The wait for weight-loss drug coverage might finally be at its end for many Medicare enrollees. A new Medicare GLP-1 Bridge pilot program that launches in July will provide these drugs for a $50 monthly copay. “It’s a big deal,” says Medicare expert Lauren Bigham Steele. “People are very excited about this.”
But: Not every Medicare enrollee will be eligible for the Bridge program, and Medicare’s coverage of weight-loss drugs following the conclusion of this pilot program remains uncertain.
We asked Bigham Steele what Medicare enrollees need to know about Medicare weight-loss drug coverage now and in future years…
Why Medicare Coverage for Weight-Loss Drugs Matters
More than two-thirds of Medicare enrollees are overweight or obese, according to a 2021 report by the Congressional Budget Office. Those extra pounds pose considerable health risks, including increased risk for heart disease, stroke, type 2 diabetes and certain cancers, according to the National Institute of Diabetes and Digestive and Kidney Diseases, the World Health Organization and many other medical organizations.
A class of weight-loss drugs known as glucagon-like peptide-1s (GLP-1s for short) has proven effective, including for Medicare-age people 65 and up, according a meta-analysis by Johns Hopkins University researchers as well as other studies. But the problem is price—patients who lack insurance or Medicare coverage for GLP-1s often face monthly bills of between $149 and $699 for these pharmaceuticals, depending on factors including the drug and dose. The Bridge program would lower that to $50 per month for eligible Medicare enrollees.
Critics warn that any program that covers pricey drugs for millions of Medicare enrollees is likely to be very expensive for taxpayers. But it is possible that covering drugs that help overweight Medicare enrollees lose weight also could help those enrollees avoid even pricier treatments for cardiovascular issues, diabetes and cancer down the road. “Medicare will be looking at that,” says Bigham Steele. “It’s looking closely at everything that’s preventative.”
Current Medicare Rules on Weight-Loss Drug Coverage
Medicare Part D plans are prohibited by a 2003 law from covering drugs prescribed to treat weight loss. But that doesn’t mean that Part D plans never cover weight-loss drugs. Part D plans can—and often do—cover GLP-1s if those drugs are FDA-approved and prescribed for a medical condition other than obesity. Examples: Some GLP-1s have been FDA-approved to treat type 2 diabetes, cardiovascular disease risk and/or sleep apnea. “The sleep apnea coverage is huge for a lot of people,” says Bigham Steele. “It’s something that a lot of people don’t even realize they have. They only find out after going through a sleep study.”
What’s Changing: The Medicare GLP-1 Bridge and BALANCE Model
Once the Medicare GLP-1 Bridge program launches on July 1, 2026, Medicare will begin covering certain GLP-1s even when they’re prescribed specifically for weight loss as long as the patient meets certain eligibility requirements. The Bridge program does not override the 2003 law prohibiting Plan D plans from covering weight-loss drugs. It sidesteps it by providing coverage of GLP-1s through a demonstration program that isn’t part of Part D.
One consequence of using this workaround to circumvent the rules governing Medicare Part D and weight-loss drugs: While eligibility for the Bridge program is restricted to people who currently have Medicare Part D (or a Medicare Advantage plan that includes drug coverage), the Bridge program’s $50-per-month copays won’t count toward the Part D out-of-pocket max, which is $2,100 in 2026.
The Bridge program is currently slated to run through the end of 2027. Originally it was intended to run through the end of 2026, at which point a longer-term GLP-1 coverage program dubbed the Medicare BALANCE Model would have begun, but that BALANCE Model is now on indefinite hold.
Which Weight-Loss Drugs Will Be Covered?
So far, only three weight-loss medications are available through the Bridge program—Wegovy, Zepbound and Foundayo. But this Medicare coverage for Wegovy and Zepbound won’t be precisely the same—while both the daily pill and weekly injection version of Wegovy are offered, only the KwikPen weekly injection version of Zepbound is covered. Foundayo is available only in daily pill form. “Which of these drugs you use should probably be based on your doctor’s recommendation,” says Bigham Steele. And keep in mind—this list of covered GLP-1s could change over the course of the Bridge program.
