Does Medicare Cover Wegovy or Zepbound? (2026–2027)

What This Means

Medicare now covers weight loss drugs for the first time. For decades, federal law specifically excluded weight loss medications from Medicare Part D coverage. That exclusion — written into the Medicare Modernization Act of 2003 — has not been repealed. But starting July 1, 2026, CMS is running a demonstration program called the Medicare GLP-1 Bridge that covers two weight loss drugs: Wegovy (semaglutide injection and tablets) and Zepbound (tirzepatide). The drugs must be prescribed to reduce excess body weight and maintain weight reduction in combination with lifestyle modification.

The Bridge program operates outside of your normal Part D benefit. That means it is not run by your Part D plan. Instead, prior authorization goes through a central CMS processor (administered by Humana). You still need to be enrolled in a Part D plan to qualify, but the Bridge itself is a separate CMS program. The cost is a flat $50 copay per prescription — regardless of the drug’s retail price or where you are in your Part D benefit phases.

This program is temporary, but it runs longer than originally announced: the GLP-1 Bridge operates from July 1, 2026 through December 31, 2027. CMS first set it to expire at the end of 2026, with coverage continuing only through Part D plans that joined a new model called BALANCE. BALANCE is not launching in 2027, and CMS extended the Bridge through the end of 2027 instead. Because the Bridge sits outside the Part D benefit and does not depend on your plan’s formulary, you do not need to change Part D plans this fall to keep this coverage — we cover what that means in detail below.

Who Qualifies

To be eligible for the Medicare GLP-1 Bridge, you must be enrolled in a Part D plan (either a standalone PDP or a Medicare Advantage plan with Part D) for 2026, and you must be age 18 or older. You must also meet one of the following BMI-based criteria.

Your doctor will need to document your BMI and any qualifying conditions as part of the prior authorization process. If you are not sure whether you meet the criteria, talk to your doctor — they can review your medical history and determine your eligibility.

What It Costs

You will pay a $50 copay per prescription. That is the same whether you get Wegovy or Zepbound, and it does not change based on where you are in your Part D benefit year.

There are important limitations to understand about this $50 copay:

• It does not count toward your Part D deductible. You still need to meet your regular Part D deductible separately for your other medications.
• It does not count toward the $2,100 annual out-of-pocket cap. The $50 you pay for each GLP-1 Bridge prescription will not bring you closer to the Part D out-of-pocket maximum. It is entirely separate spending.
• Extra Help (Low-Income Subsidy) does not apply. Even if you qualify for Extra Help, which normally reduces or eliminates copays on Part D drugs, the $50 Bridge copay is not reduced. You will pay the full $50.

The $50 copay is a fixed cost set by CMS for this demonstration program. It is not subject to the normal Part D cost-sharing rules.

How to Get It

1. Talk to your doctor. Tell your doctor you are interested in Wegovy or Zepbound for weight loss under the Medicare GLP-1 Bridge. Your doctor will evaluate whether you meet the BMI and health condition requirements and whether one of these medications is appropriate for you. The prescription must be for weight loss with lifestyle modification.
2. Your doctor submits a prior authorization to CMS. This is different from a normal Part D prior authorization. Your doctor’s office will submit the request to CMS’s central processor — not to your Part D plan. The prior authorization confirms your BMI, qualifying conditions, and that the drug is being prescribed for the right purpose. Your doctor’s office will handle this paperwork.
3. Fill your prescription at any pharmacy. Once the prior authorization is approved, you can take your prescription to any pharmacy. You will pay the $50 copay at the counter. The pharmacy will process the claim through the Bridge program, not through your regular Part D plan.

One important exception: If the drug you need is already coverable under your Part D plan for a different medical reason, the Bridge does not apply. For example, semaglutide is also sold as Ozempic for type 2 diabetes, and tirzepatide is also sold as Mounjaro for type 2 diabetes. If your doctor prescribes these drugs for diabetes (or another Part D-covered condition), you would get them through your regular Part D benefit with your plan’s normal cost-sharing. The Bridge is specifically for Wegovy and Zepbound prescribed for weight loss.

What Happens When the Bridge Ends

The GLP-1 Bridge runs through December 31, 2027 — a year longer than CMS first announced.

The original plan was for the Bridge to expire on December 31, 2026, with coverage continuing in 2027 only through Part D plans that volunteered for a new CMS model called BALANCE. That is no longer what is happening. BALANCE is not launching in 2027, and CMS extended the Bridge through the end of 2027 in its place — in CMS’s words, to keep access open while it collects utilization data to share with Part D plan sponsors “ahead of potential implementation of BALANCE in Part D.” Potential: CMS has not announced a start date for BALANCE.

What this means for you right now:

• You do not need to switch Part D plans this fall to keep GLP-1 coverage. The open enrollment period running October 15 through December 7, 2026 has no bearing on your Bridge eligibility. The Bridge operates outside the Part D benefit, so no plan’s formulary decision can take it away, and no plan choice can secure it. If you are comparing plans for other reasons — your other medications, premiums, pharmacy networks — weigh those on their own merits.
• You do need to stay enrolled in a Part D plan. Part D enrollment (either a standalone PDP or a Medicare Advantage plan with drug coverage) is an eligibility requirement for the Bridge. If you drop Part D altogether, you lose access to it.
• Revisit this at the end of 2027, not the end of 2026. CMS has not said what, if anything, replaces the Bridge on January 1, 2028. Watch for CMS guidance during 2027, and talk to your doctor about continuity of your medication then.

If you were told earlier in 2026 that you would need to find a BALANCE plan for 2027, that guidance reflected the original schedule and is now out of date.

Important Limitations

• Only Wegovy and Zepbound are covered. The Bridge does not cover other GLP-1 medications like Ozempic, Mounjaro, or Saxenda. Ozempic and Mounjaro are the diabetes-approved versions of the same active ingredients — they may be covered under your regular Part D benefit when prescribed for diabetes.
• The drug must be prescribed for weight loss. If your doctor prescribes the medication for a condition already covered by Part D (such as type 2 diabetes), use your regular Part D benefit instead — the Bridge does not apply.
• The $50 copay does not count toward your Part D deductible or the $2,100 out-of-pocket cap. This spending is entirely separate from your normal Part D benefit.
• Extra Help (Low-Income Subsidy) does not reduce the $50 copay. You pay the full $50 regardless of your income level.
• The program is temporary. Coverage under the Bridge runs July 1, 2026 through December 31, 2027. CMS has not announced what replaces it afterward, and BALANCE — the model once slated to take over in 2027 — is not launching that year.
• Prior authorization goes to CMS, not your Part D plan. Your doctor must submit the prior authorization to CMS’s central processor (administered by Humana), not to your Part D plan’s pharmacy benefit manager. CMS has described this single-central-processor arrangement for 2026; it has not yet said whether the same setup carries into 2027.
• Weight loss drugs are still excluded from Part D by statute. The Bridge is a CMS demonstration program. Federal law has not changed — the Medicare Modernization Act of 2003 exclusion remains in place. The Bridge works around it, not through it.

Sources

• CMS: Medicare GLP-1 Bridge — official program page; primary source for the July 1, 2026 – December 31, 2027 operating window, the $50 copay, and the extension made after BALANCE did not launch for 2027
• KFF: What Medicare’s Temporary Program Covering GLP-1s for Obesity Means for Beneficiaries — eligibility and cost details
• KFF: What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid — background on the BALANCE Model
• CMS: BALANCE Model — the model CMS had planned to run in 2027; it is not launching that year

Frequently Asked Questions