On Medicare? See if the $50 GLP-1 program covers you.

Original Medicare with a Part D drug plan

A standalone Part D drug plan is one of the plan types CMS lists for the Medicare GLP-1 Bridge. A Medigap supplement does not change that, and a Medigap policy is not drug coverage by itself. What matters is that you have the Part D plan.

How to confirm your plan type: look for “Prescription Drug Plan” or “Part D” on your plan card or plan documents, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).

How the Bridge sits next to your plan: the $50 copay is paid outside your Part D benefit. It does not count toward your deductible or yearly out-of-pocket limit, and Extra Help does not lower it. If your GLP-1 is prescribed for type 2 diabetes, sleep apnea or fatty liver disease instead, your Part D plan handles it, and CMS says plans must keep following their usual formulary exception process for those requests.

There is no list of participating plans. Plans do not sign up for the Bridge. CMS runs prior authorization and pays pharmacies itself, so what counts is your plan type.

Official sources: Medicare.gov, who can use the Bridge, CMS, Medicare GLP-1 Bridge and Medicare fact sheet (PDF).

Medicare Advantage with drug coverage

CMS lists Medicare Advantage coordinated care plans with drug coverage for the Bridge: HMO, HMOPOS, and local and regional PPO plans. If yours is one of those, your plan type is on the list. Private fee-for-service plans are not, and neither are Advantage plans with no drug coverage. Each has its own section on this page.

How to confirm your plan type: the plan name or card often says HMO or PPO. Your plan’s Summary of Benefits will say whether it includes drug coverage. If you are still not sure, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). Write down the date and the name of the person who answers.

What stays the same: you do not leave your Advantage plan. The $50 copay is paid at the pharmacy outside your plan’s drug benefit, so it does not count toward your plan’s deductible or out-of-pocket limit, and Extra Help does not lower it.

There is no list of participating plans. Plans do not sign up for the Bridge. CMS runs prior authorization and pays pharmacies itself, so what counts is your plan type.

Official sources: Medicare.gov, who can use the Bridge, CMS, Medicare GLP-1 Bridge and Medicare fact sheet (PDF).

Special Needs Plan or LI NET

CMS lists Special Needs Plans (SNPs) and the Limited Income Newly Eligible Transition (LI NET) program for the Bridge. CMS also says people who have both Medicare and Medicaid and are in an eligible Part D plan type can use the Bridge if they meet the prior authorization criteria.

How to confirm: your plan card or plan documents will name the plan, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and ask whether your plan is a Special Needs Plan or whether you are in LI NET.

There is no list of participating plans. Plans do not sign up for the Bridge. CMS runs prior authorization and pays pharmacies itself, so what counts is your plan type.

Official sources: Medicare.gov, who can use the Bridge, CMS, Medicare GLP-1 Bridge and Medicare fact sheet (PDF).

Drug coverage from a former employer or union

CMS lists employer or union group waiver plans (EGWPs). Not every retiree drug plan is one, and the pages we read do not say how other retiree plans are treated. Call your plan’s member services number and ask whether it is an employer or union group waiver plan. You can also call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).

There is no list of participating plans. Plans do not sign up for the Bridge. CMS runs prior authorization and pays pharmacies itself, so what counts is your plan type.

Official sources: Medicare.gov, who can use the Bridge, CMS, Medicare GLP-1 Bridge and Medicare fact sheet (PDF).

Private fee-for-service, cost and PACE plans

CMS says people in private fee-for-service plans, section 1876 cost contract plans, section 1833 health care prepayment plans, PACE organizations, fallback plans and religious fraternal benefit plans are not eligible for the Bridge, unless they are also enrolled in a standalone Part D drug plan.

If you do have a separate standalone drug plan on top of one of these, ask 1-800-MEDICARE how that applies to you.

Medicare Advantage with no drug coverage

The Bridge is listed for plans that have drug coverage. A Medicare Advantage plan without drug coverage is not on CMS’s list. Medicare.gov says that if you get Medicare drug coverage you may become eligible, and that you can sign up for a drug plan at certain times.

Medicare.gov’s joining-a-plan page says that during Open Enrollment, October 15 to December 7, you can switch to a Medicare Advantage plan with drug coverage, or add drug coverage. The plan must get your request by December 7, and coverage starts January 1. From January 1 to March 31, people already in a Medicare Advantage plan can switch to another Medicare Advantage plan with or without drug coverage, or return to Original Medicare and join a separate drug plan. Other times need a special situation, such as moving or losing coverage.

That page does not say how adding a separate drug plan affects the Medicare Advantage plan you have now. Call 1-800-MEDICARE (1-800-633-4227) before you change anything, because changing plans can affect the rest of your coverage.

