Medicare GLP-1 Bridge Tracker: Who Qualifies, Drugs Covered, and the $50 Cost
The Medicare GLP-1 Bridge went live on July 1, 2026. It is a temporary, 18-month federal demonstration — running through December 31, 2027 — that lets eligible Medicare Part D enrollees fill certain GLP-1 weight-loss drugs for a flat $50 a month. It covers three brand families: Wegovy, Zepbound (KwikPen only), and Foundayo. For the first time, Medicare is paying for GLP-1 drugs prescribed specifically for weight loss — something standard Part D is barred by law from covering.
We read every CMS page for the program — the ones for beneficiaries, Part D plans, pharmacies, and providers, plus the prior-authorization form — and cross-checked them against Medicare.gov, the FDA, KFF, and the Congressional Budget Office. Then we pulled the rules, which CMS scatters across a dozen pages, into one dated snapshot. Two numbers anchor the whole thing: CMS lists 22 covered National Drug Codes (NDCs) across the three products, and KFF estimates 3.8 million Medicare Part D enrollees were eligible based on 2023 claims data.
This page is a research reference. It does not determine any individual's eligibility, replace a prescriber's judgment, or guarantee that a prior authorization will be approved. For a personal eligibility question, talk to your prescriber or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), and confirm current details at Medicare.gov.
Medicare GLP-1 Bridge tracker at a glance
Every row below is sourced to CMS or Medicare.gov and reflects the rules as of the “last verified” date above.
| Field | Verified finding |
|---|---|
| Program name | Medicare GLP-1 Bridge (a Section 402 demonstration) |
| Program window | July 1, 2026 → December 31, 2027 (18 months) |
| Structure | Runs outside the normal Part D benefit and payment flow |
| Central processor | Humana, as administrator of the LI NET (Limited Income Newly Eligible Transition) program |
| Beneficiary cost | $50 copay per one-month supply (28 or 30 days) |
| Manufacturer net price | Participating makers supply each monthly fill at a $245 net price |
| Cost accounting | The $50 does not count toward the Part D deductible or out-of-pocket cap; no Extra Help/LIS; no coupons |
| Covered drugs | Foundayo (tablet), Wegovy (injection and tablet), Zepbound (KwikPen only) |
| Covered NDCs | 22 total — 6 Foundayo, 10 Wegovy, 6 Zepbound (CMS states the list may be updated) |
| Who qualifies | Age 18+, using the drug for weight loss, meeting BMI/condition criteria, and not covered for a GLP-1 through Part D |
| Estimated eligible | ~3.8 million Medicare Part D enrollees (KFF analysis of 2023 data) |
| Pharmacy route | Electronic claims to BIN 028918 / PCN MEDDGLP1BR (no paper claims) |
| Prior authorization | Required; submitted electronically via CoverMyMeds (or fax); prescribers only; PA valid through Dec 31, 2027 |
| After Dec 31, 2027 | Uncertain — the successor “BALANCE” model in Part D is delayed indefinitely |
Source: The RX Index analysis of CMS Medicare GLP-1 Bridge materials and Medicare.gov, verified July 1, 2026. CMS states the NDC list may change during the demonstration.
Medicare GLP-1 Bridge: the key statistics
As of July 1, 2026, CMS lists 22 covered NDCs across three Bridge drug families, and KFF estimates 3.8 million Medicare Part D enrollees were eligible based on 2023 claims, encounter, and Part D prescription-event data. The beneficiary cost is $50 a month; the manufacturer net price is $245 per monthly supply. The program runs for 18 months, July 1, 2026 through December 31, 2027.
A note on who owns which number, because it matters for anyone quoting this page: the 22-NDC count is our own aggregation from CMS’s current drug list — a figure you’d otherwise have to build by hand from CMS’s plan and pharmacy pages. The 3.8 million eligibility estimate is KFF’s separate analysis of 2023 data. We did not model it; we are reporting it, attributed.
