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By The RX Index Editorial TeamLast verified: May 28, 2026Next check: June 15, 2026Editorial Standards

Does Medicare GLP-1 Bridge Cover Wegovy Pill?

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Does the Medicare GLP-1 Bridge cover the Wegovy pill? Yes. Starting July 1, 2026, people with the right kind of Medicare drug coverage can get the Wegovy pill — and the Wegovy shot — for a flat $50 a month through a new program called the Medicare GLP-1 Bridge. It runs through December 31, 2027.

But “yes” comes with a handful of rules that trip people up. One of them decides whether you walk out of the pharmacy paying $50 or get turned away at the counter. We dug through the official CMS rules so you don’t have to.

The 10-second version

Covered?Yes — Wegovy pill and shot

Cost?$50/month if you qualify

When?July 1, 2026 – Dec 31, 2027

Catch?Eligible drug plan + medical rules + prior authorization required

This is not your normal Part D coverage — it’s a separate program. Informational only — not medical or insurance advice.

The fastest way to know your path: the Wegovy Pill Medicare Decision Matrix

Find your own situation in one glance. Every row is based on the official CMS Medicare GLP-1 Bridge rules, verified May 28, 2026.

Your situation	Does the Bridge cover the Wegovy pill?	Why	Your next move
Eligible Medicare drug plan + pill is for weight loss + you meet the medical rules	Yes, likely	CMS lists Wegovy 'injection and tablets' as covered, all formulations starting July 1, 2026	Ask your prescriber to send in the Bridge prior authorization
Original Medicare (Part A and B) but no drug plan	No — not enough	The Bridge requires a Part D drug plan or a Medicare Advantage plan with drug coverage	Look into joining a drug plan, or see the self-pay options below
Both Medicare and Medicaid (dual eligible)	Possibly yes	CMS says dual-eligible members can use the Bridge if they're in an eligible plan type and meet the rules	Confirm your plan type and have your doctor check the medical rules
Your Wegovy is for heart-attack/stroke risk (known heart disease + extra weight)	Usually regular Part D, not Bridge	CMS routes drugs coverable under normal Part D through that path instead	Ask your plan about a regular Part D request or exception
You want Ozempic, Rybelsus, or Mounjaro for diabetes	No — not the Bridge	The Bridge list is Wegovy, Foundayo, and Zepbound KwikPen for weight loss only	Use your normal Part D diabetes coverage
You qualify, but expected the $50 to count toward your yearly drug cap	Covered — but $50 doesn't count	The Bridge runs outside Part D, so the copay doesn't apply to your out-of-pocket max	Budget the $50/month on its own
You were planning to stack a manufacturer coupon on top	No coupon stacking allowed	CMS does not allow coupons or discount cards on Bridge claims	Use the Bridge if you qualify; skip the coupon
You want to fill before July 1, 2026	Not through the Bridge yet	Access starts July 1, 2026	Use the wait to gather your records (listed below)

Source: CMS Medicare GLP-1 Bridge program materials, verified May 28, 2026.

See if you likely qualify in 90 seconds — free, no sign-up →

Free tool. No sign-up. No medical records needed.

Does the Medicare GLP-1 Bridge cover the Wegovy pill?

Yes. CMS lists Wegovy “injection and tablets” as covered drugs under the Medicare GLP-1 Bridge, and states that all formulations of Wegovy will be available to eligible members beginning July 1, 2026. The Wegovy “pill” simply means Wegovy tablets — the once-daily oral form the FDA approved in December 2025. Both the pill and the shot are included, as long as it’s for weight loss and you qualify.

Question	Answer
Does the Bridge cover the Wegovy pill (tablets)?	Yes
Does it also cover the Wegovy shot (injection)?	Yes
Does coverage start today?	No — it starts July 1, 2026
How much will it cost?	$50 a month, if you qualify
Does every Medicare member qualify?	No
Does my drug plan have to opt in?	No — CMS says plans don't have to opt in
Is this the same as my normal Part D coverage?	No — it's a separate program

The part that trips people up

“Medicare covers it” and “my drug plan covers it” are not the same sentence here. The Bridge runs outside your regular Part D drug plan. A different system handles the approval and pays the pharmacy. That’s why your doctor’s office, your pharmacist, and your plan’s customer service line might all describe it a little differently — or not recognize it at all at first. None of that means you don’t qualify. It means you’re using a new lane that not everyone has learned yet.

