Medicare drug plans generally don't pay for weight-loss drugs [4]. That changed on July 1, 2026, when a temporary program called the Medicare GLP-1 Bridge started covering three of them for a flat $50 a month [1]. Zepbound is one, but only in its KwikPen form. Wegovy is another, as a shot or a pill. Whether you qualify depends on your BMI, your other conditions and what your Part D plan already covers.
The GLP-1 Bridge is a $50-a-month program outside Part D
CMS describes the Bridge as “a short-term demonstration” that gives eligible Part D enrollees access to certain GLP-1 drugs between July 1, 2026, and December 31, 2027 [2]. It runs outside the normal Part D benefit, so your plan doesn't have to opt in. In 2026, a single CMS processor handles the prior authorizations, the claims and the payments to pharmacies.
You pay a $50 copay for a one-month supply, which is 28 or 30 days depending on the drug [1]. Because it's outside Part D, CMS says the Part D deductible doesn't apply, none of the $50 counts toward your true out-of-pocket costs (the total that moves you toward Part D's yearly cap), and the low-income subsidy doesn't lower it [2].
- The good part: $50 is the whole price. There's no deductible to meet first.
- The catch: those $50 payments don't move you toward your Part D out-of-pocket cap, and Extra Help can't lower them [1].
- Also: the copay can't be spread across months with the Medicare Prescription Payment Plan.
Three drugs are covered, and Zepbound only as the KwikPen
| Drug | Form covered | Not covered | Copay |
|---|---|---|---|
| Wegovy (semaglutide) | Injection or tablet | No form excluded | $50 a month |
| Zepbound (tirzepatide) | KwikPen only | Single-dose pens and single-dose vials | $50 a month |
| Foundayo (orforglipron) | Tablet | No form excluded | $50 a month |
Source: Medicare.gov and CMS [1] [2]. Ozempic and Mounjaro are not on the list.
The KwikPen detail trips people up. Medicare's page says Zepbound is covered as the “KwikPen® only. The program doesn't cover single-dose Zepbound® vials or pens” [1]. If your current prescription is for vials, your prescriber would need to write it for the KwikPen. Lilly's own Zepbound page says eligible Part D patients can get it through the Bridge “for no more than $50/month” [6]. Foundayo is Lilly's daily pill, covered on our orforglipron page.
Who qualifies: your BMI plus, in most cases, a condition
You must be 18 or older and meet one of three tests when you start GLP-1 therapy [1]. The lower your BMI, the more you need a qualifying condition alongside it.
| Your BMI | Plus at least one of |
|---|---|
| 35 or higher | Nothing else needed |
| 30 or higher | Heart failure with preserved ejection fraction; uncontrolled high blood pressure; chronic kidney disease stage 3a or higher |
| 27 or higher | Prediabetes; a previous heart attack or stroke; peripheral artery disease with symptoms |
Age 18 or older at the start of GLP-1 therapy, with Medicare drug coverage (Part D) [1]. Not eligible: type 2 diabetes, moderate-to-severe sleep apnea, fatty liver disease, or a GLP-1 already covered by your Part D plan.
BMI is weight relative to height. At 5 feet 6 inches, a BMI of 35 is about 217 lb, 30 is about 186 lb, and 27 is about 167 lb, by our arithmetic. Your prescriber records the number that counts.
Diabetes, sleep apnea or fatty liver: Part D decides, not the Bridge
Medicare.gov lists the people who can't use the Bridge: anyone who already gets a GLP-1 through their Part D plan, and anyone who has “type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (but your Part D plan might cover your GLP-1s)” [1]. The reason is that those are conditions Part D can already cover.
CMS spells this out for plans. Its June 2026 guidance gives two examples that stay in Part D: “Zepbound® for the treatment of moderate to severe obstructive sleep apnea in adults with obesity or Wegovy® to reduce the risk of major adverse cardiovascular events” [3]. A Bridge request that lists sleep apnea, MASH (the fatty liver disease Wegovy treats) or type 2 diabetes “will be denied.” And anyone whose Part D plan paid for a GLP-1 in 2026 isn't eligible either.
So if you have sleep apnea and obesity, Zepbound may still be covered, just through your own Part D plan at your plan's cost share, which CMS says plans don't have to lower to $50 [3]. With type 2 diabetes, the diabetes brands are the usual route; Ozempic's rules are in does Medicare cover Ozempic, and Mounjaro's prices are in what Mounjaro costs.
How to get it: a prescription, prior authorization and a lifestyle program
- Your doctor or other prescriber sends a prescription for a covered drug to your pharmacy.
- When asked, they complete a prior authorization and certify that you're using the drug as part of a lifestyle program focused on diet and exercise [1].
- Your pharmacy may ask for your Medicare Number or the last four digits of your Social Security Number.
- You get a letter in the mail confirming the drug is covered under the Bridge.
Once approved, your prior authorization is “valid (including for refills and dose changes) through December 31, 2027, unless you change GLP-1s” [1]. Switching from Wegovy to Zepbound, for example, means a new authorization. Questions about eligibility or an authorization's status go to 1-800-MEDICARE (1-800-633-4227).
Both makers point Medicare patients to the same $50
Novo Nordisk's NovoCare page says eligible Medicare patients pay “$50 per month” for Wegovy through the Bridge, and that this pricing is “for adult patients with Medicare prescribed Wegovy® for weight loss only” [5]. Lilly's Zepbound page offers the same Bridge price for patients with a Zepbound prescription for weight management [6]. Neither maker's commercial savings card works with Medicare.
Medicaid works state by state
Medicaid isn't part of the Bridge. CMS says that “currently Medicare and Medicaid generally do not cover these drugs for the weight loss indication” [4]. Its answer for Medicaid is a voluntary model called BALANCE, in which CMS negotiates GLP-1 prices and coverage terms on behalf of state Medicaid agencies. States can join from May 2026 through January 1, 2027, so whether your Medicaid program covers Wegovy or Zepbound for weight depends on your state. Your state Medicaid office is the place to ask.
What happens after 2027 isn't settled
CMS extended the Bridge through December 31, 2027, because the BALANCE model isn't launching in Medicare Part D in 2027 [2]. CMS says the extra time lets it collect GLP-1 data to share with plans “ahead of potential implementation of BALANCE in Part D.” Nothing has been announced for 2028, so treat the $50 price as good through the end of 2027.
If you don't qualify, the makers' cash prices are the fallback
Without Bridge or Part D coverage, you'd pay cash. NovoCare sells the Wegovy pen for $349 a month at every dose up to 2.4 mg, $399 for the 7.2 mg HD pen, and the pill for $149 to $299 a month by strength; new patients pay $199 a month for their first two pen fills, through December 31, 2026 [5]. Lilly sells Zepbound vials and KwikPens self-pay through LillyDirect.
Full price breakdowns are in what Zepbound costs and what Wegovy costs. The two drugs are compared in Zepbound vs Wegovy and the two pills in Foundayo vs Zepbound. Programs that prescribe the brands for cash are scored in brand GLP-1 self-pay programs and, for the pill, Wegovy pill programs.