Which GLP-1 drugs and NDCs does the Bridge cover?
CMS covers three products when they are used for weight reduction and weight maintenance: Foundayo, Wegovy (injection and tablets), and Zepbound — but only the Zepbound KwikPen. As of July 1, 2026, we counted 22 covered NDCs on CMS’s official list: 6 for Foundayo, 10 for Wegovy, and 6 for Zepbound. CMS added Foundayo on April 6, 2026 after its FDA approval and, at the same time, clarified that only the KwikPen form of Zepbound is included.
The exclusions matter as much as the inclusions. Zepbound single-dose vials and single-dose pens are not covered — a detail that is easy to miss and easy to get wrong. On the prior-authorization form, Wegovy appears in three distinct covered forms: standard Wegovy Injection, Wegovy HD Injection, and Wegovy Tablets.
| Brand | Active ingredient | Manufacturer | Covered form(s) | Not covered | Covered NDCs |
|---|---|---|---|---|---|
| Foundayo | Orforglipron (oral) | Eli Lilly | Tablet (all formulations) | — | 0002-4178-31, 0002-4503-31, 0002-4794-31, 0002-4803-31, 0002-4839-31, 0002-4953-31 (6) |
| Wegovy | Semaglutide | Novo Nordisk | Injection, Wegovy HD Injection, tablets (all formulations) | — | 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 (10) |
| Zepbound | Tirzepatide | Eli Lilly | KwikPen only | Single-dose vials; single-dose pens | 0002-3566-11, 0002-3555-11, 0002-3544-11, 0002-3533-11, 0002-3522-11, 0002-3511-11 (6) |
| Total covered NDCs | 22 | ||||
Source: CMS, “Information for Part D Plans” and “Information for Pharmacies,” Medicare GLP-1 Bridge, verified July 1, 2026. Foundayo (orforglipron) was FDA-approved April 1, 2026. CMS states this list may be updated over the course of the demonstration. A machine-readable version of this table is available as a downloadable CSV.
All three covered products are FDA-approved for chronic weight management. The uses that send a request away from the Bridge and back to Part D — type 2 diabetes, moderate-to-severe sleep apnea, liver disease, or Wegovy’s cardiovascular indication — are handled through Part D because Medicare already covers GLP-1s for those conditions. More on that split in the eligibility and exclusions sections below.
What is the Medicare GLP-1 Bridge?
The Medicare GLP-1 Bridge is a short-term CMS demonstration, running July 1, 2026 through December 31, 2027, that gives eligible Part D beneficiaries certain GLP-1 drugs for weight loss at a $50 monthly copay. It sits outside the regular Part D benefit — a single central processor (Humana’s LI NET operation) handles prior authorization, claims, and pharmacy payment — so Part D plans carry no financial risk and do not have to opt in for their members to use it.
Why does a separate “bridge” need to exist? Because federal law bars Medicare Part D from covering drugs when they are used for weight loss. The Part D benefit adopts the same exclusions Medicaid may apply under Section 1927(d)(2) of the Social Security Act, which lists agents used for weight loss among the categories a plan can refuse to cover. That is why, before this program, a Medicare enrollee could get a GLP-1 like Ozempic covered for type 2 diabetes, or Wegovy covered to reduce cardiovascular events — but not for weight loss alone.
The Bridge does not change that statute. Instead of amending Part D, CMS built the program on separate footing: Section 402(a)(1)(A) of the Social Security Amendments of 1967, which lets the Secretary run demonstration projects to test new payment approaches. That is demonstration authority — meant for time-limited tests — which is why the Bridge runs on a fixed clock rather than as permanent coverage. It also grew out of a November 2025 agreement the administration announced with Eli Lilly and Novo Nordisk to lower obesity-drug costs.