Who qualifies for the Wegovy pill under the Medicare GLP-1 Bridge?

To qualify, you need two things: the right kind of Medicare drug coverage, and you have to meet one of CMS’s medical pathways (mostly based on your BMI when you started GLP-1 treatment). A doctor confirms it all on a prior authorization form. BMI is a number based on your height and weight that doctors use to measure body size.

There are two gates. You have to clear both.

Gate 1 — your plan type

Your coverage matters more than the word “Medicare.”

Your Medicare drug coverage	Eligible for the Bridge?
Standalone Part D drug plan (PDP)	✅ Yes
Medicare Advantage plan with drug coverage (MA-PD — HMO or PPO with drugs built in)	✅ Yes
Special Needs Plan (SNP)	✅ Yes
Employer or union retiree drug plan (EGWP)	✅ Yes
LI NET (Medicare program for certain low-income members)	✅ Yes
Both Medicare and Medicaid (dual eligible), in an eligible plan	✅ Yes, if you meet the medical rules
Private fee-for-service, cost plans, PACE, and some other special types	❌ No — unless you also have a standalone Part D plan
Original Medicare with no drug plan at all	❌ No

Source: CMS Medicare GLP-1 Bridge program materials, verified May 28, 2026.

Gate 2 — the medical rules (three ways to qualify)

CMS set three pathways. You only need to match one. The key detail most pages get wrong: these are based on your BMI when you first started GLP-1 treatment — not your BMI today.

Pathway	Your BMI when you started	Plus at least one of these
1	35 or higher	Nothing else needed
2	30 or higher	A certain kind of heart failure, high blood pressure that stays high even on two blood-pressure medicines, or moderate-to-worse kidney disease (stage 3a or higher)
3	27 or higher	Prediabetes, a past heart attack, a past stroke, or peripheral artery disease (poor blood flow in the legs) with symptoms

All three require that you’re 18 or older and using the drug for weight loss alongside diet and activity changes, the way the label says. Source: CMS Medicare GLP-1 Bridge program materials, verified May 28, 2026.

“I already lost weight — did I just lose my eligibility?”

No — and this is good news for a lot of you. Because CMS looks at your BMI when you started, the medicine working doesn’t disqualify you. Say you started a GLP-1 in 2024 at a BMI of 37, and now you’re down to 34. You still qualify. Your doctor just writes down that your BMI was 37 at the start. The starting line is what counts, not the finish line.

Want the deeper walk-through? See our full Medicare GLP-1 Bridge eligibility guide →

Find your likely Bridge pathway in 90 seconds →

Get a checklist you can hand your doctor — free, no sign-up.

What does the $50 Wegovy pill copay actually mean?

If you qualify, you’ll pay $50 for a one-month supply. But this $50 doesn’t behave like a normal Part D copay. Because the Bridge runs outside your Part D plan, the $50 does not count toward your yearly out-of-pocket maximum, and “Extra Help” (the low-income subsidy) does not lower it. That’s straight from CMS.

The honest drawback

That $50 a month does not count toward your Part D out-of-pocket cap (sometimes called your TrOOP — the running total that pushes you toward the yearly limit where your other drugs get a lot cheaper). If you take several pricey medicines and were counting on Wegovy to help you hit that cap faster, it won’t. We’d rather tell you that now than have you find out in November.

Why the same rule works in your favor

Because the Bridge sits outside Part D, the price doesn’t swing around with the seasons. No deductible to chew through first. No “donut hole” surprise. It’s a flat $50 in January, a flat $50 in July, a flat $50 every single month you qualify. For a fixed income, that kind of boring, predictable number is a feature, not a bug.

$50 vs. the real-world price tag

To see why qualifying is worth the paperwork:

How you pay	Wegovy pill, per month
Medicare GLP-1 Bridge (if you qualify)	$50
Self-pay, NovoCare Pharmacy — 1.5 mg	$149
Self-pay, NovoCare Pharmacy — 4 mg	$149 through Aug 31, 2026, then $199
Self-pay, NovoCare Pharmacy — 9 mg or 25 mg	$299
Full list price, no help at all	$1,349.02 per package

Sources: CMS; NovoCare/Wegovy.com pricing, verified May 2026. Self-pay prices are separate from the Bridge; NovoCare Pharmacy terms apply.

