Some of the most well-known diabetes and weight loss medications currently on the market – glucagon-like peptide-1s (GLP-1s) – are out of reach for many people because of their high cost. Weight loss drugs can run upwards of $300 per month, and that’s only if you’re able to get them through coupon programs or direct from the manufacturer. Many employer-sponsored benefit plans are dropping coverage because of the cost of the medications, and many other health plans, including Medicare Part D, only cover them for certain conditions like Type 2 diabetes and heart disease (not weight loss alone).
Because of the high demand among Medicare recipients wanting GLP-1s for weight loss, the Centers for Medicare and Medicaid Services (CMS) recently changed its coverage. Beginning in July 2026, the Medicare GLP-1 Bridge program began. It’s a pilot program that runs through December 2027 and covers GLP-1s strictly for weight loss. You may be eligible if you are a Medicare recipient whose Part D plan won’t cover the drugs. If you have an active Part D plan and a doctor’s prescription for a GLP-1, you can now get the medications for a $50 monthly copay. Read on for step-by-step instructions for the Bridge program.
Step 1: Confirm your Medicare Part D enrollment
To be eligible for Medicare’s GLP-1 weight loss drugs coverage Bridge program, you must have an active Part D drug plan. This includes Medicare Advantage prescription drug coverage, a standalone Medicare prescription drug plan, or a Special Needs Plan (like a Chronic Condition Special Needs Plan, or C-SNP). If you are new to Medicare or thinking about switching your Part D plan, you can browse options for the 2027 plan year with SmartMatch’s shopping tool.
Step 2: Verify Medicare GLP-1 eligibility criteria
You may be eligible for Medicare’s GLP-1 Bridge program if you meet these guidelines:
- You are older than 18 and have Part D coverage;
- You meet the body mass index (BMI) requirements, which are:
- A BMI of 35 or higher;
- A BMI of 30 or higher AND you have some types of heart failure, uncontrolled high blood pressure, or chronic kidney disease;
- A BMI over 27 with prediabetes, or you’ve had a heart attack, artery blockage in your legs or arms, or a stroke.
Medicare Part D already covers GLP-1s for:
- Diabetes,
- Heart disease,
- Moderate to severe sleep apnea,
- MASH (metabolic dysfunction-associated steatohepatitis).
If you have one of these conditions, talk to your doctor and Part D carrier to see if you’re eligible for coverage outside of the Bridge program.
Step 3: Work with your doctor to identify covered GLP-1 medications
Not all GLP-1s are covered under the Bridge program. Though there are a host of them on the market, the Bridge plan covers three brand-name GLP-1s:
Wegovy, a weekly at-home injection that contains semaglutide, which acts on the GLP-1 hormone. Bridge also covers the Wegovy pill, which must be taken in the morning before food.
Zepbound KwikPen contains tirzepatide, which acts on GLP-1 and GIP receptors (glucose-dependent insulinotropic polypeptide), another stomach hormone.
Foundayo contains orforglipron and is a small-molecule GLP-1 receptor agonist pill taken daily at any time, with or without food.
Some of these medications have been found to be more effective at helping with weight loss than others. Some have different side effects. Talk to your doctor about which one may be right for you.
Step 4: Schedule your doctor’s visit and submit prior authorization
If you’re interested in taking a GLP-1, your doctor can help you understand if you meet the requirements. If you qualify, your doctor will send a prescription to your preferred pharmacy, which will need your Medicare ID number. After the pharmacy has verified your eligibility for the Bridge program, your doctor will need to fill out a prior authorization form and send it to CMS for approval. Medicare will send you a note to let you know you’ve been approved.
Step 5: Fill your prescription at a participating pharmacy
When your GLP-1 prescription is ready, pick it up at your local pharmacy. There is a $50 copay for a month’s worth of the drug. This copay doesn’t count toward your deductible or out-of-pocket maximum. Your doctor will typically start you on the lowest dose of your GLP-1 and gradually increase it to find the most effective dose. You won’t need to get authorization as your dosage increases as long as you stay on the same drug.
GLP-1s can play an important role in your weight loss journey. It’s important to talk with your doctor about your weight, other health conditions, and potential side effects of the medication. If you need information about your Part D plan and its coverage of GLP-1s, contact a licensed SmartMatch agent who can help you get the most from your prescription drug benefits.
