GLP-1 Weight-Loss Drug Demonstration Begins July 2026

Starting in July 2026, some people with Medicare will be eligible for Medicare coverage of certain weight-loss medications through the new Medicare GLP‑1 Bridge Program.

Background

Under federal law, Medicare Part D plans cannot cover medications prescribed for weight loss, among several other “excluded” categories of drugs and indications. Medications that are FDA-approved for both weight loss and other indications may only be covered by Part D plans for non-weight loss indications.

GLP-1 drugs, which include medications used to treat type 2 diabetes, obesity, cardiovascular disease, and other conditions, have greatly increased in popularity in recent years due to their demonstrated effectiveness. But the federal exclusion limits Medicare coverage of these drugs.

Changing the law to permit or require Medicare Part D plans to cover medications for weight loss would require Congress to act.

Changing the law to permit or require Medicare Part D plans to cover medications for weight loss would require Congress to act. But the Centers for Medicare & Medicaid Services (CMS) has the authority to test coverage changes through Center for Medicare and Medicaid Innovation (CMMI) models and other statutory demonstration authorities.

New Test Models Announced

To work within these parameters, originally CMS announced two models to test expanded access to GLP-1 medications for people with Medicare: the GLP-1 Bridge Program and the Better Approaches to Lifestyle and Nutrition for Comprehensive Health (BALANCE) model.

The GLP-1 Bridge Program is a time-limited program that will provide eligible Medicare beneficiaries with access to certain GLP-1 drugs outside of the Part D benefit.

The BALANCE model would have allowed Part D plans to opt into the program to provide coverage for GLP-1 drugs for weight loss for their enrollees.

The BALANCE Model will be delayed indefinitely and the GLP-1 Bridge will be extended through 2027.

In its initial announcements, CMS indicated that the GLP-1 Bridge program would run from July 1, 2026, through the end of the year, with the BALANCE Model beginning in January 2027. But CMS announced in May 2026 that the Part D portion of the BALANCE Model will be delayed indefinitely and that the GLP-1 Bridge will be extended through December 31, 2027.

What Is the Medicare GLP‑1 Bridge Program?

The GLP‑1 Bridge Program will give eligible Medicare beneficiaries temporary access to certain weight‑loss drugs. The program will start July 1, 2026, and end December 31, 2027.

In the Bridge Program:

• Approved GLP-1 medications will be provided through a special program. Importantly, this is not the regular Part D drug plan.
• The Part D plan does not have to sign up for this program or participate
• A central system run by Medicare will handle approvals, process claims, and pay pharmacies.

What Medications Are Included?

Three GLP-1 medications will be covered under the Medicare GLP-1 Bridge Program:

• Wegovy (both injections and tablets)
• Zepbound (KwikPen)
• Foundayo

Who Is Eligible?

To be eligible, a person must:

• Be 18 or older
• Need the GLP-1 medication for weight loss and keeping weight off, meaning a person must meet one of these weight and health criteria to be eligible:
  • BMI of 35 or higher
  • BMI of 30 or higher and have certain health conditions, such as:
    • Heart failure
    • Uncontrolled hypertension
    • Chronic kidney disease
  • BMI of 27 or higher and have other health risks, such as:
    • Pre-diabetes
    • Heart attack
    • Peripheral artery disease
• Have Medicare with prescription drug coverage either through a standalone Part D plan or a Medicare Advantage plan that includes drug coverage
• Have prior authorization/approval from the Bridge Program.

How Much Will the GLP-1 Medications Cost?

Under the GLP-1 Bridge Program, people will pay a fixed $50 monthly copayment. The Bridge Program is separate from regular Medicare Part D drug coverage. This means the $50 copay will not count toward the deductible or out-of-pocket limit. Cost assistance programs like Extra Help cannot be used, and the $50 copay stays the same, no matter what stage of Part D applies.

These financial factors make it vital for interested Medicare enrollees to thoroughly weigh the pros and cons of using the Bridge Program to access these medications.

For More Information

Read more from Medicare Interactive.

Read more from CMS.

Read more from KFF.