Medicare and GLP-1 Medication Coverage
Medicare has a new program that may help some people access certain GLP-1 medicines for weight management at a lower cost. Because coverage depends on your health needs, the type of Medicare drug coverage you have, and whether you meet the program’s requirements, it is important to understand how the program works.
Below you will learn what GLP-1 medicines are, who may qualify, what the program covers, what you may pay, and the steps you can take to get started.
What Are GLP-1 medicines?
GLP-1 medicines are prescription drugs that act like a hormone made by your body.
They can help:
- Lower blood sugar
- Reduce hunger
- Help you feel full
- Support weight management
GLP-1 medicines were first used to treat type 2 diabetes. Some are now also used for weight management and certain heart, sleep apnea, or liver conditions. Each GLP-1 medicine is approved for specific uses.
What is the Medicare GLP-1 Bridge?
The Medicare GLP-1 Bridge is a short-term program that may help people with Medicare get certain GLP-1 treatments for weight management.
The program runs from July 1, 2026, through December 31, 2027.
People who qualify will pay $50 for a one-month supply.
The program is available across the country for individuals enrolled in a:
- Medicare Part D plan, or
- A Medicare Advantage plan that includes drug coverage
Which GLP-1 medicines does the Bridge program cover?
The CMS ‘Medicare GLP-1 Bridge program currently covers certain medications that meet the program’s requirements. The list of covered medications may change throughout the program.
Visit the Medicare GLP-1 Bridge website for the current list of covered medications. You can also ask your healthcare provider or pharmacist whether a prescribed medicine is included in the program.
Who may qualify?
You may qualify for the Medicare GLP-1 Bridge if you:
- Are age 18 or older
- Have a Medicare Part D plan or a Medicare Advantage plan that includes drug coverage
- Use a covered GLP-1 for weight management
- Met the program’s weight and health rules when you first started treatment
- Do not already receive the GLP-1 through your Medicare drug plan
- Have your doctor send a prescription and any health information Medicare requests
Some types of Medicare plans may not take part. These may include:
- PACE plans
- Some Medicare Private Fee-for-Service plans
- Some Medicare Cost Plans
You may still qualify if you also have a separate Part D plan. Call 1-800-MEDICARE at 1-800-633-4227 if you are not sure what type of plan you have. TTY users can call 1-877-486-2048.
How Medicare checks if you qualify
Medicare uses your body mass index, or BMI, and your health history to see if you may qualify.
BMI is a number based on your height and weight. Your healthcare provider can help you find your BMI.
You may qualify if you met one of these rules when you first started treatment:
BMI of 35 or higher
You do not need to have another health condition.
BMI from 30 through 34.9
You must also have at least one of these health conditions:
- A certain type of heart failure
- High blood pressure that is hard to control
- Stage 3a or higher kidney disease
- Prediabetes
- A past heart attack
- A past stroke
- Blocked arteries in your arms or legs that cause symptoms
BMI from 27 through 29.9
You must also have at least one of these health conditions:
- Prediabetes
- A past heart attack
- A past stroke
- Poor blood flow in your arms or legs that causes symptoms
Your BMI may be lower now because of treatment. Medicare may use the BMI you had when you first started treatment.
What if I am already taking a GLP-1?
You may still qualify if:
- You use the GLP-1 for weight management
- Your Medicare drug plan has not been paying for it
- You met the weight and health requirements when you first started treatment
You do not qualify for the Bridge if your Medicare drug plan has already been paying for your GLP-1. You should continue getting it through your current plan.
Could my regular Medicare plan cover my treatment?
The Medicare GLP-1 Bridge is for GLP-1 treatment used for weight management.
Your regular Medicare drug plan may cover a GLP-1 when it is prescribed for another approved health condition, such as:
- Type 2 diabetes
- Moderate-to-severe sleep apnea
- Certain fatty liver conditions
- Lowering the risk of serious heart problems in some people with heart disease
If your Part D coverage is already covering a GLP-1 medication because you have one of the conditions listed above, you must continue using your current Medicare drug plan instead of the Bridge program. This may apply even when the specific medicine is not on your plan’s covered drug list. Your provider may need to ask the plan for an exception.
How to check your regular drug coverage
Look for the Member Services or Customer Service number on:
- Your stand-alone Medicare Part D card, or
- Your Medicare Advantage plan card
Call your plan and ask:
- Is this GLP-1 covered for my health condition?
- Do I need prior approval?
- Do I need to try another treatment first?
- How much will I pay?
- What can I do if it is not on the plan’s covered drug list?
- Your provider or pharmacist can also help check your coverage.
What will I pay through the Bridge program?
If you qualify, you will pay $50 for a one-month supply.
This $50 payment:
- Does not count toward your Part D deductible
- Does not count toward your yearly Part D drug-cost limit
- Cannot be added to the Medicare Prescription Payment Plan
- Is not lowered by the Medicare Extra Help program
How do I get started?
1. Talk with your doctor
Ask:
- Is GLP-1 treatment right for me?
- What is my BMI?
- Could I qualify for the Medicare GLP-1 Bridge?
- Do you have records showing my BMI when I started treatment?
2. Your doctor sends a prescription
If the treatment may be right for you, your provider will send a prescription to your pharmacy.
Your pharmacy will send the claim to Medicare. Medicare will check whether you meet the program’s requirements
If more health information is needed, the pharmacy will usually send a prior authorization, or prior approval, request to your provider within 24 to 72 hours.
Your provider may need to confirm:
- Your BMI when you started treatment
- Your health conditions
- That your care plan includes healthy eating and physical activity
3. Follow up with your pharmacy
After 72 hours, call your pharmacy or doctor’s office. Ask if they received and completed the prior approval request.
Once approved, Medicare will send you a letter that explains whether you were approved or denied for the Bridge program.
Learn More
Visit Medicare’s official GLP-1 Bridge webpage to:
- Learn how the program works
- See if you may qualify
- Review covered GLP-1 treatments
- Learn what you may pay
- Find out how to get started
Learn more and answer the eligibility questions on Medicare.gov.
You can also download Medicare’s patient fact sheet:
Read or print “Medicare GLP-1 Bridge: GLP-1 Drugs for $50 a Month”
Need help?
Call 1-800-MEDICARE
1-800-633-4227
TTY users can call 1-877-486-2048.
Medicare is open 24 hours a day, seven days a week, except for some federal holidays.
Coverage rules may change. Check with Medicare, your doctor, pharmacy, and health plan for the latest information.