state joins and you meet the rules, Foundayo can be covered through Medicaid. If your state doesn’t join, the BALANCE Model won’t help you.

This is the big difference from Medicare. The Medicare GLP-1 Bridge is national — same program in every state. Medicaid BALANCE is a state-by-state choice.

A few things to check in your state:

✓Did your state join the BALANCE Model? States can start anytime between May 1, 2026 and January 1, 2027, and applications are due to CMS by July 31, 2026.

✓Is Foundayo on your state’s drug list? Even in a participating state, coverage runs through your state’s preferred drug list and rules.

✓Does your managed-care plan follow the same list? Many Medicaid members are in private managed-care plans that handle their own coverage.

✓What are the prior-authorization and step-therapy rules? Step therapy means being asked to try a lower-cost drug first.

One bonus for Medicaid members: the BALANCE Model covers a wider list of GLP-1s than the Bridge does — it adds Mounjaro, Ozempic, and Rybelsus on top of Foundayo, Wegovy, and the Zepbound KwikPen. So if Foundayo isn’t the right fit, there may be other covered options.

📍 State tracker — checked May 28, 2026

CMS has not yet published a final list of which states are joining the BALANCE Model. States have until July 31, 2026 to apply, and can launch any time between May 1, 2026 and January 1, 2027. Until your state confirms, call your state Medicaid office or check its preferred drug list to see whether Foundayo is covered. We update this section as states announce.

Check my Medicaid Foundayo route →

Medicaid rules change by state and by plan. Get your route first.

Can you use the Foundayo Savings Card with Medicare or Medicaid?

No. Manufacturer savings cards are for people with commercial (private) insurance, not for anyone on a government program like Medicare, Medicaid, TRICARE, or VA coverage. Eli Lilly’s Foundayo savings terms specifically exclude government-funded prescription programs. For Medicare members, the $50 Bridge is your low-cost route — not the savings card.

This matters because the “as low as $25” line is everywhere, and it’s easy to assume it’s yours. For most government-program members, it isn’t.

Who the $25 price is for:

People with commercial insurance that covers Foundayo. With the Foundayo Savings Card, eligible commercially insured patients can pay as little as $25 a month. The fine print: the card allows up to 10 fills a year, and it expires December 31, 2026. It can’t be stacked on top of the $50 Bridge — CMS doesn’t allow coupons or discount cards on Bridge claims.

Foundayo, Wegovy, or Zepbound under the Bridge — which should you ask about?

The Bridge covers three weight-management drugs: Foundayo, all forms of Wegovy, and the Zepbound KwikPen (not Zepbound vials or single-dose pens). They’re not interchangeable — the right one depends on your health history, your preference for a pill versus a shot, and your doctor’s judgment. Foundayo and the Wegovy tablet are both pills; Foundayo is the easier one to take, with no food, water, or timing rules.

Drug	Form covered by the Bridge	Pill or shot	How often	How you take it
Foundayo (orforglipron)	Tablet (all forms)	Pill	Once a day	Any time of day, with or without food
Wegovy (semaglutide)	Injection and tablet	Shot or pill	Weekly shot / daily tablet	Tablet: empty stomach, plain water only, then wait 30 min before food, drink, or other pills
Zepbound (tirzepatide)	KwikPen only (not vials or single-dose pens)	Shot	Weekly	Prefilled injection pen

Why a shot might still win: in clinical trials, the most effective injectable GLP-1s have generally produced greater average weight loss than the oral options. If maximum weight loss is your top priority, ask your clinician to compare the choices for your situation — this page is a coverage guide, not a head-to-head efficacy ranking.

What if you don’t qualify — or can’t wait until July?

If the Bridge rules don’t fit you, your state Medicaid hasn’t joined, or you simply don’t want to wait until July 1, 2026, you still have fast, legitimate ways to get FDA-approved Foundayo today. Your best path depends on your insurance: commercial insurance plus the savings card ($25), cash through LillyDirect ($149–$349), or a telehealth provider that prescribes Foundayo and checks your private coverage for you.

If you have commercial (private) insurance:

Check whether your plan covers Foundayo. If it does, the savings card can bring you to as low as $25 a month. If it doesn’t, ask your doctor about a coverage exception or appeal — and in the meantime, cash pricing is a predictable stopgap.

If you’re paying cash:

LillyDirect ships Foundayo to your door, and telehealth providers can get you a visit and a prescription quickly. Expect $149–$349 a month depending on your dose, plus any visit or membership fee.

If you want to start now and switch later:

This is a real strategy. You can begin Foundayo through cash or telehealth now, then move to the $50 Bridge once it opens on July 1, 2026 — if you’ll qualify. You don’t have to sit and wait.

