Medicare GLP-1 Bridge: Who Qualifies for $50 Wegovy and Zepbound

We built this guide from CMS’s program pages and prior authorization form, Medicare.gov, KFF and drugmaker announcements, checked September 25–26, 2026. It’s general information, not medical advice.

What Is the Medicare GLP-1 Bridge?

The Medicare GLP-1 Bridge is a temporary demonstration run by CMS, the federal agency that runs Medicare. It covers three weight-loss drugs for people with Part D at a flat $50 copay, from July 1, 2026 through December 31, 2027.

Medicare law still bars Part D plans from covering drugs used for weight loss, as KFF explains. So CMS runs the Bridge outside your drug plan, under a 1967 law (Section 402) that lets Medicare test new ways of paying for care. Humana processes approvals, claims and pharmacy payments for CMS, and your plan pays nothing.

The $50 price traces back to the November 6, 2025 deals between the White House, Eli Lilly and Novo Nordisk. The drugmakers supply Bridge drugs at a $245 net price per month. The Bridge was due to end in December 2026 until CMS extended it through 2027 on April 21, 2026. There’s nothing to sign up for.

Which Drugs and Doses Does the Bridge Cover?

The Bridge covers every dose of Wegovy (pen and pill), all Foundayo tablets and the Zepbound KwikPen. Everything else is outside it, Zepbound vials included.

CMS added Foundayo on April 6, 2026, after FDA approval, and confirmed then that only the Zepbound KwikPen counts. One KwikPen holds a 28-day supply of weekly doses, and pen needles cost extra. Choosing between the two pills? See our comparison of the Wegovy pill and Foundayo.

Sources: CMS, Novo Nordisk, FDA drug code directory. The 7.2 mg Wegovy HD dose is approved for adults who have tolerated 2.4 mg for at least four weeks. Your prescriber decides your dose.

What Does the $50 Copay Really Cost You?

You pay $50 per one-month fill, and Medicare counts a month as 28 days for shots and 30 days for pills. Your dose and income don’t change the price.

Here’s the catch in that wording. Wegovy pens and the Zepbound KwikPen come in 28-day packs, so a year of shots takes about 13 fills, roughly $650. A year of pills is just over 12 fills, about $610. CMS doesn’t allow 60- or 90-day fills, so you can’t reduce the number of copays.

Two extra costs are easy to miss. Neither the Bridge nor Part D covers KwikPen needles; LillyDirect adds them for a fee. Telehealth companies also charge a membership fee.

Who Qualifies for the Medicare GLP-1 Bridge?

You qualify if you have an eligible drug plan, are 18 or older and meet one of three BMI rules. The drug must be prescribed for weight loss alongside diet and activity changes, and Medicare uses your BMI from when you first started a GLP-1.

The fine print shuts out a lot of people. KFF’s analysis of 2023 claims found 9.7 million Part D enrollees met the clinical criteria, but only 3.8 million met every rule.

The Three Diagnoses (and One Prescription) That Rule You Out

Type 2 diabetes, moderate-to-severe obstructive sleep apnea and MASH (a fatty liver disease) with moderate-to-advanced scarring all disqualify you. CMS’s logic is that Part D can already cover GLP-1s for those conditions. The rule applies even if your own plan doesn’t.

The fourth rule gets less attention. If your Part D plan paid for any GLP-1 in 2026, you can’t use the Bridge in 2026. That includes Wegovy for heart risk, Zepbound for sleep apnea and extra weight-loss coverage through a former employer’s plan. A prescription meant to lower heart attack and stroke risk also goes to Part D.

CMS checks. Your prescriber signs the form under penalty of perjury, and CMS can compare it with your Medicare records.

Medicare Advantage, Medigap, Medicaid and Extra Help

Most Medicare Advantage plans with drug coverage qualify, including HMOs, PPOs and Special Needs Plans such as D-SNPs for people with Medicare and Medicaid. Private fee-for-service plans don’t, unless you add a standalone Part D plan. Medigap doesn’t matter here: with Original Medicare and Medigap, you need a standalone Part D plan.

Dual eligibles in an eligible plan can use the Bridge but still pay $50, because Extra Help doesn’t apply and the Bridge doesn’t coordinate with other payers. KFF notes that the $50 may be hard to afford for some low-income enrollees. With full Medicaid, ask your state whether it covers weight-loss GLP-1s; 13 states did as of January 2026, per KFF. For employer and private coverage, see how insurance covers GLP-1s.

How Do You Apply for the Medicare GLP-1 Bridge?

You don’t apply yourself. Your prescriber sends a prescription, the pharmacy bills the Bridge, and your prescriber then files a prior authorization (an approval request). The steps run in this order:

1. Ask your prescriber whether you meet the rules and which drug fits you.
2. Your prescriber adds an obesity code (E66) and the note “SEND TO BRIDGE FOR WEIGHT MANAGEMENT.” Without it, the pharmacy may bill your Part D plan by mistake.
3. Give the pharmacy your Medicare Number from your red, white and blue card. The last four digits of your Social Security number also work.
4. Expect the first claim to be rejected. That’s on purpose: the rejection tells the pharmacy a prior authorization is needed.
5. The pharmacy sends the request to your prescriber, usually within 24 to 72 hours, and your prescriber submits the form.
6. A decision comes within 72 hours, and Medicare mails you a letter.
7. Pay $50 and pick up. Refills and dose changes need no new approval through December 31, 2027. Switching drugs does.

What’s on the Prior Authorization Form?

The official Medicare GLP-1 Bridge Prior Authorization Request Form is a three-page CMS document. Only prescribing clinicians can submit it, through CoverMyMeds or by fax to 1-800-530-2404.