| What it is | Effect on GLP-1 weight-loss coverage | |
|---|---|---|
| Standard Part D exclusion | Part D’s covered-drug definition adopts the exclusions in Social Security Act §1927(d)(2), including agents used for weight loss | GLP-1s are covered for other approved uses (diabetes, cardiovascular risk, sleep apnea) but not for weight loss |
| Bridge demonstration authority | Section 402(a)(1)(A) of the Social Security Amendments of 1967, applied to Part D via §1860D-42(b) | Allows a temporary payment demonstration for weight-loss use, outside the Part D benefit, July 1, 2026–Dec 31, 2027 |
| BALANCE Model (Part D portion) | A CMS Innovation Center model that would have brought obesity coverage into Part D | Delayed indefinitely; the Bridge was extended to fill the gap |
Source: CMS Medicare GLP-1 Bridge and BALANCE Model pages; Social Security Act §§1860D-2, 1927(d)(2); KFF. Verified July 1, 2026.
Who qualifies for the Medicare GLP-1 Bridge?
To qualify, a beneficiary must be 18 or older, be prescribed the drug to lose weight and keep it off alongside a diet-and-exercise program, meet one of three BMI-and-condition thresholds, and not already be getting a GLP-1 covered through their Part D plan. A prescriber attests to all of this on a prior-authorization request. Eligibility is judged by the BMI at the time GLP-1 therapy started — and CMS is explicit that if the patient’s weight has already dropped on a GLP-1, providers should use the pre-treatment BMI for this determination.
The threshold structure is the part most summaries flatten, so here it is precisely. The higher your BMI, the fewer conditions you need.
| BMI at start of therapy | Qualifying condition needed | Accepted conditions (need at least one) |
|---|---|---|
| 35 or higher | None | — (BMI alone qualifies) |
| 30 – 34.9 | Yes (at least one) | Heart failure with preserved ejection fraction (HFpEF); uncontrolled hypertension (systolic >140 mm Hg or diastolic >90 mm Hg despite two antihypertensive medications); chronic kidney disease stage 3a or higher; prediabetes (per ADA guidelines); previous heart attack; previous stroke; symptomatic peripheral artery disease |
| 27 – 29.9 | Yes (at least one) | Prediabetes (per ADA guidelines); previous heart attack; previous stroke; symptomatic peripheral artery disease |
| Under 27 | — | Not eligible |
The three cardiometabolic conditions — HFpEF, uncontrolled hypertension, and CKD stage 3a+ — apply only at BMI 30 and above. Prediabetes, prior heart attack, prior stroke, and symptomatic PAD qualify at BMI 27 and above. Source: CMS, “Information for Part D Plans,” Medicare GLP-1 Bridge, and the CMS prior-authorization form, verified July 1, 2026.
Two definitions are worth pinning down, because the program uses strict versions of them. Uncontrolled hypertension here is not just “high blood pressure” — it means readings above 140 systolic or 90 diastolic despite being on two blood-pressure medications. Prediabetes is defined by American Diabetes Association criteria. On the prior-authorization form, the BMI bands also map to specific obesity diagnosis codes: BMI 30–34.9 is ICD-10 E66.811 (Class 1 obesity), 35–39.9 is E66.09 (Class 2 obesity), and 40+ is E66.01 (Class 3 obesity). The ICD-10 for overweight (27–29.9) is E66.3 and appears on the PA form specifically paired with the qualifying conditions for that BMI band.
One more requirement that is easy to overlook: the prescriber must attest that the drug is being used with ongoing lifestyle modification — structured nutrition and physical activity consistent with the FDA label — unless physical activity is not clinically appropriate for that patient. It is part of the attestation that makes the claim valid, not a formality.
Who is excluded because coverage should go through Part D instead?
The Bridge is only for people using a GLP-1 solely to manage weight. If a beneficiary has a condition that Part D already covers a GLP-1 for, they are routed to their Part D plan — even if they would otherwise meet the Bridge’s weight criteria. CMS names four situations specifically, and the prior-authorization form asks about each one before it lets a request proceed.
