Medicare Part D GLP-1 Coverage by Plan: 2026 Data and Coverage Routes

Educational Medicare policy reference. Not medical, legal, or individualized insurance advice.

As of July 31, 2026, Medicare Part D GLP-1 coverage by plan turns on the prescribed use, the product and formulation, and the coverage route. Basic Part D cannot cover a GLP-1 when it is used for weight loss. An enhanced alternative plan may voluntarily cover an otherwise excluded drug as a supplemental benefit, and CMS’s $50 Medicare GLP-1 Bridge is a separate demonstration outside the Part D benefit.

A second rule arrives on January 1, 2027: Part D formularies must include the selected semaglutide dosage forms and strengths that constitute covered Part D drugs and have a maximum fair price in effect. That mandate does not turn weight-management use into basic Part D coverage. KFF found that a small number of plans enrolling less than 1% of Part D enrollees covered Wegovy in 2026; that is an enrollee-weighted finding, not a count of plans.

The cleanest way to understand the subject is not “covered or not covered.” It is:

Which product, in which formulation, prescribed for which use, through which Medicare route?

This page makes those routes countable. It contains the product-by-indication matrix, the five access routes plus one source-data state, the same-package price comparison that links the Bridge to the 2027 negotiated-price program, the current Bridge NDC list, and the counting rules for a future nationwide plan-level formulary index.

Medicare Part D GLP-1 coverage by plan: the four rules

Basic Part D excludes drugs when they are used for weight loss, but that is not the end of the analysis. Supplemental benefits, indication-specific basic coverage, formulary exceptions, and the separate Bridge are different routes with different legal and operational rules.

Sources: Social Security Act §1860D-2; Social Security Act §1927; CMS Medicare GLP-1 Bridge guidance; CMS 2027 negotiation guidance. Compiled by The RX Index Research. Verified July 31, 2026.

Everything else on this page is detail hanging off those four lines.

The most useful original finding: the same Wegovy carton appears in two federal price systems

The same Wegovy carton — NDC 00169-4524-14, 2.4 mg/0.75 mL, four pens — appears in both the CMS Bridge NDC list and CMS’s package-level maximum fair price table. In 2027, that one package sits inside two federal pricing frameworks at once:

• Bridge manufacturer net price: $245 per monthly supply.
• Bridge beneficiary copay: $50.
• 2027 package-level maximum fair price: $385.63.

Those are not competing pharmacy prices. The Bridge operates outside the Part D benefit for eligible weight-management use. The maximum fair price applies through the Medicare Drug Price Negotiation Program for covered Part D use. Which framework is relevant depends on the prescription’s use and the program route.

The often-quoted $274 figure is a fourth number with a different unit: CMS’s negotiated price per 30-day-equivalent supply for the combined selected-drug group published as “Ozempic; Rybelsus; Wegovy.” It is not the package price for this Wegovy carton.

Sources: CMS Medicare GLP-1 Bridge — Information for Part D Plans; CMS negotiated-price fact sheet for 2027. Original cross-source comparison by The RX Index Research. Verified July 31, 2026.

Which GLP-1 drugs can a Medicare Part D plan cover, and for which diagnoses?

Part D eligibility follows the medically accepted use, not the active ingredient alone. The same active ingredient can be sold under different product names, with different formulations and labeled uses, and those differences change the Medicare route.

Semaglutide is the clearest example. Ozempic injection, Rybelsus, and Ozempic tablets carry type 2 diabetes uses. Wegovy injection carries cardiovascular, weight-management, and MASH uses; Wegovy tablets carry cardiovascular and weight-management uses; Wegovy HD is a weight-management presentation. The word semaglutide does not answer the coverage question. The product, formulation, and prescribed use do.

Sources: current Wegovy labeling, Zepbound labeling, Ozempic injection labeling, Rybelsus and Ozempic tablets labeling, FDA Foundayo approval, FDA Mounjaro information, and CMS Bridge product guidance. Compiled by The RX Index Research. Verified July 31, 2026.

Two corrections matter enough to say out loud.

