# Medicare GLP-1 Bridge: Eligibility, $50 Copay, How to Apply Source: https://www.dietglp.com/blog/medicare-glp-1-bridge/ Published: 2026-10-20 Keywords: medicare glp-1 bridge, medicare glp-1 bridge program, medicare glp-1 bridge eligibility criteria, medicare glp-1 bridge program form, medicare glp-1 bridge application, medicare glp-1 bridge coverage, medicare glp-1 bridge prior authorization, medicare glp-1 bridge zepbound, medicare glp-1 bridge phone number, medicare glp-1 bridge central processor, what glp-1 does medicare cover, what is medicare glp 1 bridge program, glp-1 bridge program medicare, medicare glp-1 bridge program requirements **TL;DR:** The Medicare GLP-1 Bridge is a temporary CMS program that lets eligible people with Medicare drug coverage get Wegovy (shot or pill), Foundayo or the Zepbound KwikPen for a flat $50 a month. It runs from July 1, 2026 to December 31, 2027. You qualify with a BMI of 35 or more, or a lower BMI plus certain health conditions, and your prescriber handles the prior authorization. You need Part D or a Medicare Advantage plan with drug coverage, so open enrollment (October 15 to December 7, 2026) matters, and once you start, [Sharpy](https://apps.apple.com/us/app/glp-diet-app-sharpy/id6762084138) helps you keep your muscle with one protein target and one 20-minute workout a day. What is the Medicare GLP-1 Bridge, and can you use it? **It is a temporary Medicare program that lets eligible people get Wegovy, Foundayo or the Zepbound KwikPen for a $50 copay a month, from July 1, 2026 to December 31, 2027.** You need Medicare drug coverage, a qualifying BMI (35 or more on its own, or 27 to 30 or more with certain conditions) and a prior authorization from your prescriber. There is no separate sign-up form for you to fill out. The phrase "glp-1 bridge program medicare" just started climbing in Google and Bing suggestions, and the timing makes sense. Medicare open enrollment runs October 15 to December 7, 2026. If you want the Bridge, the drug plan you pick now matters. ## What is the Medicare GLP-1 Bridge program? For years, Medicare drug plans could not cover drugs used only for weight loss. The GLP-1 Bridge is a CMS demonstration that works around that. It runs outside the normal Part D benefit. Your Part D plan does not pay for the drug or set the rules. CMS does, through one central processor. It was first meant to end on December 31, 2026, when a longer program called the BALANCE Model would take over. On April 21, 2026, CMS delayed the Part D side of BALANCE because too few plans signed up, and extended the Bridge through December 31, 2027. ## Medicare GLP-1 Bridge at a glance | Item | What the official pages say | |---|---| | Dates | July 1, 2026 to December 31, 2027 | | Your cost | $50 copay per one-month supply (28 or 30 days) | | Covered drugs | Wegovy (shot or pill), Foundayo (pill), Zepbound KwikPen only | | Not covered | Zepbound single-dose vials and single-dose pens | | Who can use it | Age 18+, with a standalone Part D plan, a Medicare Advantage plan with drug coverage, a Special Needs Plan, an employer group plan (EGWP) or LI NET | | Approval | Prior authorization by your prescriber, valid through December 31, 2027 | | Help line | 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048 | | Where | Nationwide, including US territories | ## Medicare GLP-1 Bridge eligibility criteria Medicare.gov lists three ways to qualify. You need to meet one of them **at the time you start therapy**. | BMI | Plus at least one of these | |---|---| | 35 or higher | Nothing else needed | | 30 or higher | Diastolic heart failure, uncontrolled high blood pressure, or chronic kidney disease stage 3a or higher | | 27 or higher | Prediabetes, a past heart attack, a past stroke, or peripheral artery disease with symptoms | Your prescriber must also certify that you are using the drug as part of a lifestyle program focused on diet and exercise. That part is not just paperwork. Older adults lose muscle faster than younger people, and fast weight loss can speed that up. Our guide on [sarcopenia and GLP-1](/blog/sarcopenia-and-glp1/) explains why this matters after 65. ## Who is not eligible You cannot use the Bridge if you: - Already get a GLP-1 covered through your Part D plan. - Have type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease. Your regular Part D plan may cover a GLP-1 for these uses, at that plan's copay, which can be higher than $50. Our [Zepbound sleep apnea guide](/blog/zepbound-sleep-apnea/) covers that route. - Are under 18. - Have only Original Medicare (Parts A and B) with no drug coverage. ## How to apply: the Medicare GLP-1 Bridge prior authorization You do not enroll in the Bridge on your own. Here is how it works, step by step: 1. **Talk to your prescriber.** Ask if you meet the criteria and which covered drug fits you. 2. **The prescription goes to your pharmacy.** The pharmacy may ask for your Medicare Number or the last 4 digits of your Social Security Number. 3. **The prescriber completes the prior authorization.** It goes to the Bridge's central processor, not your Part D plan. CMS posts the fax form as a PDF on CMS.gov. Trade reports and health plan notices name Humana as the central processor, and say decisions usually come within about 72 hours. 4. **You get a letter.** Medicare mails a letter confirming your coverage under the Bridge. 5. **Refills are simpler.** The approval covers refills and dose changes through December 31, 2027. Switching to a different GLP-1 needs a new approval. If you get stuck, call 1-800-MEDICARE. They can check where your prior authorization stands. ## How the $50 copay works The $50 is your full cost per month for the drug. But it plays by different rules than your normal drug copays: - It does **not** count toward your Part D deductible or your yearly out-of-pocket limit. - It does not show up on your Explanation of Benefits or Medicare Summary Notice. - **Extra Help** (the low-income subsidy) cannot lower it. - You cannot spread it out with the Medicare Prescription Payment Plan. - Manufacturer savings cards cannot be used with Medicare. For comparison, self-pay prices for the same drugs start at $149 a month for the lowest pill doses and go up from there. See our [Wegovy pill cost guide](/blog/wegovy-pill-cost/) and [weight loss pill cost guide](/blog/weight-loss-pill-cost/) for every dose. ## Medicare open enrollment and the GLP-1 Bridge Open enrollment runs **October 15 to December 7, 2026**, and changes start January 1, 2027. Three things to check this fall: - **No drug coverage?** You need Part D or a Medicare Advantage plan with drug coverage to use the Bridge. Joining late can mean a lifetime late enrollment penalty, so ask 1-800-MEDICARE or your State Health Insurance Assistance Program (SHIP) how it applies to you. - **Switching plans?** Because the Bridge runs outside the plan, CMS says Part D plans do not need to opt in. Your Bridge approval follows you as long as you keep eligible drug coverage. Still, compare plans on your other medicines. - **After 2027?** No one knows yet. CMS has not set a new date for BALANCE in Part D. Unless CMS or Congress acts, Bridge coverage ends December 31, 2027. ## Does Medicaid have a $50 GLP-1 program? Not through the Bridge. The Bridge is for Medicare. Some headlines have mixed the two up. CMS said the Medicaid part of the BALANCE Model is moving forward in states that choose to join, and state applications were due July 31, 2026. Whether your state covers GLP-1s for weight loss depends on your state Medicaid program, so ask them directly. ## Protect your muscle once you start The Bridge makes the drug affordable. It does not protect your strength. Studies of GLP-1 drugs show a real share of the weight lost can come from lean mass, and for people on Medicare, keeping leg and grip strength is what keeps you independent. Two habits help most: enough protein every day and regular strength work. Our [protein target guide](/blog/protein-target-on-glp1/) shows how to set your number. [Sharpy](https://apps.apple.com/us/app/glp-diet-app-sharpy/id6762084138) turns that into one protein