By Mike Miligi, Certified Medicare Insurance Planner- Michael M Insurance Services
A temporary CMS program is letting eligible Medicare beneficiaries access certain weight-loss GLP-1
medications for a flat $50 a month. Here’s exactly how it works, who qualifies, and how long it’s actually
set to last.
Under federal law, Medicare Part D has never been allowed to cover medications prescribed purely for
weight loss. That’s a real gap for the millions of Medicare beneficiaries living with obesity, especially as
GLP-1 medications have become one of the most talked-about tools in medicine. In July 2026, CMS
opened a narrow, temporary workaround: the Medicare GLP-1 Bridge Program. It’s not a permanent
benefit, and it doesn’t cover every GLP-1 on the market — but for people who qualify, it can mean the
difference between paying full retail price and paying $50 a month.
$50
Flat copay per 28–30 day supply for
eligible drugs under the Bridge
program — the same for everyone,
regardless of income.
Jul 1, 2026
The date the Medicare GLP-1 Bridge
officially went live nationwide.
Dec 31, 2027*
The program’s current end date —
extended from its original December
2026 sunset.
*The Bridge was originally scheduled to run only through the end of 2026, until a permanent replacement (the BALANCE Model) was set to take over.
CMS delayed that replacement indefinitely and extended the Bridge through December 31, 2027 instead — see “What Happens After 2027?” below.
What Is the GLP-1 Bridge Program, and Why Does It Exist?
The Medicare GLP-1 Bridge is a short-term demonstration program run directly by CMS — not by your
individual Part D plan. Its purpose is narrow but significant: it gives eligible beneficiaries access to specific GLP-1
medications when prescribed for weight management, something standard Part D coverage is legally barred
from paying for.
The program exists because CMS had originally planned a more permanent policy — the BALANCE Model — to
take over GLP-1 weight-loss coverage starting in 2027. That rollout has since been delayed indefinitely, leaving a
gap that the Bridge was extended to fill. In the meantime, CMS is also using the Bridge to collect real-world
data on how beneficiaries use these medications, which will likely shape whatever permanent policy eventually
replaces it.
It runs outside your regular Part D coverage entirely
This is the detail that surprises people most: the Bridge doesn’t work through your Part D plan’s normal
formulary, deductible, or payment process. CMS uses a single central processor nationwide to handle
prior authorization, claims, and pharmacy payment. Your Part D plan doesn’t have to opt in, and it has no
say in whether you’re approved — it’s entirely a CMS-run process layered on top of your existing
coverage.
Which Drugs Are Actually Covered
This is the most common point of confusion. The Bridge covers only three specific products, and only when
prescribed for weight management:
Covered under the Bridge
- Foundayo® (orforglipron) — Eli Lilly’s once-daily
oral pill - Wegovy® — injection and tablet forms
- Zepbound® — KwikPen formulation only
Not part of the Bridge
- Ozempic®
- Mounjaro®
- Rybelsus®
- Trulicity®
- Saxenda® /
- Victoza®
The single-dose vial and single-dose pen versions of Zepbound are not included — only the KwikPen. And this
matters: if one of the excluded drugs is prescribed for an approved medical reason such as type 2 diabetes, it’s
still covered the normal way, through your Part D plan’s standard formulary and cost-sharing. It simply isn’t part
of this particular program.
Who Actually Qualifies
Clinical criteria
You generally need a BMI of 35 or higher, or a BMI of 30 or higher along with at least one weight-related
condition such as uncontrolled high blood pressure or heart failure with preserved ejection fraction (sometimes
called diastolic heart failure).
Plan type matters
You need to be enrolled in a standalone Part D plan or a Medicare Advantage plan that includes drug coverage
(HMO, HMOPOS, or local/regional PPO with drug coverage). Special Needs Plans, employer group plans, and
the Limited Income Newly Eligible Transition program are also eligible. Private fee-for-service plans, cost plans,
and PACE are generally not eligible unless paired with a qualifying standalone drug plan. Dual-eligible
beneficiaries (Medicare and Medicaid) can participate as long as their plan type qualifies.
You may be excluded if you already qualify another way
If you have type 2 diabetes, moderate-to-severe obstructive sleep apnea, or MASH (formerly known as
NASH) with moderate-to-advanced liver scarring, you’re not eligible for the Bridge — even if your current
plan doesn’t happen to cover a GLP-1 for that condition. The reasoning is that these conditions already
have an approved pathway to GLP-1 coverage through standard Part D, so the Bridge is reserved for
people who don’t otherwise qualify for coverage.
What It Actually Costs
If you’re approved, you pay a flat $50 for a 28- or 30-day supply — the same amount no matter your income or
plan. A few important details most people miss:
- It doesn't count toward your deductible. The $50 copay sits entirely outside your Part D deductible and out of-pocket maximum tracking.
- Extra Help doesn't reduce it further. Even if you qualify for the Part D low-income subsidy, the $50 copay stays the same.
- It doesn't change based on your Part D coverage stage. Whether you're in the deductible phase, initial coverage, or catastrophic coverage on your regular Part D benefit, the Bridge copay is always $50.
