What is the Medicare GLP-1 Bridge, and do I qualify?

Centers for Medicare & Medicaid Services (CMS)

The Medicare GLP-1 Bridge: GLP-1s for $50 a month

Updated August 25, 2026

Medicare is running a temporary scheme that puts Wegovy, Zepbound and Foundayo at a flat $50 a month for people who qualify. It runs until 31 December 2027, your prescriber has to apply for you, and having type 2 diabetes rules you out of it.

What you pay: $50
Runs until: December 31, 2027

Read this part first

Any one of these means the program does not apply to you, however well you match everything further down.

Not eligible: You have type 2 diabetes

Then your Part D plan already covers a GLP-1, so the Bridge does not apply to you. Keep going through your plan. This surprises people, because it reads like being turned away for being sicker. It is not: it is CMS saying you already have the cover this scheme exists to substitute for.
Not eligible: You have moderate to severe obstructive sleep apnea

Also a Part D covered use, so also outside the Bridge.
Not eligible: You have noncirrhotic MASH

Metabolic dysfunction-associated steatohepatitis. Another Part D covered use, so also outside the Bridge.
Not eligible: You are on the Zepbound vial or the single-dose pen

Only the Zepbound KwikPen is covered. Lilly states that the Single-Dose Vial and the Single-Dose Pen auto-injector are not covered under the Bridge. If you are on either, the prescription has to be written for the KwikPen instead. There is a reason for it: a KwikPen holds four weekly doses in one 2.4 mL syringe, and a month of the starting dose costs a pharmacy about $482 that way against about $1,052 as four single-dose pens. Foundayo, which is a tablet, is unaffected.
Not eligible: You have no Medicare drug plan at all

The Bridge is a demonstration, not a drug plan, and it cannot be joined on its own. Call 1-800-MEDICARE or your State Health Insurance Assistance Program about getting drug cover first.

Who does qualify

You need all four of the first list, and any one of the second.

All four of these

You are 18 or over
You are on a Medicare drug plan that counts

A standalone Part D plan, or a Medicare Advantage plan with drug cover (HMO, HMO-POS, or a Local or Regional PPO). Special Needs Plans, employer and union group plans, and LI NET all count. Private fee-for-service, cost contract, PACE, fallback and religious fraternal benefit plans do not, unless you also hold a standalone Part D plan.
The prescription is for weight, not for another condition

CMS covers it only when the drug is prescribed to reduce excess body weight and keep it off, alongside ongoing changes to food and activity, in line with the label.
Your prescriber files a prior authorization and attests you meet the rules

You cannot apply yourself. Nothing happens until they file it.

And any one of these

BMI of 35 or over

Measured when you first started the GLP-1, not today.
BMI of 30 or over, plus one of three conditions

Heart failure with preserved ejection fraction; uncontrolled high blood pressure (above 140 systolic or 90 diastolic despite two blood pressure medicines); or chronic kidney disease at stage 3a or worse.
BMI of 27 or over, plus one of four conditions

Pre-diabetes as the American Diabetes Association defines it; a previous heart attack; a previous stroke; or peripheral artery disease with symptoms.

Three things that cost money and are easy to miss

The $50 does not count toward your out-of-pocket limit

Part D has a cap on what you pay in a year, and money you spend here does not count toward reaching it. Twelve months on the Bridge is $600 that moves you no closer to the cap than if you had spent nothing.

There is no extra help, even if you normally get it

If you have the Low Income Subsidy, it does not apply to the Bridge. Everybody pays the same $50. For somebody whose Part D copays are usually a few dollars, this scheme can be more expensive than their ordinary cover, not less.

It ends on 31 December 2027, and it is not a plan

This is a time-limited demonstration that sits outside Part D. Your plan carries no risk for it and did not have to agree to it. When it ends, the $50 price ends with it unless something replaces it.

Pen needles are not included

The Zepbound KwikPen needs pen needles and they are sold separately, through the pharmacy or online. The $50 does not cover them. Foundayo is a tablet, so it does not have this problem.

Why no Medicare drug plan covers this

It is not that plans have chosen not to. Federal law does not let them. Medicare drug coverage borrows its list of excluded medicines from the Medicaid rules, and weight-loss medicines are on that list.

Such term does not include drugs or classes of drugs, or their medical uses, which may be excluded from coverage or otherwise restricted under section 1396r-8(d)(2) of this title, other than subparagraph (E) of such section (relating to smoking cessation agents) Medicare Part D, covered drug defined and exclusions (42 U.S.C. 1395w-102(e))

The same sentence works two different ways. For Medicaid it makes covering these medicines optional, which is why the answer changes at a state line. For Medicare it rules the coverage out altogether. That is the reason this program exists as a separate arrangement rather than as part of a drug plan, and the reason shopping for a plan that covers Wegovy for weight loss will not find one.