This is the distinction that separates an accurate description of the program from a wrong one. The Bridge did not make Medicare start covering every GLP-1 for everyone. It created a narrow lane for weight-loss-only use, and it deliberately steers clinically complex patients back to the coverage they already have.
| Diagnosis / use | Bridge status | Where it goes instead |
|---|---|---|
| Type 2 diabetes | Not eligible | Part D (GLP-1s are covered for diabetes) |
| Moderate-to-severe obstructive sleep apnea | Not eligible | Part D (e.g., Zepbound is approved for OSA) |
| Noncirrhotic MASH with moderate-to-advanced liver scarring (fibrosis) | Not eligible | Part D |
| Wegovy to reduce major cardiovascular events in adults with established cardiovascular disease | Not eligible | Part D |
| Weight reduction/maintenance only, meeting BMI criteria, no Part D-covered condition | Eligible | The Bridge, at the $50 copay |
“MASH” is metabolic dysfunction-associated steatohepatitis, formerly called NASH. Source: CMS, “Information for Part D Plans,” and the CMS prior-authorization form, verified July 1, 2026.
There is also a hard gate that has nothing to do with diagnosis: if you filled a GLP-1 prescription under your Part D plan in 2026, you cannot use the Bridge. The program is built for people who are not already getting a GLP-1 through Part D. CMS says it will monitor plans’ formulary and utilization-management practices to make sure they do not push patients off Part D coverage and onto the Bridge to save money.
Finally, a handful of Medicare arrangements do not qualify at all: private fee-for-service plans, Section 1876 cost plans, Section 1833 health care prepayment plans, PACE organizations, fallback plans, and religious fraternal benefit plans — unless the person is also enrolled in a standalone Part D drug plan. Eligible plan types are standalone Part D (PDP), Medicare Advantage plans with drug coverage (MA-PD, including HMO, HMOPOS, and local/regional PPO), Special Needs Plans, employer/union group waiver plans, and LI NET. Dual-eligible beneficiaries in an eligible plan type can participate.
How does the $50 copay work — and what’s the catch?
Eligible beneficiaries pay a flat $50 for a one-month supply, and it stays $50 regardless of which phase of the Part D benefit they are in. The catch: because the drug is furnished outside Part D, that $50 buys nothing toward your plan’s deductible or annual out-of-pocket cap. Under the hood, participating manufacturers supply each monthly fill at a $245 net price; the beneficiary pays $50 at the pharmacy and Medicare’s central processor covers the rest — a net of roughly $195 per fill to Medicare.
For most people the $50 is a dramatic discount — these drugs have carried list prices well above $1,000 a month. But the accounting quirk is real money for anyone with other expensive prescriptions, so it is worth stating plainly.
| Feature | Medicare GLP-1 Bridge | Standard Part D coverage |
|---|---|---|
| Your monthly cost | $50 flat (28- or 30-day supply) | Plan cost-sharing, which varies, until you hit the cap |
| Counts toward your deductible | No | Yes |
| Counts toward the annual out-of-pocket cap ($2,100 in 2026; $2,400 in 2027) | No | Yes |
| Reduced by Extra Help / low-income subsidy | No | Yes |
| Can be spread out via the Medicare Prescription Payment Plan | No | Yes |
| Coupons or manufacturer discounts apply | No | (Varies; generally not for Part D) |
| Shows up on your Part D Explanation of Benefits or Medicare Summary Notice | No | Yes |
The Part D out-of-pocket cap is $2,100 in 2026, rising to $2,400 in 2027 (KFF). Because the Bridge sits outside Part D, none of the $50 counts toward that cap. Source: CMS, “Information for Part D Plans,” and Medicare.gov, verified July 1, 2026.
How many Medicare beneficiaries could actually use it?