$50 versus a list price north of $1,300. The paperwork is worth it.

Is Wegovy pill Bridge coverage the same as Part D coverage?

No. The Medicare GLP-1 Bridge is separate from your normal Part D drug benefit. The same Wegovy pill can travel down two different roads depending on why it’s prescribed. Weight loss goes through the Bridge. Heart-risk reduction usually goes through regular Part D.

Door 1 — the Bridge

For weight loss and keeping weight off. $50 a month. Approval is handled by a central processor the program set up — CMS uses Humana (the company that already runs its low-income drug program) to administer it. This is the door this whole page is about.

Door 2 — regular Part D

For uses Medicare already covers. The biggest one: Wegovy to lower the risk of heart attack or stroke in adults who have known heart disease plus extra weight. That’s a separate FDA-approved use, and your plan can cover it the normal way. Diabetes drugs like Ozempic, Rybelsus, and Mounjaro also go through this door.

Why this saves you a headache

If a claim gets denied, the first question isn’t “does Medicare cover Wegovy?” It’s “which door did we try?” Send a weight-loss request through the regular Part D door and it can bounce, even though the Bridge door was wide open. Send a heart-risk request through the Bridge and it may not fit, because that use belongs to Part D. Knowing which door is yours — before your doctor hits submit — is half the battle.

Which Wegovy forms are covered, and what does the pharmacy need?

CMS says all formulations of Wegovy are covered under the Bridge — both the pill (tablets) and the injection. CMS also publishes the exact drug ID numbers and the billing codes pharmacies use.

The Bridge pharmacy execution card (save this)

When the Bridge goes live, pharmacies bill it through a special routing — not your normal plan. Here’s what CMS’s official payer sheet lists:

Medicare GLP-1 Bridge — Pharmacy Execution Card

Plan / Group nameGLP1Bridge

BIN028918

PCNMEDDGLP1BR

Central administratorHumana

Claims routingSS&C Health (all claims routed through RelayHealth)

Pharmacy / provider help desk844-673-0910

Prior authorization numberRequired once issued

Not allowedPaper claims · pay-and-get-reimbursed · manufacturer coupons · compounded drugs

Use only after your Bridge prior authorization is approved, and only for a Bridge-eligible prescription. The BIN and PCN are just ID codes a pharmacy types in to send your claim to the right payer.

The Wegovy drug ID numbers (NDCs)

CMS listed these Wegovy NDCs as Bridge-eligible:

0169-4525-14 · 0169-4505-14 · 0169-4501-14 · 0169-4517-14 · 0169-4524-14 · 0169-4415-31 · 0169-4404-31 · 0169-4409-31 · 0169-4425-31 · 0169-4572-14

One warning, in plain English: don’t treat this list as gospel at the counter. CMS says the list can change during the program. Have your pharmacy confirm the current NDC for your specific product on the day you fill. The pharmacy’s live system is the final word.

Print the Bridge pharmacy card to hand to your pharmacist →

Takes 30 seconds. Saves a lot of confusion at the counter.

What to ask your doctor and pharmacist before July 1

The Bridge isn’t something you sign up for on a website. You get it through your own doctor and pharmacy. Your doctor has to confirm the medicine is right for you, document your starting BMI and any qualifying condition, and submit the Bridge prior authorization for a weight-loss use.

Copy-and-paste message for your doctor

“I’m trying to find out if I qualify for the Medicare GLP-1 Bridge for the Wegovy pill when it starts July 1, 2026. Can we look at my BMI when I started GLP-1 treatment, any qualifying conditions I have, and whether the Wegovy pill is right for me? If I qualify, can your office submit the Bridge prior authorization — not a regular Part D weight-loss request?”

Copy-and-paste message for your pharmacist

“This may be a Medicare GLP-1 Bridge prescription, not a normal Part D claim. Once the prior authorization is approved, can you check whether it should route through the Bridge (Group GLP1Bridge, BIN 028918, PCN MEDDGLP1BR) and confirm the current drug NDC?”