Who Is Eligible for Medicare Weight-Loss Drug Coverage?
If you’re enrolled in a Medicare Part D plan (or a Medicare Advantage plan that includes prescription drug coverage), you’re likely to be eligible for this coverage if you are at least age 18 and…
- Have a body mass index (BMI) of 35 of higher
- Or have a BMI of 30 or higher and one or more of uncontrolled hypertension, heart failure with preserved ejection fraction or chronic kidney disease stage 3A or above
- Or have a BMI of 27 or higher and also one or more of prediabetes, a prior heart attack, prior stroke or symptomatic peripheral artery disease.
A few caveats are worth noting about these eligibility criteria…
You could qualify for the Bridge program even though your BMI falls short of the figures cited above if you already are taking a GLP-1 and your BMI was high enough to qualify immediately before your use of that weight-loss drug began.
On the other hand, if you already are taking a GLP-1 to treat diabetes, sleep apnea or a heart condition, then you’re not eligible for the Bridge program—your prescription instead should continue to be covered by your Medicare Part D (or Medicare Advantage). “We’ve had a lot of people ask us, ‘Well I’m already on it because I’m diabetic so how do I get it now?” says Bigham. “If you’re already getting it through a Part D plan because it’s for your diabetes or sleep apnea or something like that, it’s going to continue to be covered under your Part D plan.”
Whether it’s better to receive GLP-1 coverage through the Bridge program or Part D varies.
If you easily meet your Part D plan’s out-of-pocket max every year, then getting your GLP-1 through that plan is preferable because you won’t have to ante up an additional $50 per month for the Bridge program’s co-pays.
But if you don’t meet your Part D out-of-pocket max, then the Bridge program is probably the better deal, because its $50 monthly copays are likely to be substantially lower than your Part D’s copays for these drugs. Medicare weight-loss drug copays vary, but the average out-of-pocket cost to obtain GLP-1s through Part D at the end of 2025 was $167 per month and climbing, according to a study by researchers at University of Pennsylvania.
How Will Coverage Work? Enrollment, Prior Authorization and Copays
Wondering exactly how the Bridge program will work? With the clock ticking down to the start of this coverage, many health-care professionals are wondering the same thing. “We’ve talked to some doctors and they’re not sure,” says Bigham. “They haven’t gotten a ton of information either.”
What has been laid out by the Centers for Medicare & Medicaid Services (CMS) as of mid-May is that when a doctor determines that his/her patient qualifies for the Bridge program, that doctor will send a prior authorization request directly to a centralized system administered by Humana. Patients will pay the program’s $50 monthly copays at their pharmacies.
What Happens After 2027? The BALANCE Model Explained
What lays ahead for FDA-approved weight-loss drugs and Medicare remains unclear. The intended transition from the Bridge program to the BALANCE Model is on indefinite hold, and as of May 2026 no replacement post-Bridge-program plan has been enacted. This is a crucial issue in part because patients who discontinue use of GLP-1s tend to regain much or all of the weight they lost while taking the drug, according to several studies, including a meta-analysis by researchers at England’s University of Oxford.
“People keep asking ‘What’s going to happen on December 31, 2027?’” says Bigham Steele. “For now, all we can tell them is ‘That’s a great question, the answer to which we will find out together’.”
Alternatives If You Don’t Qualify or Need Help Now
If you don’t qualify for the Bridge program and you’re seeking alternatives to Medicare coverage for weight-loss drugs, you could consider paying for these expensive drugs out of pocket. But before anteing up, ask your doctor if it’s worth investigating whether you have a heart or sleep problem that could qualify you for coverage through Part D. “It’s definitely good to see if you qualify through any other way,” says Bigham Steele. “If you think you might have sleep apnea…if you have certain sorts of heart issues…see if any of those conditions qualify.”