KFF estimates that 3.8 million Medicare Part D enrollees met all of the Bridge’s eligibility criteria, based on 2023 claims, encounter, and Part D prescription-event data. That is a fraction of the population you might expect — and the gap between the headline “obesity” number and the real eligible number is the most instructive statistic on this page. CMS has not published its own estimate, though its Medicare director, Chris Klomp, has said the agency expects the program to start with “single-digit millions” of beneficiaries.
Here is KFF’s funnel, reorganized into a table. The underlying estimates are KFF’s; the layout is ours.
| Step | Estimated beneficiaries | What it counts |
|---|---|---|
| 1 | 13.3 million | Medicare beneficiaries who met the BMI thresholds for obesity or overweight (BMI 27+) in 2023 |
| 2 | 9.7 million | Part D enrollees who also met the Bridge’s clinical criteria |
| 3 | 3.8 million | Those who met all eligibility criteria — after excluding anyone with a Part D-covered condition (like diabetes) or who filled a GLP-1 through Part D |
Estimates: KFF analysis of 2023 Medicare claims, Medicare Advantage encounter data, and Part D prescription-event data (KFF, June 29, 2026). Table layout by The RX Index.
Cost follows participation. KFF modeled it directly: if 10% to 25% of those 3.8 million enroll and fill monthly for the full run, the cost to Medicare would be $1.3 billion to $3.3 billion (that is the $245 net price minus the $50 copay, or $195 a month, per fill). At 50% to 75% participation, it rises to $6.7 billion to $10 billion. These are KFF projections, not CMS enrollment counts — no one yet knows the real take-up.
For contrast, the Congressional Budget Office has separately estimated that if Medicare were authorized to cover anti-obesity medications broadly — a far wider policy than this narrow demonstration — roughly 12.5 million enrollees would qualify in 2026. That is a useful reminder that the Bridge is a deliberately limited pilot, not comprehensive coverage.
How the program actually operates (pharmacy and prior authorization)
The Bridge runs on its own claims plumbing, separate from Part D. The pharmacy bills a dedicated route, a prescriber submits the prior authorization, and the beneficiary pays $50 at the counter. We include this because it is the part that is genuinely tedious to assemble from CMS’s separate pages — and because it is what determines whether an eligible person can actually walk out with the drug.
| Step | What happens |
|---|---|
| 1 | The prescriber confirms the request is for weight-loss use only — not a Part D-covered condition like diabetes, OSA, MASH, or cardiovascular risk. |
| 2 | The pharmacy submits an electronic claim to the Bridge’s dedicated route: BIN 028918 / PCN MEDDGLP1BR. Paper claims and direct member reimbursement are not accepted. |
| 3 | A denied pharmacy claim to that Bridge route must exist before the prescriber submits the prior authorization. No Part D denial is required. |
| 4 | The prescriber submits the prior authorization electronically through CoverMyMeds (or by fax). Only prescribing clinicians can submit it; the form requires the patient’s Medicare Beneficiary Identifier (MBI). |
| 5 | The central processor (Humana LI NET) reviews the request; the Bridge is the primary payer and does not coordinate benefits with other coverage. |
| 6 | Once approved, the beneficiary pays the $50 copay and receives a single one-month supply (28 or 30 days, depending on the drug). |
Source: CMS, “Information for Pharmacies” and the CMS Medicare GLP-1 Bridge prior-authorization form, verified July 1, 2026. Operational details are the most likely part of this program to change; confirm current specifics on the CMS pages before relying on them.
Once granted, a prior authorization is valid through December 31, 2027 — including refills and dose changes — unless the beneficiary switches to a different GLP-1. Approved beneficiaries get a letter confirming coverage. For eligibility or status questions, CMS directs people to 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).
