Starting July 1, 2026 through Dec. 31, 2027 there are three GLP-1 drugs not typically covered by Medicare that will be available for $50/month. Wegovy (injection and tablet), Foundayo and Zepbound (KwikPen) are the 3 GLP-1 drugs that qualify for this Bridge program.

This Bridge program operates outside of Medicare. While it is necessary to have Part D coverage through a regular stand-alone Part D plan or Medicare Advantage plan, the $50 monthly copay will not count toward the 2026 Medicare TRooP (TRue out of Pocket) cost of $2,100.

To be eligible for this new program, a provider must submit a prior authorization request that confirms that the drug was prescribed to reduce excess body weight and maintain weight reduction in combination with current and ongoing lifestyle modification, structured nutrition, and physical activity. Applicants must meet one of these further criteria:

  1. Having a BMI of ≥35.
  2. Having a BMI ≥30 in combination with a diagnosis of a. heart failure, b. uncontrolled hypertension, or c. chronic kidney disease of stage 3a or above.
  3. Having a BMI ≥27 in combination with a diagnosis of a. pre-diabetes, b. previous myocardial infarction, c. previous stroke or d. symptomatic peripheral artery disease.

To access these GLP-1 medications, a doctor or provider much submit a prior authorization request and a prescription for one of the eligible GLP-1 drugs. These requests will NOT be processed prior to July 1, 2026. The prior authorization form and further information can be found at the website cited below.

Some Medicare Part D drug plans currently provide coverage for GLP-1 drugs only if prescribed in combination for another condition. These include Mounjaro, Ozempic, Rybelsus and Trulicity.

Finding the right plan and learning about new programs can feel confusing. The licensed insurance agents at On Point Insurance Agency (insuranceonpoint.com) are here to help you navigate these changes!

For more information visit: cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-medicare-beneficiaries.