What to have ready

·Your Medicare card and your drug plan (Part D or Medicare Advantage) card
·Your current list of medicines
·Your height and weight, and your BMI when you started GLP-1 treatment (if you've taken one before)
·The date you started, if you're already on a GLP-1
·Your qualifying condition, if you're on Pathway 2 or 3 — for example: recent A1C or glucose labs for prediabetes; your blood-pressure medicines if that's your pathway; kidney labs or stage; or your heart-attack/stroke/artery history

The early weeks after July 1 may be bumpy as offices learn the new lane. Getting your records together before July 1 puts you near the front of the line.

Get a doctor-ready eligibility summary you can print and bring in →

Free. No sign-up. Outputs your pathway + checklist in plain English.

What if Medicare already denied your Wegovy pill?

A denial isn’t always a “no” to the Bridge. If you were denied before July 1, 2026, the Bridge didn’t exist yet, so that denial doesn’t answer the Bridge question. And if your request went down the wrong road, it can be re-submitted the right way.

What happened	The likely problem	What to ask next
Denied before July 1, 2026	The Bridge wasn't live yet	Gather your records now and try again once the program opens
Denied through regular Part D for weight loss	Wrong door — weight loss runs through the Bridge	Ask your prescriber to submit it as a Bridge request instead
Denied for missing medical proof	No starting BMI, qualifying condition, or lifestyle note on file	Have your doctor add the documentation and resubmit
Denied for a heart-risk use	That use belongs in regular Part D, not the Bridge	Ask your plan about a Part D request, exception, or appeal — the Bridge doesn't change those rights

Does the Bridge cover the Wegovy pill on Medicare Advantage?

It can — but it’s the drug coverage that matters, not the words “Medicare Advantage.” CMS includes Medicare Advantage plans that come with prescription drug coverage (MA-PD plans, like most HMOs and PPOs). A Medicare Advantage plan with no drug coverage isn’t enough on its own.

Your coverage	Bridge path
Medicare Advantage with drug coverage (MA-PD)	Likely eligible if you meet the medical rules
Original Medicare + a standalone Part D plan	Likely eligible if you meet the medical rules
Original Medicare only (no drug plan)	Not eligible on its own
Medicare Advantage HMO or PPO without drug coverage	Don’t assume you can just add a standalone Part D plan — for most HMO/PPO plans that isn’t allowed and can drop you from your plan
Medical Savings Account (MSA) plans and some private fee-for-service plans	May be able to pair with a separate Part D drug plan

If your Medicare Advantage plan has no drug benefit, call 1-800-MEDICARE or your plan before changing anything. The rules about what you can pair depend on your exact plan type, and a wrong move can leave you worse off.

Does the Bridge cover the Wegovy pill if you also have Medicaid?

Yes, dual eligibility doesn’t lock you out. CMS says people who have both Medicare and Medicaid can use the Bridge if they’re enrolled in an eligible Part D plan type and meet the prior-authorization rules. Don’t assume your Medicaid coverage controls the answer here — for the Bridge, it’s your Medicare drug plan type and the medical rules that decide it.

Two things not to assume if you’re dual eligible: first, a past regular-Part-D denial doesn’t equal a Bridge denial. Second, manufacturer savings cards still don’t apply. Beyond that, the same path applies: eligible plan + medical rules + prior authorization.

Does the Bridge cover Ozempic, Mounjaro, or compounded GLP-1s?

No. The Bridge list is short and specific: Wegovy (pill and injection), Foundayo, and the Zepbound KwikPen — all for weight loss. Ozempic, Rybelsus, and Mounjaro are diabetes medicines that go through your normal Part D coverage, not the Bridge. Compounded GLP-1s aren’t part of this program at all.

Covered by the Bridge (for weight loss)

✓Wegovy pill and Wegovy injection
✓Foundayo (orforglipron — FDA-approved weight-loss pill)
✓Zepbound KwikPen only (single-dose vials and pens are NOT covered)

Not covered by the Bridge

✗Ozempic, Rybelsus, Mounjaro (use regular Part D for diabetes)
✗Saxenda
✗Compounded semaglutide or tirzepatide

Compounded medications are made by pharmacies outside the standard FDA approval process for finished brand-name drugs. They’re not part of the Medicare GLP-1 Bridge — the program’s own pharmacy rules spell out “compounds not allowed.”

Is the Wegovy pill different from the Wegovy pen for Medicare?