How the four Medicare GLP-1 coverage paths compare
Medicare touches GLP-1 drugs through four separate channels, and only one of them — the Bridge — covers weight-loss-only use for people who are not already covered another way. Keeping them straight is the difference between “Medicare covers GLP-1s for weight loss now” (misleading) and an accurate picture.
| Pathway | Covers GLP-1s for… | Cost to beneficiary | Counts toward Part D cap? | Status |
|---|---|---|---|---|
| Standard Part D | Non-weight-loss FDA uses: type 2 diabetes, cardiovascular risk reduction, sleep apnea, MASH | Plan cost-sharing until the cap | Yes | Ongoing |
| Medicare GLP-1 Bridge | Weight reduction/maintenance (obesity/overweight) | $50/month flat | No | July 1, 2026 → Dec 31, 2027 |
| Medicaid (state option) | Obesity — each state chooses | Medicaid cost-sharing (varies) | N/A | Covered for obesity in 13 states as of Jan. 2026 (down from 16 in 2025) |
| BALANCE Model (Part D portion) | Planned obesity coverage inside Part D | To be determined | To be determined | Delayed indefinitely |
Source: CMS Medicare GLP-1 Bridge and BALANCE Model pages; Medicare.gov; KFF (Medicaid state count). Verified July 1, 2026.
The timeline — and what happens after 2027
The Bridge is scheduled to end on December 31, 2027, and what comes next is genuinely uncertain. The program was originally meant to be a short bridge to a permanent CMS model called BALANCE. But the Part D piece of BALANCE has been delayed indefinitely, and CMS extended the Bridge to fill the gap. That leaves an open question no one can currently answer: how beneficiaries keep Medicare coverage of a weight-loss GLP-1 once the Bridge closes.
| Date | Event | Source |
|---|---|---|
| November 2025 | The administration announces a deal with Eli Lilly and Novo Nordisk to lower obesity-drug costs; the Bridge is part of it | CNN |
| December 23, 2025 | CMS announces the BALANCE Model and a short-term demonstration (later named the Medicare GLP-1 Bridge) | CMS; KFF |
| April 1, 2026 | FDA approves Foundayo (orforglipron), Eli Lilly’s oral GLP-1 for weight management | FDA |
| April 6, 2026 | CMS updates the Bridge drug list to add Foundayo and clarify Zepbound is KwikPen-only | CMS |
| April 2026 | CMS says it will not advance the Part D portion of BALANCE for 2027 | Humana; KFF |
| May 2026 | CMS extends the Bridge through Dec. 31, 2027 (from its original Dec. 31, 2026 end); Part D BALANCE portion delayed indefinitely; Medicaid coverage under BALANCE can begin as early as May 2026 | Medicare Rights Center; KFF; CMS |
| July 1, 2026 | The Medicare GLP-1 Bridge launches; prior authorizations begin | CMS; Medicare.gov |
| December 31, 2027 | Scheduled end of the Bridge | CMS |
| 2028 and beyond | Uncertain — depends on whether CMS extends the Bridge, implements BALANCE in Part D, or another path emerges | KFF |
Verified July 1, 2026.
How we built and verified this tracker
We assembled this page the way a careful reader would if they had a free afternoon and a tolerance for federal FAQ pages. We read CMS’s four Bridge pages (for beneficiaries, Part D plans, pharmacies, and providers), the CMS prior-authorization form, the Medicare.gov consumer page and its fact sheet, KFF’s eligibility and cost analysis, and the CBO estimate. Then we pulled the pieces most people never see side by side — the drug list, the exact NDC count, the BMI thresholds with their clinical definitions, the Part D routing rules, the cost accounting, and the pharmacy workflow — into the tables above.
