How to enroll in the Medicare GLP-1 Bridge: $50 a month if you qualify

Who qualifies for the Medicare GLP-1 Bridge?

You qualify if you're 18 or older with eligible Medicare drug coverage, your BMI and diagnoses meet one of three tiers, and no excluded diagnosis applies.

Which Medicare plans count?

PDP

A standalone Part D plan alongside Original Medicare

MA-PD

A Medicare Advantage plan that includes drug coverage

SNP

A chronic-condition, dual-eligible or institutional Special Needs Plan

EGWP

An employer group plan that wraps Medicare drug coverage

LI NET

Transitional drug coverage for new low-income subsidy enrollees

Your Part D plan does not have to opt in, because the Bridge runs as a separate CMS demonstration.

If you have both Medicare and Medicaid, you can qualify through an eligible Part D plan. Medicaid enrollment alone is not enough.

Check CMS's exact plan-type rules before you change coverage.

Which BMI and diagnosis do you need?

• Tier 1BMI 35 or higherNo other diagnosis needed.
• Tier 2BMI 30 or higherWith heart failure with preserved ejection fraction (HFpEF), uncontrolled high blood pressure, or chronic kidney disease stage 3a or above.
• Tier 3BMI 27 or higherWith prediabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease.

If you started a GLP-1 at a higher BMI and have since lost weight, your prescriber records your initial BMI from when therapy started.

Which diagnoses send you to regular Part D instead?

Those diagnoses go through your ordinary Part D coverage, under your plan's formulary and authorization rules. A plan denial does not undo the exclusions.

CMS had not set the 2027 prior-use lookback when we checked on September 26, 2026.

A heart history can count toward a BMI tier for a weight-management prescription.

If your GLP-1 is prescribed to reduce major cardiovascular events, CMS sends it to ordinary Part D, even alongside weight management.

Ask your prescriber to confirm the actual indication. Being routed off the Bridge is not a judgment that you need the drug less.

It means your own Part D plan might cover a GLP-1 for that condition, on its own formulary. The Bridge's $50 copay does not follow you there.

CMS explains the exclusions, the prior-use rule and the cardiovascular-use distinction, checked September 26, 2026.

What will you pay on the Bridge?

You pay $50 for each one-month supply at any dose, and that $50 sits outside your Part D totals.

Your copay

You pay $50 at the pharmacy for each one-month supply, which is 28 or 30 days depending on the drug. There is no 90-day fill.

Your prior authorization

One approval covers your refills and dose changes through December 31, 2027. Switching to a different GLP-1 needs a new one.

Your confirmation

You get a letter in the mail confirming that the Bridge covers your GLP-1.

Your Part D totals

The $50 does not count toward your Part D deductible or the $2,100 yearly out-of-pocket cap. It does not appear on your Part D Explanation of Benefits or your Medicare Summary Notice.

Extra Help and the payment plan

Extra Help (the low-income subsidy) cannot lower the $50, so you pay the same as everyone else. The Medicare Prescription Payment Plan cannot spread it across months.

Other costs

Clinic visits and membership fees are separate from the $50 drug copay.

Medicare.gov, weight-loss drugs and the CMS Bridge FAQs, checked September 26, 2026.

What do you pay if the Bridge doesn't cover you?

If a diagnosis routes you back to your Part D plan, your GLP-1 copays "can run them $200 to $600 a month, if not more," KFF Health News reported on August 25, 2026.

That is 4 to 12 times the Bridge copay for the same molecule.

• Medicare GLP-1 Bridge$50If you qualify and your prescriber gets authorization.
• Your Part D plan$200 to $600+As reported by KFF Health News; your plan's formulary and tiers decide your share.
• Wegovy at NovoCare (cash)from $149The oral pill starts at $149 a month; pens cost more. Full NovoCare prices are below.
• Foundayo at LillyDirect (cash)from $149$149 a month at the two lowest doses, rising with the dose. Full LillyDirect prices are below.

NovoCare Wegovy, self-pay

pen $199/mo for the first two 0.25 mg or 0.5 mg fills through December 31, 2026, then $349/mo at standard strengths or $399/mo for Wegovy HD; oral pill from $149/mo, dose-dependent

LillyDirect Foundayo, self-pay

$149/mo at 0.8 or 2.5 mg; $199/mo at 5.5 mg; $299/mo at 9 mg (2.5/5.5 mg promotional prices through December 31, 2026); $299/mo at 14.5 mg or 17.2 mg when refilled within 45 days, otherwise $349/mo

Cash spending does not count toward your Part D deductible or your $2,100 out-of-pocket cap. At the starting strengths, both cash prices still undercut the $200 to $600 Part D range.

