The Medicare GLP-1 Bridge, Explained: Who Qualifies for the $50 Copay and How Long It Runs

Since July 1, 2026, the Centers for Medicare & Medicaid Services (CMS) has run a short-term demonstration called the Medicare GLP-1 Bridge. According to CMS, it gives eligible Part D enrollees access to certain GLP-1 drugs prescribed for weight management, operating outside the regular Part D benefit under the agency's Section 402 demonstration authority. In an April 21, 2026 notice, CMS extended the Bridge through December 31, 2027 and delayed the Part D portion of its BALANCE Model for 2027.

CMS lists Foundayo, Wegovy (injection and tablets), and the KwikPen formulation of Zepbound as eligible when used to reduce excess body weight and maintain weight reduction. Single-dose Zepbound vials and pens are not included, and pen needles for the KwikPen are not covered.

Medicare.gov describes the cost as a $50 copayment for a one-month supply. Because the drugs are furnished outside the Part D benefit, CMS says the copay does not count toward the Part D deductible or out-of-pocket limit, and Extra Help (the low-income subsidy) cannot lower it.

Enrollees must be in an eligible plan type, such as a standalone drug plan or a Medicare Advantage coordinated care plan with drug coverage, and a prescriber must complete a prior authorization. Per CMS, adults qualify with a BMI of 35 or higher, a BMI of 30 or higher with heart failure with preserved ejection fraction, uncontrolled hypertension, or stage 3a or higher chronic kidney disease, or a BMI of 27 or higher with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease. The criteria apply at the time therapy started, not at the time of the request.

People with type 2 diabetes, moderate-to-severe obstructive sleep apnea, or qualifying MASH are excluded from the Bridge, because CMS says those indications are already eligible for coverage through Part D plans. CMS also states there is no appeals process; a prescriber may resubmit with corrected information.

The BALANCE Model is a separate, voluntary CMS Innovation Center model in which CMS negotiates GLP-1 pricing and coverage terms with manufacturers on behalf of state Medicaid agencies and, potentially, Part D plans. According to CMS, states could join between May 1, 2026 and January 1, 2027, and Medicaid coverage depends on which states and manufacturers participate, so it does not guarantee coverage for any individual.

Medicare's annual open enrollment runs October 15 to December 7, and the Bridge only reaches people enrolled in an eligible Part D plan type, so someone considering a GLP-1 for weight management may want to confirm their 2027 drug coverage first. Medicare.gov has an eligibility checker, and the final decision rests on a prior authorization from the prescriber. Because the program is a time-limited demonstration, it is reasonable to plan for the possibility that terms change after 2027.