The original work here is the aggregation and verification, not the underlying rules, which belong to CMS. Specifically: we counted the CMS-listed NDCs (22, as of this date), reconciled the BMI thresholds across the consumer page, the plan and pharmacy pages, and the PA form so they read as one coherent matrix, and separated Bridge-eligible use from the diagnoses that route to Part D. Every figure carries a verification date because a program this new will move — CMS last modified its main Bridge page on June 22, 2026 and its Part D plan page on May 29, 2026, and its pharmacy page was updated again around launch.
| Source | What it confirmed | Verified |
|---|---|---|
| CMS — Medicare GLP-1 Bridge (overview/FAQs) | Program dates, outside-Part-D structure, central processor, authority | July 1, 2026 |
| CMS — Information for Part D Plans | The 22 NDCs, clinical criteria, $245 net price, routing rules | July 1, 2026 |
| CMS — Information for Pharmacies | Eligible plan types, electronic-claims-only processing | July 1, 2026 |
| CMS — Prior Authorization Request Form | BIN/PCN, attestations, MASH/fibrosis language, covered forms | July 1, 2026 |
| Medicare.gov — Weight loss drugs / fact sheet | Consumer eligibility, drugs, $50 cost mechanics | July 1, 2026 |
| FDA — Foundayo (orforglipron) approval | Foundayo = orforglipron, approved April 1, 2026 | July 1, 2026 |
| KFF — eligibility analysis (June 29, 2026) | 13.3M → 9.7M → 3.8M funnel; cost model | July 1, 2026 |
| KFF — BALANCE Model explainer | BALANCE status; Medicaid state count | July 1, 2026 |
| CBO — anti-obesity medication estimate | ~12.5M would qualify under broad coverage (context) | July 1, 2026 |
| Social Security Act §§1860D-2, 1927(d)(2) | Statutory basis for the Part D weight-loss exclusion | July 1, 2026 |
Source: The RX Index primary-source review, July 1, 2026.
What this tracker does not do: it does not determine any individual’s medical eligibility, replace a prescriber’s judgment, guarantee that a prior authorization will be approved, or reflect any specific plan’s formulary. It is a research reference, not medical, financial, or enrollment advice. For a personal eligibility question, talk to your prescriber or call 1-800-MEDICARE, and confirm current details at Medicare.gov.
Limitations and what could change
A few honest caveats, because they affect how much weight to put on any single figure here.
- The drug and NDC list can change. CMS says so explicitly. New approvals or formulations could be added; codes could be revised.
- Operational details are the most volatile part. CMS updated its pharmacy Bridge page around the July 1, 2026 launch, and the prior-authorization form still showed a placeholder fax number at our review — so the BIN/PCN, the PA fax and help-desk contacts, and claim-processing rules should be rechecked against CMS before operational use.
- The 3.8 million figure is an estimate, not a count. It is KFF’s modeling of 2023 data, and actual eligibility and enrollment will differ. The cost ranges are projections tied to unknown participation.
- Cost-cap figures are indexed and change yearly. The $2,100 (2026) / $2,400 (2027) out-of-pocket cap will keep moving.
- The post-2027 picture is unresolved. The successor BALANCE model in Part D is delayed indefinitely, so any statement about coverage after December 31, 2027 is speculative.
Frequently asked questions
Does Medicare cover GLP-1 drugs for weight loss in 2026?
Yes, but only through the temporary Medicare GLP-1 Bridge, and only for eligible Part D enrollees, at a $50 monthly copay, from July 1, 2026 through December 31, 2027. Outside the Bridge, Part D still covers GLP-1s only for non-weight-loss uses like diabetes, cardiovascular risk, or sleep apnea.
Which GLP-1 drugs are included in the Bridge?
Foundayo (orforglipron tablets), Wegovy (injection and tablets), and Zepbound — but only the Zepbound KwikPen. We counted 22 CMS-listed NDCs across the three products as of July 1, 2026.
Does the Bridge cover Zepbound vials or single-dose pens?
No. Only the Zepbound KwikPen is covered. Single-dose vials and single-dose pens are excluded.
Is Ozempic or Mounjaro covered by the Bridge?
No. The Bridge covers only the three weight-management products above. Ozempic and Mounjaro may be covered under standard Part D for type 2 diabetes.
Who qualifies for the $50 copay?
People 18 or older who are prescribed the drug for weight loss, meet a BMI threshold (35+, or 27+ with a qualifying condition), use it alongside diet and exercise, and are not already getting a GLP-1 covered through their Part D plan.
