What it costs. One flat copay, at every dose and on every covered drug.
Which drugs. Wegovy and Foundayo in every form, plus the Zepbound KwikPen. The Zepbound vial and single-dose pen are left out, so ask your prescriber to write the KwikPen.
Who qualifies. You need Medicare drug coverage, you have to be 18 or older, and the drug has to be prescribed to lose weight and keep it off. Then one of three BMI rules has to fit.
When. July 1, 2026 through December 31, 2027. CMS runs it as a demonstration and has not said what follows.
The Bridge rules on this page come from CMS, Medicare GLP-1 Bridge (page updated July 13, 2026) and CMS, Medicare GLP-1 Bridge: Information for Providers (page updated August 6, 2026), read September 5, 2026.
The three rules
Your prescriber has to attest that one of these fits you.
- BMI 35 or higher. That is enough on its own.
- BMI 30 or higher, plus one condition. Heart failure with preserved ejection fraction, blood pressure still above 140/90 on two blood pressure drugs, or chronic kidney disease at stage 3a or higher.
- BMI 27 or higher, plus one condition. Pre-diabetes, a past heart attack or stroke, or symptomatic peripheral artery disease.
CMS asks whether you met the rule when you started GLP-1 therapy, not on the day the form is filed. Someone who began at a BMI of 37 and is now at 34 still meets the first rule.
Three diagnoses are shut out. Part D already covers type 2 diabetes, moderate to severe sleep apnea and MASH, so CMS keeps all three out of the Bridge even when the BMI rule fits. A prescription written to cut heart attack and stroke risk goes to your Part D plan as well.
Which plans count.You need a standalone drug plan or a Medicare Advantage plan with drug coverage. Special needs plans, employer group plans and LI NET (Medicare's Limited Income Newly Eligible Transition plan) are in. Private fee-for-service plans, cost plans, PACE and religious fraternal benefit plans are out, unless you also hold a standalone drug plan.
Check where you land
Do you have Medicare with a drug plan (Part D)?
If you pay for prescriptions through a Medicare plan, that is Part D.
What each dose costs
The Bridge charges one $50 copay at every strength. The makers charge by dose. The $50 covers the Zepbound KwikPen. The vials below are Lilly's published ladder.
| What you fill | Bridge | Cash |
|---|---|---|
| Wegovy pill, starter dose (1.5mg) | $50/mo | $149/mo |
| Wegovy pill, 4mg | $50/mo | $199/mo |
| Wegovy pill, maintenance dose (9mg/25mg) | $50/mo | $299/mo |
| Wegovy HD injection (7.2mg), ongoing | $50/mo | $399/mo |
| Wegovy injection | $50/mo | $349/mo |
| Zepbound vial, starter dose (2.5mg) | Not covered | $299/mo |
| Zepbound vial, maintenance (5mg) | Not covered | $399/mo |
| Zepbound vial, higher doses (7.5mg+) | Not covered | $449/mo |
Cash prices come from NovoCare and LillyDirect, the makers' own pharmacies, checked every Monday. The covered drug list is CMS, Medicare GLP-1 Bridge: Information for Providers (page updated August 6, 2026), read September 5, 2026.
What the $50 does not do
The Bridge runs outside the Part D benefit. That is the reason for all five.
- Your Part D deductible does not apply to it.
- None of the $50 counts toward your $2,100 out-of-pocket limit for 2026.
- Extra Help does not lower it.
- The Medicare Prescription Payment Plan cannot spread it across the year.
- Pen needles are not covered. You buy those yourself.
The copay terms are CMS, Medicare GLP-1 Bridge (page updated July 13, 2026). The $2,100 figure is Medicare.gov, costs for Medicare drug coverage. Both read September 5, 2026.
How the approval works
The prior authorization comes after the pharmacy bills.
- Your prescriber sends the prescription to your pharmacy.
- The pharmacy bills the Bridge, then asks your prescriber for prior authorization.
- You get the decision by mail within 72 hours, and your prescriber gets it too.
- Approval holds through December 31, 2027, refills and dose changes included, unless you switch to a different GLP-1.
There is no appeal. If the answer is no, your prescriber can send a corrected form. Prescribers can call the Bridge line at 855-273-0102, weekdays 8am to 7pm ET.
The process and the call center number are CMS, Medicare GLP-1 Bridge: Information for Providers (page updated August 6, 2026). The length of an approval is Medicare.gov, weight loss drugs. Both read September 5, 2026.
Questions people ask
What is the Medicare GLP-1 Bridge?
It is a short-term demonstration run by CMS. Between July 1, 2026 and December 31, 2027 it gives people with Medicare drug coverage a $50 copay on Wegovy, Foundayo and the Zepbound KwikPen. It runs outside the Part D benefit, so your plan does not carry the cost and does not have to opt in.
How much does the Bridge cost?
$50 a month, at every dose. CMS sets one copay for every covered drug and every strength.
Which drugs does the Bridge cover?
Wegovy in every form (injection and tablets), Foundayo in every form and the Zepbound KwikPen. The Zepbound vial and the single-dose pen are not covered, so ask your prescriber to write the KwikPen.
Does a BMI of 35 qualify on its own?
Yes. A BMI of 35 or higher qualifies with no other condition, as long as you are 18 or older and the drug is prescribed to lose weight and keep it off. Below 35 you need a listed condition as well.
I have type 2 diabetes. Can I use the Bridge?
No. Part D already covers a GLP-1 for type 2 diabetes, for moderate to severe sleep apnea and for MASH. CMS keeps all three out of the Bridge even when the BMI rule fits.
Does Extra Help lower the $50?
No. CMS says there is no low-income subsidy inside the Bridge. Your Part D deductible does not apply to it either, and none of the $50 counts toward your $2,100 out-of-pocket limit for 2026.
How long does the approval last?
Medicare says an approved prior authorization holds through December 31, 2027, refills and dose changes included, unless you switch to a different GLP-1. There is no appeal if you are turned down. Your prescriber can send a corrected form.
What happens after December 31, 2027?
The demonstration ends. CMS extended it to that date while it collects data ahead of a possible BALANCE program in Part D. Nothing past the end date is settled.
