Information for Medicare Beneficiaries

The Medicare GLP-1 Bridge is a short-term demonstration run by CMS that will provide eligible Medicare Part D beneficiaries with access to certain GLP-1 drugs between July 1, 2026, and December 31, 2027.

Beneficiaries are not required to register or opt-in to access GLP-1 drugs via the Medicare GLP-1 Bridge and do not need to take any action at this time. More detailed information for beneficiaries on how to access GLP-1s through the Medicare GLP-1 Bridge will be forthcoming prior to the launch on July 1, 2026.

The Medicare GLP-1 Bridge will be nationwide and available in all states and territories. Only Medicare Part D beneficiaries who are enrolled in eligible plan types,  use GLP-1s to reduce excess body weight and maintain weight reduction, and meet the Medicare GLP-1 Bridge Clinical Criteria (see FAQ “What clinical criteria must a beneficiary meet in order to qualify for the Medicare GLP-1 Bridge?”) will be eligible for coverage under the Medicare GLP-1 Bridge. 

Eligible plan types: To qualify for coverage of eligible GLP-1 drugs via the Medicare GLP-1 Bridge, Medicare beneficiaries must be enrolled in a standalone prescription drug plan (PDP) or Medicare Advantage (MA) coordinated care plan (i.e., HMO, HMOPOS, and Local and Regional PPO plans) that offers prescription drug coverage (MA-PD plans) in CY 2026. Part D beneficiaries in Special Needs Plans (SNPs), employer/union group waiver plans (EGWPs), and the Limited Income Newly Eligible Transition (LI NET) program are eligible to participate. Beneficiaries enrolled in private fee-for-service plans, section 1876 cost contract plans, section 1833 health care prepayment plans, PACE organizations, fallback plans, and religious fraternal benefit plans are not eligible to participate, unless also enrolled in a standalone PDP, as applicable. Additionally, dually-eligible beneficiaries who are enrolled in eligible Part D plan types and meet the prior authorization criteria will have access to GLP-1 drugs via the Medicare GLP-1 Bridge.

Please note that the Medicare GLP-1 Bridge is a Section 402 demonstration and does not constitute a Medicare Part D plan offering prescription drug coverage. Beneficiaries in need of prescription drug coverage should contact 1-800-MEDICARE (1-800-633-4227) or their local State Health Insurance Assistance Program (SHIP). 

TRICARE For Life beneficiaries will have access to GLP-1 drugs via the Medicare GLP-1 Bridge ONLY if they are enrolled in a Medicare GLP-1 Bridge eligible Part D plan type and meet the prior authorization criteria under the Medicare GLP-1 Bridge. 

Eligible beneficiaries will have a $50 copay. Eligible GLP-1 drugs furnished under the Medicare GLP-1 Bridge are provided outside of the Part D benefit payment flow and coverage. This means that the Part D deductible will not apply, no part of the $50 copay counts towards the beneficiary’s TrOOP costs, and there is no low-income subsidy (LIS) provided for LIS beneficiaries. 

At this time, for the purposes of the Medicare GLP-1 Bridge, an eligible GLP-1 drug is any of the following products when used to reduce excess body weight and maintain weight reduction: Foundayo®, Wegovy® (injection and tablets), and Zepbound® (KwikPen®). 

Note: This was updated on April 6, 2026, to include Foundayo® following FDA approval and to clarify that only the KwikPen®  formulation of Zepbound® is included.

Beginning July 1, 2026, all formulations of Foundayo®, all formulations of Wegovy®, and the KwikPen ® formulation of Zepbound® will be available to eligible beneficiaries through the Medicare GLP-1 Bridge. The single-dose vial and single-dose pen formulations of Zepbound® will not be available through the Medicare GLP-1 Bridge. The specific National Drug Code (NDCs) are listed below:  

• Foundayo® NDCs: 0002-4178-31, 0002-4503-31, 0002-4794-31, 0002-4803-31, 0002-4839-31, 0002-4953-31
• Wegovy® NDCs: 0169-4525-14, 0169-4505-14, 0169-4501-14, 0169-4517-14, 0169-4524-14, 0169-4415-31, 0169-4404-31, 0169-4409-31, 0169-4425-31, 0169-4572-14.
• Zepbound® NDCs: 0002-3566-11, 0002-3555-11, 0002-3544-11, 0002-3533-11, 0002-3522-11, and 0002-3511-11.   

This list of products and NDCs may be updated over the course of the Medicare GLP-1 Bridge.  

To access GLP-1 medications via the Medicare GLP-1 Bridge, an eligible beneficiary must have a medical provider submit a prior authorization request and a prescription for an eligible GLP-1 drug for a use covered under the demonstration. Prior authorization requests will be accepted electronically or by fax using the Medicare GLP-1 Bridge prior authorization form. CMS strongly encourages providers to submit prior authorization electronically. 

Providers do not need to take any action at this time. CMS will provide additional information on prior authorization processes in June 2026, including the Medicare GLP-1 Bridge prior authorization fax form, on the CMS webpage for the Medicare GLP-1 Bridge. Prior authorization requests will not be accepted or processed before July 1, 2026, at which point a provider may submit a prescription to a pharmacy and will receive a request to complete prior authorization.