Do people with type 2 diabetes qualify for the Bridge?
No. Diabetes is a Part D-covered use, so those beneficiaries get GLP-1s through their Part D plan instead — even if they would otherwise meet the weight criteria. The same applies to moderate-to-severe sleep apnea and noncirrhotic MASH with moderate-to-advanced fibrosis.
Does the $50 copay count toward my Part D deductible or out-of-pocket cap?
No. Because the drug is furnished outside Part D, the $50 does not count toward your deductible or annual cap, cannot be lowered by Extra Help, and cannot be spread out under the Medicare Prescription Payment Plan.
Is a Part D denial required before I can use the Bridge?
No Part D denial is required. The pharmacy submits a claim to the Bridge’s dedicated route (BIN 028918 / PCN MEDDGLP1BR), and a denied claim to that Bridge route must exist before the prescriber submits the prior authorization. Only prescribing clinicians can submit the PA.
Can I get a 90-day supply?
No. Fills are limited to a single one-month supply (28 or 30 days, depending on the drug).
What happens when the Bridge ends on December 31, 2027?
It is uncertain. CMS’s current public Bridge window ends December 31, 2027, and the successor BALANCE model in Part D has no announced restart date, so continued Medicare coverage of GLP-1s for weight loss after that would depend on future CMS action.
How to cite this page
How to cite this page
The RX Index. “Medicare GLP-1 Bridge Tracker: Who Qualifies, Drugs Covered, and the $50 Cost.” The RX Index Research. Last verified July 1, 2026. https://therxindex.com/research/medicare-glp1-bridge-tracker/
A machine-readable version of the covered-drug and NDC list (matching the table above) is available as a CSV download at the same location. If you quote the 22-NDC count, please attribute it as The RX Index’s own aggregation of the CMS drug list, verified July 1, 2026. The 3.8 million eligibility estimate is KFF’s and should be cited to KFF.
Update log
| Date | Change |
|---|---|
| July 1, 2026 | Initial publication and verification against CMS, Medicare.gov, FDA, KFF, CBO, and Social Security Act sources. |
This tracker will be updated when CMS modifies the drug list, eligibility criteria, or other program parameters. The verification date in the byline reflects the most recent review.
Primary sources
- CMS — Medicare GLP-1 Bridge (overview and FAQs) https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge
- CMS — Information for Part D Plans (NDC list, clinical criteria, $245 net price) https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-part-d-plans
- CMS — Information for Pharmacies (plan types, claims processing) https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-pharmacies
- CMS — Medicare GLP-1 Bridge Prior Authorization Request Form https://www.cms.gov/glp-1-bridge.pdf
- Medicare.gov — Weight loss drugs (eligibility, drugs, cost) https://www.medicare.gov/coverage/weight-loss-drugs
- Medicare.gov — Medicare GLP-1 Bridge fact sheet https://www.medicare.gov/publications/12234-medicare-glp-1-bridge-glp-1-drugs-for-50-a-month.pdf
- CMS — BALANCE Model https://www.cms.gov/priorities/innovation/innovation-models/balance
- FDA — Foundayo (orforglipron) approval (April 1, 2026) https://www.fda.gov/news-events/press-announcements/fda-approves-first-new-molecular-entity-under-national-priority-voucher-program
- KFF — Nearly four million beneficiaries met the eligibility criteria in 2023 (funnel and cost model) https://www.kff.org/medicare/nearly-four-million-medicare-beneficiaries-met-the-eligibility-criteria-in-2023-for-the-medicare-glp-1-bridge/
- KFF — What to know about the BALANCE Model and the Medicare GLP-1 Bridge https://www.kff.org/medicare/what-to-know-about-the-balance-model-for-glp-1s-in-medicare-and-medicaid/
- CBO — How would authorizing Medicare to cover anti-obesity medications affect the federal budget? https://www.cbo.gov/publication/60441