Medicare GLP-1 Bridge Program: $50/Month — Now Live as of July 1, 2026
As of July 1, 2026, Medicare Part D beneficiaries can now 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).
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Does Medicare cover it? At a glance
| Drug | Covered? | How / cost |
|---|---|---|
| Zepbound (KwikPen only) $50/mo copay via Part D Bridge, July 1, 2026 – Dec 31, 2027. Vials + single-dose pens NOT covered. | Yes | $50/mo copay via Part D Bridge, July 1, 2026 – Dec 31, 2027. Vials + single-dose pens NOT covered. |
| Wegovy (injection + oral tablet) $50/mo copay via Part D Bridge, all formulations, July 1, 2026 – Dec 31, 2027. | Yes | $50/mo copay via Part D Bridge, all formulations, July 1, 2026 – Dec 31, 2027. |
| Foundayo (orforglipron) $50/mo copay via Part D Bridge, all formulations of the once-daily oral GLP-1. | Yes | $50/mo copay via Part D Bridge, all formulations of the once-daily oral GLP-1. |
| Ozempic Covered by your regular Part D plan for type 2 diabetes only. Not FDA-approved or covered for weight loss. | T2D only | Covered by your regular Part D plan for type 2 diabetes only. Not FDA-approved or covered for weight loss. |
| Compounded semaglutide / tirzepatide Not covered by the Bridge or Part D. Cash-pay only, see cheapest providers below. | No | Not covered by the Bridge or Part D. Cash-pay only, see cheapest providers below. |
Sources and full detail in which drugs are covered below. If you don't qualify, cash-pay options start around $99/mo.
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Which drugs are covered?
The at-a-glance table above gives the yes/no answer. Here's the detail on the four Bridge-covered products, including 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.
CMS released the official prior authorization request form on June 8, 2026. It specifies a two-step sequence:
- Your pharmacy first runs a claim against the dedicated Bridge processor (BIN 028918, PCN MEDDGLP1BR) and receives a denial, that denied claim opens the prior-auth pathway.
- Your prescriber then files the CMS form electronically via CoverMyMeds or by fax. Only prescribing clinicians can submit; beneficiaries cannot self-file.
- The PA routes through Humana for central processing regardless of your specific plan. Nothing is processed before July 1, 2026.
- 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, the form instructs your prescriber to record your initial BMI at the time therapy started.
Who qualifies, and the comorbidity twist
- ✓ 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
- ✓ Tier 1, BMI ≥ 35, no additional diagnosis required
- ✓ Tier 2, BMI ≥ 30 with HFpEF, uncontrolled hypertension, or CKD stage 3a+
- ✓ Tier 3, BMI ≥ 27 with pre-diabetes, prior MI, prior stroke, or symptomatic PAD
Not sure which tier you fall in? Enter your height and weight.
Rule of thumb: BMI 30+, or 27+ with a weight-related condition, generally qualifies for GLP-1 weight-management treatment.
Educational estimate only, not medical advice or a diagnosis. Your prescriber confirms eligibility. Full check: eligibility checker.
Providers to watch for the Bridge
These telehealth providers carry Bridge-covered drugs on their menus (in some cases announced as coming soon, not yet live). Useful now for a consultation, and worth watching as the Bridge rolls out.
$149/mo · 7.2/10
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.