target, one 20-minute workout and one Shape Score each day, so you can see that you are losing fat, not muscle. Sharpy is not a medical device and is not part of Medicare or any drug maker. ## The bottom line The Medicare GLP-1 Bridge gives eligible people with Medicare drug coverage Wegovy, Foundayo or the Zepbound KwikPen for $50 a month through December 31, 2027. Qualify by BMI 35, or a lower BMI plus a listed condition. Your prescriber files the prior authorization. Use open enrollment to make sure you have drug coverage for 2027, and ask your doctor whether a GLP-1 is right for you. Then use [Sharpy](https://apps.apple.com/us/app/glp-diet-app-sharpy/id6762084138) to keep the muscle you have. ## Sources - [Medicare GLP-1 Bridge, Medicare.gov](https://www.medicare.gov/glp1bridge) - [Medicare GLP-1 Bridge, CMS](https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge) - [Medicare GLP-1 Bridge prior authorization form (PDF), CMS](https://www.cms.gov/files/document/glp-1-bridge.pdf) - [What Medicare's temporary program covering GLP-1s for obesity means for beneficiaries, KFF](https://kfforg.substack.com/p/what-medicares-temporary-program) - [Regulatory roundup: CMS extends Medicare GLP-1 Bridge, delays BALANCE in Part D, Rise Health](https://www.risehealth.org/insights-articles/regulatory-roundup-cms-extends-medicare-glp-1-bridge-delays-balance-in-part-d-and-more/) - [Medicare's $50 per month GLP-1 Bridge: what you need to know, Sheppard Mullin](https://www.sheppard.com/insights/blogs/medicares-50-per-month-glp1-bridge-what-you-need-to-know) - [Medicare is now covering some GLP-1 weight loss drugs for $50, ABC News (AP)](https://abcnews.com/amp/Health/wireStory/medicare-now-covering-glp-1-weight-loss-drugs-134368105) ## Frequently asked questions **Q: What is the Medicare GLP-1 Bridge program?** A: It is a short-term CMS demonstration that covers certain GLP-1 drugs for weight loss for people with Medicare drug coverage. Eligible people pay a $50 copay for a one-month supply. It started July 1, 2026 and runs through December 31, 2027. **Q: What are the Medicare GLP-1 Bridge eligibility criteria?** A: You must be 18 or older and have Medicare drug coverage. Medicare.gov lists three ways to qualify when you start therapy: a BMI of 35 or higher; a BMI of 30 or higher plus diastolic heart failure, uncontrolled high blood pressure or chronic kidney disease stage 3a or higher; or a BMI of 27 or higher plus prediabetes, a past heart attack or stroke, or peripheral artery disease with symptoms. **Q: What GLP-1 does Medicare cover through the Bridge?** A: Wegovy (injection or tablet), Foundayo (tablet) and Zepbound in the KwikPen only. Zepbound single-dose vials and single-dose pens are not covered. Ozempic and Mounjaro are diabetes drugs and stay under your regular Part D plan. **Q: How do I apply for the Medicare GLP-1 Bridge?** A: You do not fill out an application yourself. Your prescriber sends a prescription to your pharmacy and completes a prior authorization when asked. The prescriber also certifies that you are in a diet and exercise program. You get a letter in the mail confirming coverage. **Q: Where is the Medicare GLP-1 Bridge prior authorization form?** A: CMS posts the fax form at cms.gov/files/document/glp-1-bridge.pdf. Prior authorization goes to the program's central processor, not to your Part D plan. Trade reports name Humana as that processor. Approval lasts through December 31, 2027 unless you switch to a different GLP-1. **Q: What is the Medicare GLP-1 Bridge phone number?** A: Call 1-800-MEDICARE (1-800-633-4227) to ask about eligibility or check a prior authorization. TTY users can call 1-877-486-2048. The official page is Medicare.gov/glp1bridge. **Q: Who is not eligible for the Medicare GLP-1 Bridge?** A: People who already get GLP-1s covered by their Part D plan, people with type 2 diabetes, moderate to severe sleep apnea or fatty liver disease (their Part D plan may cover a GLP-1 for those), and anyone under 18. People with only Original Medicare and no drug coverage cannot use it either.