Its 12 questions screen for sleep apnea, MASH and type 2 diabetes. They also ask for your BMI range when you started a GLP-1 and cover the qualifying conditions in the table above. Bring records of your starting weight and BMI, especially if another clinic started your GLP-1.

Why Bridge Claims Get Rejected, and What to Do

Most rejections have a fix, according to CMS’s pharmacy reject-code guide:

• If your Medicare Number or birth date doesn’t match, the pharmacy re-checks your card details.
• If you had no Part D on the fill date, or your plan type doesn’t count, call 1-800-MEDICARE.
• If your Part D plan already paid for a GLP-1, the Bridge is closed to you. Ask your plan about a formulary exception.
• If the product is wrong, such as Zepbound vials, your prescriber sends a new KwikPen prescription.
• If more than 30 days were requested, the pharmacy resubmits as a 28- or 30-day fill.
• If it’s too soon to refill, wait until about 75% of your supply is used.

Which Pharmacies Fill Medicare GLP-1 Bridge Prescriptions?

Pharmacies don’t have to sign up for the Bridge, so a retail store or a mail-order pharmacy can bill it. If yours hasn’t filled a Bridge claim before, call ahead.

At the counter, ask them to bill the Bridge as your primary coverage, not your Part D plan. Lilly’s patient guide lists the codes: BIN 028918, PCN MEDDGLP1BR, Group GLP1Bridge. The Bridge doesn’t take paper claims or repay members, so paying full price and mailing in a receipt won’t work.

For home delivery, LillyDirect Pharmacy fills Bridge prescriptions for the Zepbound KwikPen and Foundayo. Lilly says a checkout link arrives within two business days of approval, with delivery about three business days after checkout. All sales are final. For Wegovy, NovoCare’s Obesity & Bridge Support line is 1-888-809-3942 (weekdays, 8 a.m. to 8 p.m. ET).

Traveling? Pharmacies can use a vacation override for an early fill, but lost or stolen medicine can’t be replaced.

Already on a GLP-1? How to Switch to the $50 Price

If you pay cash for Wegovy, Zepbound or Foundayo today, you can usually switch, as long as you met the rules when you started. Medicare.gov says people who began a GLP-1 through a self-pay program before July 1, 2026 may qualify.

CMS’s own example: someone who started at a BMI of 37 and is now at 34 still meets the BMI 35 rule. Get records of that starting number from whoever first prescribed your GLP-1.

Some switches need a new prescription. Zepbound vials and single-dose pens don’t count, so you’d move to the KwikPen, and any change to a different covered drug needs a new prior authorization. Compounded semaglutide and tirzepatide aren’t covered at all. CMS hasn’t said whether a compounded start sets your starting date, so ask your prescriber how they’ll document it. If your compounded supply is ending anyway, read what’s legal now for compounded GLP-1s.

Can a Telehealth Company Handle the Bridge for You?

Yes. Some telehealth companies will write the prescription and do the prior authorization for you, but you pay their fee on top of the $50.

Found is one. It says it handles the prior authorization process for members, and it lists Wegovy, the Zepbound KwikPen and Foundayo for eligible Bridge patients. In September 2026, its brand-name-drug membership ran $49 to $149, depending on plan length and whether you use insurance. Found bills every 28 days, so that’s about $637 to $1,937 a year before the drug.

Found doesn’t serve Alaska, Arkansas, Delaware, Louisiana, Mississippi, Rhode Island, Vermont or West Virginia. Joinfound.com is LegitScript-certified (lookup on September 25, 2026), and we score Found 3.8 out of 5 in our Found review.

Your own doctor may be cheaper. Medicare’s 2027 fact sheet says you can get Medicare telehealth services at home through December 31, 2027, so ask whether a video visit can cover the prescription.

We explain our affiliate model on how we make money.

What Happens When the Medicare GLP-1 Bridge Ends?

Nothing is set to replace the Bridge after December 31, 2027. Every approval ends that day, and Medicare hasn’t announced weight-loss drug coverage for 2028.

CMS planned for the Bridge to lead into its BALANCE Model, where Part D plans would cover GLP-1s for weight loss at negotiated prices from January 2027. On April 21, 2026, CMS put that Part D launch on hold “pending further evaluation and data collection.” KFF noted reports that major Part D plans were reluctant to join. It sees no clear path to coverage after 2027 unless the Bridge is extended again or BALANCE starts in Part D.

Two things do change on January 1, 2027. The Part D out-of-pocket cap rises to $2,400. And Medicare’s negotiated semaglutide price, $274 a month for Ozempic, Rybelsus and Wegovy, starts for Part D-covered uses such as diabetes. It doesn’t add weight-loss coverage.

So plan for 2028 now: know your cash options, including where to buy FDA-approved GLP-1 injections online, and watch for CMS news in 2027.

What Should You Check During Medicare Open Enrollment?

Open Enrollment runs October 15 to December 7, 2026, and changes take effect January 1, 2027. If you’re on the Bridge or plan to be, check five things:

• Stay in an eligible plan type. A standalone Part D plan or a Medicare Advantage HMO or PPO with drug coverage keeps you in. Private fee-for-service, cost plans and PACE don’t, unless you add a standalone Part D plan.
• Ignore Bridge “perks” in plan ads. CMS bars plans from advertising the Bridge or tying it to enrollment. Any eligible plan gets you the same $50.
• Don’t fill a GLP-1 through Part D while you’re on the Bridge. That ends your eligibility, and CMS hasn’t set its 2027 look-back rule.
• Price your other drugs. The Bridge copay won’t move you toward the $2,400 cap.
• If you have diabetes, sleep apnea, MASH or heart disease, compare how each plan covers GLP-1s, since yours goes through Part D.

Compare plans at Medicare.gov/plan-compare or with a free State Health Insurance Assistance Program (SHIP) counselor.