First, Wegovy tablets are not weight-only products under the current label. They also carry a cardiovascular risk-reduction indication, so they can follow a basic Part D route for that use. Second, current Zepbound labeling includes multi-dose vials in addition to single-dose pens, single-dose vials, and KwikPen. Only the CMS-listed KwikPen NDCs are in the Bridge.

CMS’s prose says all formulations of Wegovy are available through the Bridge, but the same page publishes a specific NDC list and says it may change. For operational use, this page treats the current CMS NDC list as the lookup. A newly marketed or differently packaged NDC is not assumed to be Bridge-eligible until CMS lists it.

What are the Medicare access routes for a GLP-1?

There are five access routes and one source-data state, and they are not interchangeable. Calling all six of them “coverage” is how an otherwise careful analysis ends up with a wrong numerator.

Source: Analytical taxonomy developed by The RX Index Research from the Social Security Act, CMS Part D formulary-file structure, and CMS Bridge guidance. Verified July 31, 2026.

Category 3 is the reason the sentence “no Part D plan covers weight-loss drugs” is too broad. The statute permits supplemental coverage of products that would otherwise be Part D drugs but for the exclusion. CRS reports that approximately 75% of Part D beneficiaries are enrolled in enhanced alternative plans, but there is no requirement that those plans cover weight-loss GLP-1s, and a national count of the plans that elect to do so is not published here.

Category 6 needs its own warning for the opposite reason. An absent source row is not a denial. It means the listing was not found in the stated release. The plan’s live documents and coverage-determination process remain the sources for an individual decision.

What will the same GLP-1 cost under Medicare, and why do the numbers differ?

The numbers differ because CMS is publishing different units for different programs. A selected-drug 30-day-equivalent price, an NDC-level package price, a Bridge manufacturer net price, a beneficiary copay, and a commercial list-price benchmark are not interchangeable.

Sources: CMS 2027 negotiated-price fact sheet and CMS Bridge guidance. Compiled by The RX Index Research. Verified July 31, 2026.

The $274 and $385.63 figures are not in conflict. The first is a 30-day-equivalent price across the selected semaglutide group. The second is the package-level MFP CMS published for one Wegovy NDC.

The Bridge copay behaves unlike Part D cost-sharing because the demonstration sits outside the benefit. The $50 does not count toward the Part D deductible or true out-of-pocket costs, and the low-income subsidy does not reduce it. In 2026, the standard Part D deductible is $615 and the annual out-of-pocket threshold is $2,100; a Bridge fill does not move a beneficiary toward either threshold.

What is the Medicare GLP-1 Bridge, and how is it different from Part D coverage?

The Bridge is a temporary CMS demonstration running July 1, 2026 through December 31, 2027 that provides certain GLP-1 products for eligible weight-management use at a flat $50 monthly copay. It operates outside the Part D benefit’s coverage and payment flow. Part D sponsors carry no risk for Bridge drugs and did not have to opt in.

CMS uses Humana, through the Limited Income Newly Eligible Transition infrastructure, as the central processor for prior authorization, claims adjudication, and pharmacy payment. CMS built the Bridge under Section 402(a)(1)(A) of the Social Security Amendments of 1967, made applicable to Part D by Section 1860D-42(b) of the Social Security Act. The statutory weight-loss exclusion remains in place.

Sources: CMS Medicare GLP-1 Bridge — Information for Part D Plans and Information for Providers. Verified July 31, 2026.

CMS says PFFS plans, Section 1876 cost contracts, Section 1833 health care prepayment plans, PACE organizations, fallback plans, and religious fraternal benefit plans are not eligible through those plan types; an applicable standalone PDP can still be the enrollment route where CMS permits it.

Which exact products and NDCs are in the Bridge?

CMS currently lists Foundayo, Wegovy injection and tablets, and Zepbound KwikPen for eligible weight-management use. CMS updated the page on April 6, 2026 to add Foundayo and clarify the Zepbound formulation restriction.

Source: CMS Medicare GLP-1 Bridge — Information for Part D Plans. Verified July 31, 2026. CMS says the product and NDC list may change during the demonstration.