How to Actually Get Started
The process is a little different from a typical prior authorization, and it starts with your doctor, not a form you
fill out yourself:
01
Talk to your doctor
Your provider reviews your health history and confirms whether a GLP-1 for weight management, and specifically
the Bridge program, is appropriate for you
02
Your doctor sends the prescription to your pharmacy
It’s written for weight management specifically, often noted with an obesity diagnosis code, so the pharmacy knows to route it to the Bridge rather than your standard Part D benefit.
03
The first claim gets rejected — on purpose
That initial rejection is a normal, expected part of the process. It automatically triggers a prior authorization request back to your doctor.
04
Your doctor submits the prior authorization
This goes to CMS’s central processor, electronically or by fax, confirming your BMI and any relevant conditions.
05
CMS responds, typically within about 72 hours
There’s no expedited or urgent review option for this particular authorization, so plan for a few business days.
06
Your pharmacy reprocesses the claim
Once approved, you pay $50 and pick up your prescription. Your approval stays valid through December 31, 2027,
unless you switch to a different GLP-1 medication, which would require a new authorization.
What Happens After 2027?
This is the honest answer: nobody knows yet, and that’s worth sitting with rather than glossing over. The Bridge
was designed from the start as temporary. It was originally supposed to hand off to the BALANCE Model in
2027, but that transition has been delayed indefinitely, which is the entire reason the Bridge got extended
through the end of 2027 in the first place. There’s no guarantee a permanent replacement will be in place
when the Bridge ends, and no guarantee the Bridge itself gets extended again. If you’re eligible now, that’s a
reason to seriously consider using this window rather than waiting — not because of pressure, but because the
terms available today aren’t promised to still be there in a couple of years.
Quick Questions, Straight Answers
What is the Medicare GLP-1 Bridge Program, in plain terms?
It’s a temporary CMS program that lets eligible Medicare beneficiaries get certain GLP-1 medications for weight
management at a flat $50 monthly copay, running outside your normal Part D coverage.
When does the program start and how long will it last?
It started July 1, 2026, and currently runs through December 31, 2027. It was originally set to end in 2026, but was
extended when its planned permanent replacement was delayed.
Which GLP-1 drugs are actually covered?
Only three: Foundayo® (the oral pill), Wegovy® (injection and tablet), and the Zepbound® KwikPen specifically. Other
formulations and other GLP-1 drugs are not included.
Does this include Ozempic or Mounjaro?
No. Ozempic, Mounjaro, Rybelsus, Trulicity, Saxenda, and Victoza are not part of the Bridge program. If prescribed
for an approved condition like type 2 diabetes, they may still be covered through your standard Part D plan.
How much will I pay for the medication?
A flat $50 for a 28- or 30-day supply, regardless of your income or which Part D plan you have.
Does the $50 copay count toward my Part D deductible or out-of-pocket limit?
No. The Bridge operates entirely outside your regular Part D benefit, so the $50 doesn’t apply toward your
deductible, your coverage stage, or your annual out-of-pocket maximum.
Do I need a specific Part D plan to use this program?
You need a standalone Part D plan or a Medicare Advantage plan with drug coverage. Your specific plan doesn’t need
to “opt in” — the Bridge works the same regardless of which qualifying plan you have.
Who qualifies based on BMI or health conditions?
Generally, a BMI of 35 or higher, or a BMI of 30 or higher with a qualifying condition such as uncontrolled high blood
pressure or heart failure with preserved ejection fraction.
What happens if I already have diabetes or sleep apnea?
If you have type 2 diabetes, moderate-to-severe obstructive sleep apnea, or advanced MASH, you’re excluded from
the Bridge specifically — because those conditions already have an approved path to GLP-1 coverage through
standard Part D.
What happens after December 31, 2027?
It’s genuinely uncertain. The program’s planned permanent replacement has been delayed indefinitely, and there’s
no guarantee of what coverage will look like once the Bridge’s current end date arrives.
Programs like the GLP-1 Bridge move fast, and the details — who qualifies, what’s covered, how long it lasts
— can shift with little notice. I’ve spent over 10 years helping people navigate exactly these kinds of changes,
and I’m a Medicare beneficiary myself, so I understand how confusing this can feel. If you’d like help figuring
out whether you qualify or how to get started in Babylon, give me a call. That conversation is always free.
Mike Miligi
Owner, Michael M Insurance Service
For over 10 years, Mike has helped seniors and other Medicare-eligible individuals understand their options, including
Medicare Advantage Plans (Part C), Medicare Supplement Plans (Medigap), Prescription Drug Plans (Part D), and dental
and vision programs. Mike is licensed in seven states and certified with 11 insurance carriers. As an independent
Medicare health insurance broker, he works for the client, not the insurance carriers, providing accurate, unbiased
options. Mike recertifies with CMS annually and completes continuing education to stay current on industry standards.
(631) 774-3786 | mmilinsurance@gmail.com | www.mymedicaremike.com
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