Medicare to Start Covering GLP-1s for Weight Loss
As of July 1, eligible Medicare beneficiaries can access certain GLP-1 medications for weight-loss management through the Medicare GLP-1 BRIDGE Program, a temporary demonstration program administered by the Centers for Medicare & Medicaid Services. The program operates outside the Medicare Part D benefit and is designed to expand access for beneficiaries who do not otherwise qualify for GLP-1 coverage through Part D.
The program is scheduled to run through Dec. 31, 2027. Eligible patients pay $50 per month for a covered medication, regardless of their Part D plan’s deductible or out-of-pocket maximum. The monthly payment does not count toward either limit.
Patients Must Meet Specific Criteria
CMS intends for the program to provide access to patients who do NOT have Part D coverage for Wegovy (past myocardial infarction, cerebrovascular accident, peripheral artery disease, metabolic dysfunction-associated steatohepatitis) or Zepbound (moderate-to-severe obstructive sleep apnea). Eligibility is based on the patient’s Body Mass Index and diagnoses at the time GLP-1 therapy was initiated.
Patients must meet the following criteria via prior authorization:
- BMI of 35 or higher, regardless of additional qualifying diagnoses.
- BMI of 30 or higher with heart failure with preserved ejection fraction (HFpEF), uncontrolled hypertension or chronic kidney disease stage 3a or higher. For this program, uncontrolled hypertension is defined as systolic blood pressure above 140 mmHg or diastolic blood pressure above 90 mmHg despite concurrent treatment with two antihypertensive medications.
- BMI of 27 or higher with prediabetes, a previous MI, a previous stroke or symptomatic PAD.
Patients who are eligible to receive GLP-1 medications through their Part D plan are not eligible for BRIDGE. This includes patients with type 2 diabetes, moderate-to-severe OSA or noncirrhotic MASH with moderate-to-advanced liver fibrosis, for whom GLP-1 coverage may be available through Part D. Patients who have received a GLP-1 medication paid for by their Part D plan during 2026 are also ineligible for BRIDGE.
Because eligibility depends on coverage, clinical history and the indication for treatment, providers should review CMS guidance before prescribing.
Prescribing and Pharmacy Processing
Providers should assess potential eligibility before sending a prescription. The Medicare GLP-1 BRIDGE currently covers:
- Wegovy: Injectable and tablet formulations
- Zepbound: KwikPen formulation only
- Foundayo: Tablet formulation
The single-dose pen and vial formulations of Zepbound are not covered under the program. Pen needles must be purchased separately.
Prescribers should consider eligibility before prescribing. Prescriptions can be sent to any pharmacy. Prescriptions should include an obesity diagnosis code (E66.X) and the statement, “Send to BRIDGE for Weight Management” in the notes to pharmacy. Pharmacies will submit a claim to Humana, the central processor for the BRIDGE program. Humana will verify eligibility and request a prior authorization.
What Patients Can Expect
Eligible patients pay a flat $50 monthly copayment for covered medications through BRIDGE. This cost does not count toward their Part D deductible or annual out-of-pocket limit. Patients should be advised that prior authorization is required and that the process may take time. Those who already receive a GLP-1 product under Part D or who have covered conditions will not be eligible for BRIDGE.
We expect high demand and initial challenges as the program begins.
Additional Resources