For the Bridge, both the pill and the pen (injection) are covered — so coverage isn’t the deciding factor between them. The real difference is how you take them, and that’s a conversation for you and your doctor. The best form is a medical choice, not a coverage one.

The pill has specific instructions: taken in the morning on an empty stomach with a small sip of water, waiting at least 30 minutes before eating, drinking anything else, or taking other pills. You swallow it whole — no crushing or splitting. The injection is a once-weekly shot on a different schedule. Neither is “better” across the board; it depends on your routine and what your clinician recommends.

A safety note, because this is your health: Wegovy carries serious warnings, including a boxed warning about thyroid tumors. It isn’t right for everyone — for example, people with a personal or family history of medullary thyroid carcinoma or the condition MEN 2. Always read the official Wegovy Prescribing Information and Medication Guide and talk with your own clinician before starting. We’re a coverage and pricing resource, not your doctor.

The biggest catches people miss

Most surprises with the Bridge come down to a handful of things: it starts July 1, you need a drug plan, you need prior authorization, the $50 doesn’t count toward your cap, coupons can’t be stacked, there are no paper claims or cash reimbursements, heart-risk Wegovy may go through regular Part D, and the program is temporary.

It starts July 1, 2026 — not a day sooner.

Before that, the Bridge price isn't available.

You need a Part D or MA-PD drug plan.

Original Medicare alone won't do it.

You need prior authorization.

No form, no $50.

The $50 doesn't count toward your yearly drug cap.

Budget it on its own.

No coupon stacking.

CMS doesn't allow manufacturer coupons or discount cards on Bridge claims. The standard $25 Wegovy savings card excludes people with Medicare or other government coverage — don't build your plan around it.

No pay-now-get-reimbursed shortcut.

CMS says Bridge claims must go through electronically. Paper claims and direct member reimbursements won't be accepted — so don't pay cash expecting the Bridge to pay you back later.

Heart-risk Wegovy may not be a Bridge drug for you.

If it's prescribed to reduce heart attack or stroke risk, that's usually the regular Part D door.

It's temporary.

The Bridge runs through December 31, 2027. What happens after depends on whether a larger program (CMS calls it the BALANCE Model) launches in Medicare — and that's not guaranteed. This is a real, current, government-backed program — not a scam, not a teaser. But it has an expiration date.

What to do next

If you likely qualify, your next step isn’t to buy anything online — it’s to talk to your prescriber about whether the Wegovy pill is right for you and get the Bridge prior authorization moving. If you don’t qualify (or can’t wait until July 1), self-pay is your realistic path.

If you likely qualify

1Ask your prescriber to confirm your BMI when you started treatment.

2Confirm your qualifying condition, if you're on Pathway 2 or 3.

3Ask whether the Wegovy pill is medically right for you.

4Ask the office to submit the Bridge prior authorization.

5After it's approved, make sure the pharmacy routes the claim through the Bridge.

If you don’t have a drug plan

You can’t use the Bridge without Part D or an MA-PD plan. Look into whether you can join one during an enrollment period, or call 1-800-MEDICARE to talk through your options.

If you don’t qualify — or you want to start before July 1

If the Bridge isn’t open to you, or you don’t want to wait, the Wegovy pill is available self-pay for about $149 a month at the lower doses (1.5 mg and 4 mg; the 4 mg deal moves to $199 after Aug 31, 2026, and the 9 mg and 25 mg doses run $299). The most direct route is NovoCare, the manufacturer’s own pharmacy — authentic, FDA-approved Wegovy at those prices, paid out of pocket and separate from the Medicare GLP-1 Bridge. That’s the cleanest self-pay option for the pill specifically.

Want to weigh every angle? See our full Wegovy pill insurance and self-pay options breakdown →

For non-Medicare readers or people outside the Bridge

Affiliate link. Ro is not a Medicare Bridge approval tool — the Bridge always runs through your own doctor and pharmacy.

If you’re not on Medicare and want to see what your commercial insurance might pay, Ro (sponsored affiliate link, opens in a new tab) offers FDA-approved GLP-1 care and a free insurance coverage checker that runs your plan and gives you a personalized report. It’s useful for sorting out commercial coverage — just don’t mistake it for a Medicare Bridge approval.