Original Medicare with no drug plan

Medicare.gov says you are not eligible for the Bridge right now if you do not have Medicare drug coverage. It also says that if you get Medicare drug coverage you may become eligible. Medicare.gov’s joining-a-plan page says that Open Enrollment, October 15 to December 7, lets you join a Medicare drug plan if you are in Original Medicare. The plan must get your request by December 7, and coverage starts January 1. Other times need a special situation, such as moving, losing coverage, or getting Extra Help.

Before you add a plan only for this program, remember that it is temporary and scheduled to end December 31, 2027. Weigh that against what a drug plan costs you.

VA, TRICARE and other non-Medicare drug coverage

The CMS and Medicare.gov pages we read do not mention the VA, TRICARE or other non-Medicare drug coverage, so we cannot tell you how the Bridge treats them. The question Medicare.gov asks first is whether you have Medicare drug coverage (Part D). Call 1-800-MEDICARE (1-800-633-4227) and ask.

Not sure what Medicare coverage you have

Look at the cards in your wallet. A Medicare Advantage or Part D plan has its own card from the plan, separate from your red, white and blue Medicare card. Call 1-800-MEDICARE (1-800-633-4227) and ask what kind of plan you have and whether it includes drug coverage. Medicare.gov’s own check starts with that question.

Type 2 diabetes, sleep apnea or fatty liver

CMS says people with type 2 diabetes, moderate to severe obstructive sleep apnea, or noncirrhotic MASH with moderate to advanced liver scarring are not Bridge patients, even if they meet the weight and BMI criteria. Those conditions are handled through your regular Part D plan. The Bridge is only for a GLP-1 prescribed for weight management.

CMS says the same applies when a GLP-1 is prescribed to lower the risk of heart attack or stroke in an adult with established heart or blood vessel disease and obesity or overweight (for example Wegovy for that purpose), and for Zepbound prescribed for moderate to severe sleep apnea in an adult with obesity. Those go through your Part D plan, and your plan’s usual exception process applies. A Bridge prior authorization that lists one of these diagnoses is denied.

Ask your prescriber and your plan whether a GLP-1 is covered for that condition. That is a medical and a plan question, not one this page can answer.

Not sure about those conditions

Your prescriber decides whether a diagnosis applies. CMS tells prescribers to use clinical judgment and says they attest, under penalty of perjury, that the information on the prior authorization form is accurate. CMS may check Medicare data, for example for type 2 diabetes. Ask your prescriber before anything is sent.

Already covered by your Part D plan

Medicare.gov and the CMS fact sheet say you are not eligible for the Bridge if your Medicare drug plan has paid for a GLP-1 for you, for any reason. You keep getting it through your plan. CMS also says that anyone who received a GLP-1 through Part D in 2026 is not eligible for the Bridge, even if a GLP-1 is now prescribed for weight management and they meet the other criteria.

CMS counts products with these active ingredients as GLP-1 drugs: semaglutide, tirzepatide, orforglipron, dulaglutide and liraglutide.

Taking a GLP-1 now, paid another way

The CMS pages we read exclude one group of people already on a GLP-1: anyone whose Medicare drug plan has paid for one, for any reason. They do not exclude someone who pays another way, such as cash. The weight and condition criteria are measured when therapy starts, and the prior authorization form says to use the starting BMI if your BMI has since dropped.

The Bridge covers only Wegovy, Zepbound in the KwikPen, and Foundayo, in 28-day or 30-day fills. If you take something else, your prescriber would have to write one of those. The pages do not say whether a gap or a switch changes anything beyond that. Call 1-800-MEDICARE (1-800-633-4227) and ask before you stop or switch anything.

If you stopped

Do not restart on your own. Ask your prescriber how to restart safely, because after a gap the dose may need to be lower.

One CMS rule matters here. If your Medicare drug plan paid for any GLP-1 for you in 2026, for any reason, you are not eligible for the Bridge, even if you stopped. Your coverage stays with your drug plan.

The Medicare GLP-1 Bridge

Medicare started a temporary program on July 1, 2026 called the Medicare GLP-1 Bridge. It runs through December 31, 2027. If you qualify, you pay a $50 copay for a one-month supply at your pharmacy.

Medicines covered: Wegovy (injection or tablet), Zepbound in the KwikPen only (not the single-dose vials or single-dose pens), and Foundayo (tablet).

Who qualifies: age 18 or older, prescribed for weight reduction and keeping it off along with a lifestyle program of diet and exercise, and one of these, measured when you start the medicine:

• BMI 35 or higher, or
• BMI 30 or higher with heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease stage 3a or higher, or
• BMI 27 or higher with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease.

The prior authorization form asks for your BMI when GLP-1 treatment started, and says that if your BMI has dropped since you started a GLP-1, the starting BMI is the one to use.