For fast online access: Ro Body (sponsored affiliate link, opens in a new tab)

Ro carries FDA-approved Foundayo directly. Ro Body (sponsored affiliate link, opens in a new tab) lists Foundayo cash pricing at $149–$299/month with the manufacturer offer (the 14.5 mg and 17.2 mg doses can run $349 if you miss the 45-day refill window), and the membership fee is separate from the medication — $39 for the first month, then as low as $74/month on an annual plan paid up front (otherwise $149/month). Ro also runs your insurance for free with its coverage checker and handles the prior-authorization paperwork.

Important: Ro works with private insurance and cash pay — it can’t coordinate GLP-1 coverage through government programs like Medicare or Medicaid. If you qualify for $50 Foundayo on the Bridge, that’s almost always your cheapest route.

See if I’m eligible for Foundayo on Ro →Compare on Sesame →

Affiliate links. Commission at no extra cost to you. Not for Medicare/Medicaid/VA/TRICARE members seeking government coverage.

Cash-pay price comparison: GLP-1 cost without insurance →

Foundayo safety: the warnings worth knowing before you ask

Foundayo (orforglipron) is FDA-approved for adults with obesity, or overweight with at least one weight-related health condition, used with a reduced-calorie diet and more activity. Like other GLP-1 medicines, it most often causes stomach-related side effects, and it carries a boxed warning about a possible thyroid tumor risk — though, notably, orforglipron did not cause those tumors in animal studies. This is a plain-English starting point, not the full label — always go over it with your doctor.

The boxed warning, explained honestly.

A boxed warning is the FDA’s strongest caution. For injectable GLP-1s, it comes from animal studies where the drugs caused thyroid C-cell tumors in rats. Foundayo’s label includes a similar warning — but with an important difference: orforglipron is not active in rats and mice and did not produce tumors in those animals. The FDA says the human relevance “has not been determined.” In plain terms: the warning is there as a class precaution, but Foundayo itself did not cause those tumors in animal testing.

Who should not take Foundayo (contraindications).

People with a personal or family history of medullary thyroid carcinoma (MTC), people with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), or anyone who’s had a serious allergic reaction to orforglipron or any ingredient in Foundayo.

Serious risks to know.

Pancreatitis (severe belly pain that won’t go away) · Severe stomach problems (nausea, vomiting, diarrhea, constipation) · Dehydration and kidney injury from severe vomiting · Gallbladder problems · Low blood sugar (especially with insulin or sulfonylureas) · Vision changes in people with diabetic eye disease · Serious allergic reactions · Tell any anesthesia team you take Foundayo.

What’s common.

The most frequent side effects are digestive — nausea (up to about 1 in 3 people at higher doses), constipation, diarrhea, vomiting, indigestion, and belly pain — and they tend to ease over time. Some people notice headache, fatigue, a small bump in heart rate, or hair loss tied to weight loss.

Pregnancy and birth control.

Foundayo may harm a developing baby — don’t use it in pregnancy. Because Foundayo slows digestion, it can make oral birth control pills less effective. The label advises switching to a non-pill method, or adding a barrier method (like condoms), for 30 days after you start and for 30 days after each dose increase.

Other medicines.

Tell your prescriber about everything you take. Key interactions: simvastatin (don’t go above 20 mg/day with Foundayo), certain drugs that change how your liver processes medicines (CYP3A4 inhibitors and inducers), and — again — insulin or sulfonylureas. Don’t take Foundayo with another GLP-1 medicine.

Taking it: Foundayo is one pill a day. Swallow it whole — don’t crush or chew it — with or without food. It starts at 0.8 mg and steps up over time, at least 30 days per step, to a maximum of 17.2 mg. This isn’t the full label. Read the official prescribing information and talk with your clinician before you start.

The mistakes that get people denied, delayed, or sent in circles

Most Foundayo delays don’t come from the drug — they come from asking about the wrong program. Here are the six mix-ups we see most.

Waiting for BALANCE to cover you on Medicare in 2027. It’s delayed. Your live route is the Bridge, July 2026 through December 2027.

Assuming Medicaid BALANCE works in every state. It’s a state choice. Check whether your state joined.

Thinking a BMI of 27 qualifies by itself. It doesn’t. A BMI of 27–29 needs one of the listed health conditions too. (A BMI of 35+ qualifies alone.)

Expecting Extra Help to lower the $50. CMS says the low-income subsidy doesn’t apply to the Bridge copay. It’s a flat $50.

Trying to use a coupon with Medicare. Government programs are excluded from the savings card, and CMS doesn’t allow coupons on Bridge claims. The $50 is your discount.

Assuming the pharmacy will know the Bridge on day one. It’s brand new. Bring the processor details (Humana; BIN 028918, PCN MEDDGLP1BR), and ask the pharmacy to confirm the latest CMS payer sheet.

What we verified — and what changed

The biggest thing to get right: for Medicare, Foundayo’s $50 route is the Medicare GLP-1 Bridge through December 31, 2027 — not a January 2027 BALANCE Part D launch. We re-checked every number on this page against primary sources, and we date-stamp it so you know how fresh it is.