Three other mechanics matter:

• The Bridge is the primary payer and does not coordinate benefits with other payers.
• Coupons and discount programs cannot be applied to Bridge claims.
• The central processor accepts electronic claims under the NCPDP Telecommunication Standard; CMS says paper claims and direct member reimbursement are not accepted.

Why does a Part D-coverable diagnosis make someone ineligible for the $50 Bridge route?

CMS designed the Bridge for beneficiaries seeking a listed GLP-1 solely for weight reduction. CMS says beneficiaries with type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH with F2-F3 fibrosis are ineligible for the Bridge even when they otherwise meet the clinical criteria.

That rule applies regardless of whether the plan currently lists the eligible GLP-1 for that condition. If a beneficiary has a Part D-coverable use and the drug is not on the formulary, the relevant route is the plan’s coverage-determination and formulary-exception process — not automatic transfer to the Bridge. The Bridge does not modify the beneficiary’s Part D appeal rights.

CMS recognizes one overlap. A beneficiary with prior myocardial infarction, stroke, or symptomatic peripheral artery disease may satisfy Bridge weight-management criteria and also have a cardiovascular indication that can be covered under Part D. CMS says that when the drug is prescribed to reduce MACE risk, the prescription should go to the Part D plan even if weight reduction is also intended.

What changes for Medicare Part D GLP-1 coverage on January 1, 2027?

The negotiated price and the formulary-inclusion rule arrive together, but neither repeals the weight-loss exclusion. CMS selected the semaglutide group published as “Ozempic; Rybelsus; Wegovy” for initial price applicability year 2027 and agreed to a price of $274 per 30-day-equivalent supply.

CMS’s final guidance states that formularies must include the selected drug’s dosage forms and strengths that constitute covered Part D drugs and have an MFP in effect. It does not say every semaglutide presentation becomes basic Part D coverage for every labeled use. For 2027, CMS also does not impose one uniform tier or utilization-management rule across every plan.

That distinction is the whole story for Wegovy. The formulary rule expands access to Wegovy for uses that qualify as covered Part D uses. It does not make weight management a basic Part D use.

The scale is still enormous. CMS reports that in calendar year 2024:

• 2,282,000 Part D enrollees used the selected group Ozempic; Rybelsus; Wegovy.
• The group accounted for $15,161,908,000 in total Part D gross covered prescription-drug costs.
• The $274 negotiated price is 71% below CMS’s $959 list-price benchmark.

Across the broader GLP-1 class, KFF calculated $27.5 billion in gross Part D spending in 2024, about five times the 2019 amount. KFF also cautions that gross spending does not account for rebates.

CMS says the BALANCE Model is not launching in Part D in 2027. The Bridge is extended through December 31, 2027 while CMS collects utilization data ahead of any potential Part D implementation of BALANCE.

Sources: CMS negotiated-price fact sheet; CMS final 2027 guidance; CMS Bridge guidance; KFF spending analysis.

How should Medicare Part D GLP-1 coverage by plan be counted?

A national plan-level coverage rate is a data-engineering result, not a number that can be read from one formulary PDF. Six rules are publication blockers.

1. Do not count service-area rows as plans. Geography is one-to-many. A plan offered in many counties appears in many service-area rows. Geography belongs in a separate table.
2. Use the plan-benefit-package grain. The plan unit is contract ID + plan ID + segment ID. Dropping plan ID or segment ID can collapse distinct benefit packages. Joining one-to-many geography without deduplication can inflate them.
3. Keep supplemental excluded-drug evidence out of the basic-coverage numerator. The excluded-drug file can show an enhanced alternative plan’s supplemental benefit. It is real access, but it is not the basic Part D benefit.
4. Preserve indication-based evidence. A product may be treated as on-formulary for one disease and not another. A product-level yes/no field without the raw disease value is not enough.
5. Keep Bridge NDCs out of plan numerators. The Bridge is a CMS demonstration, not a plan formulary benefit.
6. Report unweighted and enrollment-weighted results separately. “40% of plan benefit packages list the drug” and “plans enrolling 12% of beneficiaries list the drug” answer different questions. Every percentage needs a numerator, denominator, unit, source release, and exclusions.