Your BMI

Below 27 is under the lowest BMI level in the Bridge criteria on Medicare.gov, so you would not meet them as written.

Your BMI

At a BMI of 27 to 29.9 you also need at least one of these: prediabetes, a prior heart attack or stroke, or blocked arteries in your legs or arms (peripheral artery disease) with symptoms. CMS adds that if a GLP-1 is prescribed to reduce the risk of heart attack or stroke, that prescription goes to your Part D plan, not the Bridge. Ask your prescriber which applies.

Your BMI

At a BMI of 30 to 34.9 you also need at least one of these: heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease stage 3a or higher. On the prior authorization form, uncontrolled high blood pressure means above 140 systolic or above 90 diastolic despite two blood pressure medicines.

Your BMI

At a BMI of 35 or higher you meet the BMI part of the criteria on its own. Your prescriber still has to confirm the rest.

How to start

You do not apply to the Bridge yourself. Ask your prescriber to send the prescription to your pharmacy first. Your prescriber should not send the prior authorization form first, because that can cause a “patient not found” error.

The pharmacy then submits the claim and asks your prescriber for a prior authorization, usually within 24 to 72 hours. If that request never arrives, your prescriber can send CMS’s prior authorization form electronically through CoverMyMeds or by fax. The form says the pharmacy’s claim must have been sent to the Bridge first. CMS says decisions are mailed to you and sent to your prescriber within 72 hours, and the fact sheet says you will get a letter from Medicare telling you the medicine is covered. There is no appeals process, but a prescriber can send a corrected form.

Your pharmacy may ask for your Medicare Number or the last 4 digits of your Social Security Number. If approved, the prior authorization is valid, including refills and dose changes, through December 31, 2027, unless you change GLP-1s. Questions go to 1-800-MEDICARE (1-800-633-4227) or Medicare.gov/glp1bridge.

At the pharmacy: CMS tells pharmacies to collect the $50 from everyone, including people with Extra Help. The Bridge pays first and does not combine with other insurance, and manufacturer coupons and discount cards cannot be applied to a Bridge claim. The claim form accepts only commercially available products, not compounded ones. Medicare rejects a claim if the name, birth date and Medicare Number do not match its records, or if it shows no Part D enrollment on the fill date, and you would then call 1-800-MEDICARE. Fills are one 28-day or 30-day supply at a time, with no partial fills, and a refill is rejected as too soon until about 75 percent of the last supply would be used.

Forms and documents you can download: there is no application for you to send to the Bridge. These are the documents CMS publishes, and your prescriber is the one who uses the form.

• Medicare’s fact sheet for people with Medicare (PDF, 2 pages). What the Bridge is and how to get it.
• CMS information for prescribers (PDF, 2 pages). Print it and bring it to your visit.
• Medicare GLP-1 Bridge prior authorization request form (PDF, 3 pages). Your prescriber fills it out and sends it through CoverMyMeds or by fax to 1-800-530-2404. Your prescriber should use it only after the pharmacy’s claim has been sent, and only if the pharmacy’s request never arrives.
• Social Security, Extra Help with Medicare drug costs. Where to apply for Extra Help. It helps with your regular Part D costs. It does not change the $50 Bridge copay.

Three catches worth knowing

1. The $50 does not count toward your Part D deductible or your yearly out-of-pocket limit. Extra Help does not lower it, and it cannot be spread out with the Medicare Prescription Payment Plan.
2. It is temporary. The program is scheduled to end December 31, 2027. The program is run by CMS, not by your plan, so ask 1-800-MEDICARE what is planned after that date.
3. It covers three brand-name medicines only, in the forms listed above.

Other ways to lower the cost

Medicare.gov lists these for people who are not eligible for the Bridge:

• Check whether the company that makes your drug offers help paying for it.
• Find out whether your state offers help with drug costs.
• Check costs at mail-order pharmacies, which are sometimes cheaper.
• Ask whether the Medicare Prescription Payment Plan could help you spread out your costs.
• Compare cash prices on discount sites such as TrumpRx.gov. Discount cards are not creditable coverage, and what you pay with them does not count toward your Medicare deductible or out-of-pocket maximum.

Paying cash through the manufacturer

Eli Lilly and Novo Nordisk both sell their brand-name medicines directly to patients at published self-pay prices. Prices, doses and conditions change often, and some introductory prices end December 31, 2026, so read the current terms at lilly.com/lillydirect and novocare.com before you decide.

Both makers’ coupon cards exclude people with Medicare, but their cash programs are open to anyone who pays out of pocket. Novo Nordisk’s terms say that means asking no insurer to reimburse it, and the money does not count toward your deductible or out-of-pocket limit. Lilly’s cash terms do not name Medicare, so read them first.