KFF Health News also followed a 68-year-old turned down because of severe obstructive sleep apnea. His denial notice did not say why.

So first find out which program issued your denial. A Part D plan decision has its own appeal route, and the Bridge does not (see who to contact).

Jackie Fortiér, KFF Health News, August 25, 2026. Cash prices are our own tracking of NovoCare and LillyDirect, re-verified August 2026. Programs and eligibility change, so confirm at checkout.

Does the 2027 Medicare negotiated price fix this?

Partly, and only for semaglutide. CMS announced on November 25, 2025 that semaglutide is in the second cycle of Medicare drug price negotiation.

Ozempic, Rybelsus and Wegovy count as one selected drug because they share an active ingredient.

• Semaglutide, 30-day supply$27471% below the $959 CY2024 list price, effective January 1, 2027.
• Ozempic 4 mg/3 mL pen$276.78CMS per-package price.
• Rybelsus 7 mg, 30 tablets$276.78CMS per-package price.
• Wegovy 2.4 mg/0.75 mL, four pens$385.63CMS per-package price, and the one that matters for Wegovy.

These are what Medicare pays the pharmacy, not your copay. Your share still depends on your plan's deductible and coinsurance tier.

It also depends on where you are in the benefit year, and whether your plan covers the drug for your indication.

Zepbound (tirzepatide) and Foundayo (orforglipron) are not on the 2027 list, so that negotiation does not set their prices. Other pricing programs can still change what you pay.

Side by side, you pay $50 on the Bridge. The Wegovy tablet starts at $149 a month in cash at NovoCare, already below Medicare's $274.

The 2027 price helps Medicare's budget. If you are routed off the Bridge, your options are still your own Part D plan or the manufacturer's cash price. Compare cash-pay prices across every provider we track.

CMS 2027 negotiated prices fact sheet, retrieved August 26, 2026.

Novo Nordisk and Eli Lilly separately agreed a $245 a month most-favored-nation net price with the administration. That is a different mechanism and a different number; see our Medicare coverage guide.

How do you enroll in the Medicare GLP-1 Bridge?

Your prescriber and pharmacy file the paperwork. You confirm your plan, get a visit on the record and agree the exact drug.

1. Confirm eligible drug-plan enrollment. Use Medicare's official guidance or call 1-800-MEDICARE.Original Medicare without drug coverage is not enough. Check your plan type with Medicare or SHIP before you switch plans.
2. Get a clinic visit on the record. Your prescriber verifies your diagnoses and any earlier Part D-paid GLP-1 use.They record the BMI from when GLP-1 treatment began, not a lower current BMI.
3. Join a diet and exercise program. Your prescriber has to attest that the GLP-1 is part of one. A prescription alone is not enough.
4. Agree the medication and formulation. The covered brands differ in evidence, dosing and cautions.Our Wegovy vs Zepbound and Foundayo vs Wegovy pill pages list questions to ask.
5. Your pharmacy submits the Bridge claim first. It then asks your prescriber for prior authorization.CMS warns that filing before the pharmacy claim can return a patient-not-found error.
6. Your prescriber files the CMS form. They use the current CMS form, through CoverMyMeds or by fax.Only prescribers can submit it. Humana reviews it for CMS, whatever plan you're in.
7. Fill it at a pharmacy that can bill the Bridge. Once approved, you pay $50 for each monthly supply.Ask your prescriber or the central processor about authorization status and timing.

Where can you fill it?

Ask the pharmacy whether it can process the exact Bridge-covered product. A prescription, an authorization and a pharmacy able to bill the demonstration are separate steps.

Amazon Pharmacy says it delivers Wegovy (injection and tablet), the Zepbound KwikPen and Foundayo at the $50 copay, free, with no Prime membership needed.

That is Amazon's description of its service, not a CMS coverage approval. The Bridge is not exclusive to Amazon.

Amazon, August 2026.

Which dates matter, July 2026 to December 2027?

July 1, 2026

The Bridge launched and the first prescriptions were filled.