The CMS public use files provide the necessary building blocks: plan information, basic formulary data, indication-based coverage, excluded-drug data, geography, beneficiary cost, pharmacy network, and related files. The live Medicare Plan Finder may update more often than a dated public use file, so a national snapshot and an individual beneficiary decision are not the same thing.

Status of the nationwide plan-level index

The plan-level listing rates, tier distributions, and prior-authorization, step-therapy, and quantity-limit rates are not published in this version. They publish only after the current source file has been:

1. downloaded and checksummed;
2. validated against the current layout;
3. mapped to reviewed RxCUIs and 11-digit NDCs;
4. deduplicated at contract + plan + segment;
5. classified into basic, indication-based, supplemental, Bridge, exception-context, and not-listed states;
6. tested with explicit numerators and denominators;
7. spot-checked in Medicare Plan Finder and current carrier documents.

The one current external formulary result retained here is KFF’s February 2026 finding: a small number of plans enrolling less than 1% of Part D enrollees covered Wegovy in 2026. That is KFF’s enrollee-weighted analysis, not this page’s plan-level computation.

How do you check whether a specific Part D plan covers a specific GLP-1?

Use the source closest to the beneficiary’s actual plan contract.

1. Medicare Plan Finder. Enter the exact drug and compare plans in the beneficiary’s location.
2. The plan’s current formulary and coverage documents. Check the product, formulation, tier, and any indication or utilization-management notation.
3. The plan’s coverage-determination and formulary-exception process. This is the relevant route when the prescribed use is Part D-coverable but the product is not listed.
4. The CMS public use files. These are appropriate for reproducible national analysis, not a substitute for the live beneficiary-level check.

For Bridge questions, CMS directs beneficiaries to 1-800-MEDICARE and publishes the current program details and NDCs on its Bridge pages.

Why this matters now

Medicare is in an 18-month transition that began July 1, 2026 and ends December 31, 2027. During calendar year 2027, the Bridge and the negotiated-price framework overlap for some semaglutide packages while the basic-benefit weight-loss exclusion remains in force.

Medicare Open Enrollment runs October 15 through December 7. A plan listing Wegovy in 2027 does not, by itself, mean the plan covers Wegovy for weight management. The product, use, formulation, and route still decide the answer.

Sources: CMS Bridge; Medicare Open Enrollment; CMS 2027 formulary guidance.

How was this page built?

Statutory, program, negotiated-price, and current-label claims were checked against the Social Security Act, CMS, Medicare.gov, FDA approval material, and current DailyMed labeling on July 31, 2026. KFF and Congressional Research Service analyses are attributed by name rather than presented as agency findings.

The original evidence on this page was produced by joining facts that the source agencies publish separately:

• the product + formulation + indication + Medicare-route matrix;
• the five access routes plus one source-data state;
• the same-NDC comparison between the Bridge and the 2027 package-level MFP;
• the current CMS Bridge NDC reference;
• the pre-registered plan-counting rules.

Where sources use different units, this page preserves the units rather than forcing the numbers into one comparison. Where the current FDA label changed the answer, the current label wins. That is why Wegovy tablets now appear as Part D-eligible for their cardiovascular use and why current Zepbound formulations include multi-dose vials.

The plan-level index is deliberately withheld. A coverage percentage without the completed computation, denominator, source version, and spot checks would be the most dangerous number on the page because it would look finished enough to repeat.

What this data shows, and what it does not

This page reports statutes, labeled uses, program mechanics, federal price references, and an analytical coverage taxonomy as of a stated date. It does not predict an individual coverage determination or pharmacy cost.

This is independent educational research. It is not medical advice, individualized insurance advice, or legal advice. For a beneficiary-specific decision, use the current plan document, Medicare Plan Finder, the plan’s coverage-determination process, a State Health Insurance Assistance Program counselor, or 1-800-MEDICARE.

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About this research. The RX Index Research publishes independent reference datasets on GLP-1 coverage, pricing, and access, assembled from dated public sources. This page carries no commercial relationships, product recommendations, sponsored placements, provider routing, or affiliate links.