What we checked	Source	Last verified
Bridge covers Foundayo; runs Jul 1, 2026 – Dec 31, 2027	CMS Medicare GLP-1 Bridge FAQ	May 28, 2026
Bridge copay is $50; $245 net price; doesn’t count toward out-of-pocket cap; Extra Help doesn’t lower it	CMS Medicare GLP-1 Bridge FAQ	May 28, 2026
BALANCE Medicare Part D delayed (not 2027)	CMS; reported by AHA and KFF (Apr 21–22, 2026)	May 28, 2026
BALANCE Medicaid is state-by-state, May 2026 – Jan 1, 2027; state list not yet published	CMS BALANCE Model page; KFF	May 28, 2026
Foundayo FDA indication, boxed warning, contraindications, side effects, interactions	FDA prescribing information (label)	May 28, 2026
Foundayo cash pricing ($149–$349 by dose); savings card ($25; excludes government programs)	Eli Lilly / Foundayo	May 28, 2026
Ro Foundayo cash pricing; medication separate from membership; can’t coordinate government-insurance coverage	Ro Foundayo cost page + Lilly terms	May 28, 2026

What changed from older pages: If you’ve seen guidance saying “BALANCE Part D starts January 1, 2027,” that’s now outdated. CMS shifted course in April 2026. The current Medicare answer is the Bridge, through the end of 2027.

Last verified: May 28, 2026. We re-check this page monthly and immediately if CMS changes the Bridge, the drug list, the copay, or the BALANCE status.

Frequently asked questions about the CMS BALANCE Model and Foundayo

Does the CMS BALANCE Model cover Foundayo?

Yes, Foundayo is included in CMS’s GLP-1 coverage programs. For Medicaid members, it can be covered under the BALANCE Model in states that join, starting as early as May 2026. For Medicare members, the program that delivers Foundayo at $50 a month is the separate Medicare GLP-1 Bridge, beginning July 1, 2026 — not the BALANCE Model’s Medicare Part D plan, which CMS delayed.

When can Medicare members get Foundayo for $50?

Starting July 1, 2026. The Medicare GLP-1 Bridge runs from July 1, 2026 through December 31, 2027 and sets a flat $50 monthly copay for covered drugs, including Foundayo, for members who qualify.

Is Foundayo the only oral GLP-1 in the Medicare Bridge?

No. Foundayo and the Wegovy tablet are both once-daily pills covered under the Bridge. Foundayo’s practical advantage is simpler dosing — you can take it any time of day, with or without food — while the Wegovy tablet must be taken on an empty stomach with plain water, followed by a 30-minute wait before food, drink, or other medicines.

Does regular Medicare Part D cover Foundayo for weight loss?

Generally no. By long-standing federal rule, Part D plans haven’t covered drugs used only for weight loss. The Bridge is the special, temporary route that lets eligible members get Foundayo for weight management at $50 a month.

Does Medicare Advantage qualify for the Bridge?

Often yes. Medicare Advantage plans that include drug coverage (MA-PD) are generally eligible, along with standalone Part D plans. A few plan types are excluded unless you also have standalone drug coverage, so check what kind of plan you have.

Will Extra Help lower the $50 Bridge copay?

No. CMS says the low-income subsidy (Extra Help) does not reduce the Bridge copay. It stays at a flat $50 a month.

Does the $50 count toward my Part D out-of-pocket cap?

No. Because the Bridge sits outside your normal Part D benefit, the $50 you pay each month does not count toward your yearly Part D out-of-pocket limit.

Can I use a Foundayo coupon or savings card with Medicare?

No. Eli Lilly’s savings card excludes government programs like Medicare and Medicaid, and CMS doesn’t allow coupons or discount cards on Bridge claims. For Medicare members, the $50 Bridge price is the discount.

Does Medicaid cover Foundayo?

It depends on your state. Foundayo is on the BALANCE Model’s covered list, but states choose whether and when to join (as early as May 2026). Coverage also depends on your state’s drug list and rules.

What happens after December 31, 2027?

That’s not settled yet. The Bridge is temporary, and CMS hasn’t finalized how members will keep Foundayo coverage once it ends. The BALANCE Model may come to Medicare later, but it’s not confirmed. We’ll update this page as CMS shares more.

Does the Bridge cover compounded GLP-1s?

No. The Bridge covers specific FDA-approved, brand-name products — Foundayo, Wegovy, and the Zepbound KwikPen. It does not cover compounded versions of these drugs.

Still not sure which path is right for you?

Medicare, Medicaid, private insurance, and cash all play by different rules, and the wrong door costs you time. Take our free 60-second quiz to nail down your route first.

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By The RX Index Editorial Team — a pricing intelligence and comparison resource for GLP-1 telehealth providers. Published May 28, 2026. Last verified: May 28, 2026. This article is for general information and is not medical advice. Coverage, eligibility, and prices depend on your plan, your diagnosis, your prescriber, and your pharmacy, and can change — talk with a licensed clinician and confirm current details with your plan before making decisions. Some links are affiliate links — we may earn a commission at no extra cost to you.