October 15 to December 7, 2026

Medicare open enrollment. Compare your overall benefits if you need to; your plan does not have to opt in and does not process Bridge claims.

January 1, 2027

The Bridge is set to continue at $50 per monthly supply. Check CMS's updated rules, because the 2027 prior-use lookback was not specified when we checked.

October 15 to December 7, 2027

Medicare open enrollment. Check CMS for any transition guidance; a release in this window is not confirmed.

December 31, 2027

The Bridge demonstration is scheduled to end.

Which programs and providers can help you?

The Bridge pays for the drug. You still need a prescriber, and if you don't qualify, a cash program.

Telehealth providers to watch for the Bridge

These programs list branded GLP-1 options. That does not confirm they take the Bridge, stock the covered formulation or handle authorization.

Confirm those, and any consultation or membership fees, before you pay.

How many people qualify, and how many use it?

Medicare has published no enrollment figure. KFF's analysis of 2023 claims is the closest thing to a size: 3.8 million Part D enrollees met every eligibility rule.

• Medicare Part A and B beneficiaries with obesity or overweight (BMI 27+)13.3M
• Medicare Part D enrollees47.5M
• Part D enrollees meeting the Bridge clinical criteria9.7M
• Met every eligibility rule3.8M39% of the 9.7M, and 8% of all Part D enrollees.
• Clinically qualified, excluded on diagnosis5.9M

Treat these as orders of magnitude. They are modelled on 2023 data and assume nobody's diagnoses or GLP-1 use changed by 2026.

KFF put the cost to Medicare at $1.3bn to $3.3bn over 18 months at 10% to 25% participation, and $6.7bn to $10bn at 50% to 75%.

• CVS100,000+CVS's own statement to NPR, as of mid-August 2026.
• Walgreens~100,000Its chief pharmacy officer said about half of its Bridge patients had never taken a GLP-1 before.
• Walmart and Sam's Clubno figureSays it processes Bridge prescriptions at 5,000+ pharmacies, growing weekly.
• CMSno figureGave NPR no figures. Its Bridge page had not been modified since July 13, 2026.

A USC analyst quoted by NPR read the fills as "somewhere between 5% and 10% of the eligible population". That treats every fill as a person and roughly doubles the total for chains that did not report.

Neither step has a published basis, so we report fills as fills. Sign-ups, approvals and fills are three different counts, and nobody has published all three for the same date.

KFF (Cubanski and Sroczynski), June 29, 2026; NPR (Lupkin), August 26, 2026; CMS Bridge page, last modified July 13, 2026. All read August 28, 2026.

NPR's August 27 correction concerns a cited paper's authorship, not these figures. CMS had published no Bridge enrollment figure as of September 4, 2026.

Medicare GLP-1 Bridge: frequently asked questions

What should you check in your first 90 days on the Bridge?

Your prescriber sets your dose steps and your pharmacist fills each one, so settle who you will call before your dose first goes up.

Which dose does each label put you on by day 90?

• Wegovy injection1.7 mg weeklyDay 90 falls in weeks 13 to 16 of the label's steps. The label recommends 2.4 mg as the maintenance dose from week 17.
• Wegovy pill9 mg dailyDays 61 to 90 on the label's steps. From day 91 the label moves you to 25 mg, the maintenance dose.
• Zepbound KwikPen5 mg to 10 mg weeklyYou start at 2.5 mg for 4 weeks, then take 5 mg, a maintenance dose. Your prescriber may raise it by 2.5 mg after at least 4 weeks at each dose.
• Foundayo5.5 mg dailyYou take 0.8 mg for at least 30 days, then 2.5 mg for at least 30 days. Higher doses come only if your prescriber raises them.

If you cannot tolerate a step, the Wegovy injection label lets your prescriber delay the next step by 4 weeks. The Zepbound label lets your prescriber choose a lower maintenance dose.

Each full schedule is on our Wegovy dosage, Zepbound dosage and Foundayo dose schedule pages.

What your $50 covers, and what it doesn't, is listed under what you pay. Your prescriber decides your dose, any delay and any restart.

This checklist summarizes the drug labels and Medicare's rules. It is not medical advice and makes no promise about your results.

We read Medicare's Bridge coverage and cost rules, the CMS Bridge FAQ, and the Wegovy (revised June 2026), Zepbound (revised August 2026) and Foundayo (revised July 2026) prescribing information on October 16, 2026.