Medicare GLP-1 Bridge Program: $50/Month Starting July 1, 2026
Starting July 1, 2026, Medicare Part D beneficiaries can get Foundayo, Wegovy, and Zepbound KwikPen at a flat $50/month copay through the Medicare GLP-1 Bridge demonstration — confirmed by CMS, NPR, and KFF. The program runs through December 31, 2027.
The $50 copay does notcount toward the Part D deductible or the $2,100 annual out-of-pocket cap. Prior authorization is required and processed through Humana (CMS's designated central processor via LI NET infrastructure).
Which drugs are covered?
Four products are covered under the Bridge. Note the Zepbound restriction — only the KwikPen formulation qualifies.
Source: CMS Medicare GLP-1 Bridge, NPR May 2026, KFF
Which Medicare plans qualify?
Part D sponsors do not have to opt in — the Bridge runs as a separate CMS demonstration. Any beneficiary enrolled in one of the five eligible plan types automatically has access.
How prior authorization works
Humana is the single central processor for all Bridge prior authorizations and claims adjudication. This is the same Humana infrastructure that already runs the LI NET (Low-Income Newly Eligible Transition) program for CMS.
From your perspective as a patient, the process looks like any other Part D prior authorization:
- Your prescriber documents your BMI and any qualifying comorbidities in their clinical notes.
- They submit a PA request through your Part D plan's standard prior auth portal.
- The claim routes through Humana for central processing regardless of your specific plan.
- Once approved, you fill the prescription at any participating pharmacy at the $50 copay.
If you were already on a GLP-1 at a higher BMI and have since lost weight, your prescriber can attest in the PA that you met the BMI threshold when therapy started.
Who qualifies clinically?
- ✓ Enrolled in Medicare Part D (PDP, MA-PD, SNP, EGWP, or LI NET)
- ✓ Age 65+ OR disability via SSDI (24+ months) OR End-Stage Renal Disease
- ✓ BMI ≥ 30 (obesity), OR
- ✓ BMI ≥ 27 with a qualifying comorbidity (T2D, hypertension, CVD, sleep apnea, NAFLD, CKD, dyslipidemia)
Providers ready for the Bridge
These telehealth providers already prescribe Bridge-covered drugs and have Part D prior auth workflows in place. Useful now for consultation — and ready on day one when the Bridge launches.
$249/mo · 8.8/10
$212/mo · 7.8/10
$158/mo · 7.8/10
Frequently asked questions
Does the $50 copay count toward my Part D deductible?
No. The $50 copay is outside of standard Part D cost-sharing. It does not count toward the Part D deductible, nor does it count toward the $2,100 annual out-of-pocket cap (OOPC). This is intentional — CMS designed the Bridge as a separate demonstration layer so Part D sponsors don't need to opt in.
Will the $50 go up when I increase my dose?
No. The copay is flat at $50/month regardless of which dose you're on. Whether you're at the 0.25 mg Wegovy starting dose or the 2.4 mg maintenance dose, you pay $50.
Why is Zepbound KwikPen-only? What about the vials?
CMS restricted Zepbound to the KwikPen formulation for the Bridge. Single-dose vials and single-dose pens — which are often used by compounding pharmacies as reference products — are excluded. If you currently use vials, ask your prescriber about switching to KwikPen before July 1.
What does 'prior auth via Humana' mean for patients?
CMS designated Humana as the single central processor for all Bridge prior authorizations and claims, using the same LI NET infrastructure Humana already operates. In practice: your prescriber submits a prior auth the same way they submit any Part D PA. The claims then route through Humana's central processing regardless of which plan you're enrolled in.
Can I get the Bridge if I have Medicare Advantage?
Yes, if your Advantage plan includes Part D drug coverage (MA-PD). The Bridge is a CMS demonstration that runs separately from the plan — Part D sponsors don't have to opt in for their enrollees to access it.
What happens after December 31, 2027?
The BALANCE Model permanent CMMI program was canceled April 21, 2026. The Bridge is now the only federal Medicare obesity pathway. What happens after December 2027 is unresolved — CMS may extend the demonstration, Congress may pass the Treat and Reduce Obesity Act, or coverage may lapse. We'll update this page as details emerge.