Your plan does not get a say

This program is not part of your drug plan. It runs alongside it, on separate legal authority, with one central processor handling the paperwork and paying the pharmacy. Your plan carries no cost for it, and it does not have to agree to it.

Part D sponsors will not carry risk for eligible GLP-1 drugs furnished under the Medicare GLP-1 Bridge, and Part D sponsors do not have to opt in to the Medicare GLP-1 Bridge for eligible beneficiaries to access these drugs. Medicare GLP-1 Bridge: authority, and why it sits outside Part D

So if somebody at your plan tells you they do not offer this, that is not the test. The test is whether you are eligible, which is the checklist above.

The end date has already moved once

This program was built as a bridge to a permanent arrangement called BALANCE, under which Medicare negotiates prices with the manufacturers directly. BALANCE is not starting in Medicare drug plans in 2027, so the bridge was made longer to cover the gap.

Will the Medicare GLP-1 Bridge continue into 2027? Yes. The Medicare GLP-1 Bridge has been extended through December 31, 2027. BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model

That is worth knowing if you are planning around the end date, because it means the date is a decision rather than a law, and decisions move. It is still a date: nothing here promises another extension.

What to do, in order

Check the two things that rule people out first

If you have type 2 diabetes, sleep apnea or MASH, stop here: you go through your Part D plan instead. If you have no Medicare drug plan, that is the thing to fix first.
Work out your BMI at the time you started, not today

If you were already on a GLP-1 before July 2026, the number that counts is the one from when you started. CMS gives the example itself: started at 37, now 34, and you still qualify on the 35 rule.
Ask your prescriber to file the prior authorization

This is the whole application, and only they can do it. They attest that you meet the rules. Their helpline is 855-273-0102, Monday to Friday, 8am to 7pm Eastern.
Check the prescription carries the routing note

Lilly states that every Bridge prescription needs this exact note on it: "SEND TO MEDICARE GLP-1 BRIDGE FOR WEIGHT MANAGEMENT". That note is what tells the pharmacy to send the claim to the Bridge processor instead of billing your Part D plan. It is worth asking your prescriber to confirm it is there.
Take these four things to the pharmacy

The pharmacist needs BIN 028918, PCN MEDDGLP1BR, Group GLP1Bridge, and either your Medicare number or the last four digits of your Social Security number. You can use any retail pharmacy you like, or LillyDirect for home delivery. Most prior authorizations clear instantly and the rest come back within 72 hours.
Check your own status with Medicare

Medicare.gov/glp1bridge, or 1-800-MEDICARE (1-800-633-4227). TTY 1-877-486-2048. Lilly runs a separate line for the Bridge on 1-844-559-3471.

Which medicines it covers

Where to get the prescription

You need a prescriber to file the prior authorization, and it can be your own doctor. If you do not have one, Eli Lilly lists these independent telehealth companies as able to support Medicare Part D patients using the Bridge. Lilly says it does not endorse or recommend them, and neither do we. The fee below buys the appointment, not the medicine: under the Bridge the medicine is the $50.

Sesame
On Lilly’s telehealth panel. Cheapest recurring care fee on it

$99 a month for the care
WeightWatchers
On Lilly’s panel, and it runs its own affiliated medical group

$149 a month for the care
General Medicine
🔴 The only one on Lilly’s panel with no membership at all. Pay per visit

$100 a visit, self-pay
Form Health
Obesity-medicine physicians and registered dietitians. Left Lilly’s panel

No. It was listed on 25 August 2026 and is not on 26 August 2026
knownwell
On Lilly’s panel, and the only one with in-person clinics

$299 a visit, no membership

If the program rules you out, paying cash is the other route and it is not one price. See what every provider charges or compare the cash prices.

We earn a referral fee from some of the providers we list, though not from any named on this page. It never changes what you pay. How we make money

Sources

Every claim above is checked against the primary text, and the date is the day we last opened it.

1
Medicare GLP-1 Bridge
Centers for Medicare & Medicaid Services Primary text read and checked Checked August 25, 2026
2
Medicare GLP-1 Bridge: information for providers
Centers for Medicare & Medicaid Services Primary text read and checked Checked August 25, 2026
3
Medicare GLP-1 Bridge Program for Weight Loss Medicines
Eli Lilly and Company (LillyDirect) Primary text read and checked Checked August 25, 2026
4
Independent telehealth for obesity
Eli Lilly and Company Primary text read and checked Checked August 26, 2026

We publish information. We do not prescribe, we do not sell medication, and nothing here is medical advice. Eligibility is decided by CMS and by your prescriber, not by this page. Checked August 25, 2026.