Additional information on how to submit a prior authorization request will be available on the CMS webpage for the Medicare GLP-1 Bridge in June 2026. Prior authorization requests will not be accepted or processed before July 1, 2026. 

For a beneficiary to qualify for the Medicare GLP-1 Bridge, a provider must submit a prior authorization request that attests the beneficiary meets the following criteria:

• The beneficiary is prescribed the requested drug to reduce excess body weight and maintain weight reduction in combination with current and ongoing lifestyle modification including structured nutrition and physical activity consistent with the applicable FDA approved label, AND
  • The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to thirty-five (≥35) at the time of initiation of GLP-1 therapy, or
  • The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to thirty (≥30) at the time of initiating GLP-1 therapy with a diagnosis of one or more of the following: (A) heart failure with preserved ejection fraction, (B) uncontrolled hypertension (defined as systolic blood pressure above 140 mm Hg or diastolic blood pressure above 90 mm Hg, despite concurrent treatment with two antihypertensive medications), or (C) chronic kidney disease stage 3a or above, or
  • The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to twenty-seven (≥27) at the time of initiating GLP-1 therapy with a diagnosis of one or more of the following: (A) pre-diabetes (as defined by American Diabetes Association guidelines), (B) previous myocardial infarction, (C) previous stroke, or (D) symptomatic peripheral artery disease.

The Medicare GLP-1 Bridge was designed to increase access to GLP-1s for beneficiaries who seek the drug solely to reduce excess body weight or maintain weight reduction. Type 2 diabetes, obstructive sleep apnea, and noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) indications are eligible for Part D coverage. Beneficiaries with these diagnoses are eligible to receive GLP-1s through their Part D plan and therefore are ineligible to receive them through the Medicare GLP-1 Bridge, even if they otherwise meet the Medicare GLP-1 Bridge clinical criteria. Eligible GLP-1s are only furnished under the Medicare GLP-1 Bridge, with the $50 co-pay, when prescribed for a weight management indication. If a Medicare Part D beneficiary has a prescription for a GLP-1 drug for an indication covered under Medicare Part D, they should continue to obtain their GLP-1 through their Part D plan. 

Eligible beneficiaries must meet the clinical criteria at the time of GLP-1 therapy initiation. This includes beneficiaries who initiated therapy prior to enrolling in Medicare Part D and/or prior to the July 1, 2026 launch of the Medicare GLP-1 Bridge. 

For example, if a beneficiary initiated GLP-1 therapy in September 2024 with a body mass index (BMI) of 37 and has a BMI of 34 at the time of a July 2026 prior authorization request, the prescribing provider should attest that the beneficiary met the BMI ≥35 criterion at the time therapy was initiated. 

Under the Medicare GLP-1 Bridge, participating manufacturers will provide eligible GLP-1 drugs at a net price of $245 per monthly supply. Coverage of eligible GLP-1 drugs furnished under the Medicare GLP-1 Bridge is provided outside of the Part D benefit payment flow and coverage. As such, no part of the $245 net price for eligible GLP-1 drugs prescribed for uses covered under the Medicare GLP-1 Bridge would count toward an eligible beneficiary’s gross covered prescription drug costs (GCPDC), and no part of the $50 copay would count toward the beneficiary’s true out-of-pocket costs (TrOOP) under their Part D plan. In addition, the $50 copay for eligible beneficiaries would remain the same, regardless of the phase of the Part D benefit an eligible beneficiary is in when they fill a prescription for an eligible GLP-1 drugs covered under the Medicare GLP-1 Bridge. Similarly, low-income cost-sharing subsidies would also not apply to any portion of the copay.

Beneficiaries who are prescribed an eligible GLP-1 drug for a use that is coverable under the basic Medicare Part D benefit, regardless of whether the eligible GLP-1 drug is on the Part D plan’s formulary (e.g., Zepbound® for the treatment of moderate to severe obstructive sleep apnea (OSA) in adults with obesity; Wegovy® to reduce the risk of major adverse cardiovascular (CV) events in adults with established CV disease and either obesity or overweight) would not qualify for coverage of that eligible GLP-1 drug under the Medicare GLP-1 Bridge. Part D plan sponsors must continue to follow their existing formulary exception processes for these requests. CMS will monitor Part D formulary and utilization management practices, including formulary exception processes, to ensure plans do not shift coverage or access decisions from the Part D benefit to the Medicare GLP-1 Bridge.

The Medicare GLP-1 Bridge was designed to increase access to GLP-1s for beneficiaries who seek the drug solely to reduce excess body weight or maintain weight reduction. Type 2 diabetes, obstructive sleep apnea, and noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) indications are eligible for Part D coverage. Beneficiaries with these diagnoses are eligible to receive GLP-1s through their Part D plan and therefore are ineligible to receive them through the Medicare GLP-1 Bridge, even if they otherwise meet the Medicare GLP-1 Bridge clinical criteria. Eligible GLP-1s are only furnished under the Medicare GLP-1 Bridge, with the $50 co-pay, when prescribed for a weight management indication. If a Medicare Part D beneficiary has a prescription for a GLP-1 drug for an indication covered under Medicare Part D, they should continue to obtain their GLP-1 through their Part D plan.