Check your FDA-approved GLP-1 coverage options →

Free insurance check — not a Bridge tool

What we actually verified

We don’t ask you to take our word for it. Here’s what we checked, where, and when:

✓

Coverage of the Wegovy pill, the $50 copay, dates, eligible drugs and forms, plan types, medical rules, NDCs, BIN/PCN, and the no-paper-claims/no-coupons/compounds-not-allowed rules → Official CMS Medicare GLP-1 Bridge page and pharmacy payer sheet (cms.gov). Verified May 28, 2026.

✓

The $50-doesn't-count-toward-your-cap detail and the program's temporary nature → CMS, plus KFF's policy analysis. Verified May 2026.

✓

Self-pay Wegovy pill pricing ($149 / $199 / $299 by dose) and the list price ($1,349.02/package) → NovoCare and Wegovy.com. Verified May 2026.

✓

The savings-card exclusion for government beneficiaries → NovoCare savings terms. Verified May 2026.

This page is informational and isn’t medical or insurance advice. Your eligibility is ultimately decided by your prescriber’s attestation and CMS — always confirm with your plan, CMS, or 1-800-MEDICARE.

Frequently asked questions

Does Medicare GLP-1 Bridge cover the Wegovy pill?

Yes. CMS lists Wegovy injection and tablets as covered Bridge drugs and says all Wegovy forms are available to eligible members beginning July 1, 2026, for a $50 monthly copay.

Does the Bridge cover both Wegovy tablets and the Wegovy injection?

Yes. CMS includes all formulations of Wegovy — the pill and the shot.

When does Medicare GLP-1 Bridge coverage start and end?

It runs July 1, 2026 through December 31, 2027.

How much will the Wegovy pill cost under the Bridge?

$50 for a one-month supply, if you qualify. The price is flat regardless of your dose or the time of year.

Is the Medicare GLP-1 Bridge available in my state?

Yes. CMS says the Bridge is nationwide and available in all states and territories. You still need eligible Medicare drug coverage, you have to meet the medical rules, and you need prior authorization.

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

No. The Bridge runs outside Part D, so the $50 copay doesn't count toward your out-of-pocket maximum, and Extra Help doesn't lower it.

Can I pay cash and get reimbursed by the Bridge later?

No. CMS says Bridge claims must be processed electronically through the program. Paper claims and direct member reimbursements aren't accepted, so don't pay full price expecting the Bridge to pay you back.

Can I use a Wegovy coupon or the $25 savings card with the Bridge?

No. CMS doesn't allow coupons or discount cards on Bridge claims, and the standard Wegovy savings card excludes people with Medicare or other government coverage.

Does my drug plan have to opt in?

No. CMS says Part D plans don't have to opt in for eligible members to use the Bridge.

Who submits the prior authorization?

A medical provider — your prescriber's office submits the prior authorization request and the prescription for an eligible Bridge drug.

Is Rybelsus or Ozempic covered under the Bridge?

No. The Bridge list is Wegovy (pill and injection), Foundayo, and Zepbound KwikPen for weight loss. Ozempic and Rybelsus go through your normal Part D coverage.

Is Zepbound covered?

Only the Zepbound KwikPen. The single-dose vials and single-dose pens are not covered by the Bridge.

Can a telehealth provider guarantee Bridge approval?

No. No provider can promise approval. The Bridge runs through your own prescriber and pharmacy, and approval depends on your eligibility, your records, and CMS's rules.

Still not sure which GLP-1 program is right for you? If you’re on Medicare, start with a conversation with your prescriber. If you’re not on Medicare, or the Bridge isn’t open to you, compare your FDA-approved options separately so you don’t tangle Medicare rules with commercial insurance or cash-pay prices.

Take the free 60-second GLP-1 matching quiz →

Free. No sign-up.

Related guides

Sources

The RX Index is a pricing intelligence and comparison resource for GLP-1 telehealth providers. We built this page by reading the official CMS Medicare GLP-1 Bridge guidance, its pharmacy payer sheet, and CMS press materials, along with KFF’s policy analysis, the Wegovy prescribing and pricing information, and provider pricing pages directly. Disclosure: The RX Index may earn a commission if you start care through some links on this page, at no extra cost to you. It never changes your price or our verdict. Last verified: May 28, 2026.