New CMS program · July 1, 2026 – December 31, 2027
How the Medicare GLP-1 Bridge works
For the first time, Medicare is opening a door to GLP-1 medications for weight loss. The Bridge is a short-term CMS demonstration that covers brand-name Wegovy, Zepbound (KwikPen), and Foundayo for weight management — outside your regular Part D plan, with a low fixed copay. Here's the whole process, start to finish.
Why this program exists
Medicare has historically not covered medications for weight loss. That left people choosing between roughly $350–$500 a month at self-pay programs like LillyDirect and NovoCare, compounded versions of uncertain quality, or going without. The Bridge changes that math for people who meet the published criteria — but it runs on its own track, with its own rules, which is exactly why a little preparation goes a long way.
The process, step by step
You and your doctor decide it's appropriate
Your clinician confirms the criteria fit what's in your chart — BMI at the time therapy starts, qualifying conditions, and no exclusions — and decides a GLP-1 is medically right for you. Our free screener helps you arrive at that conversation organized.
Your doctor sends a specially marked prescription
The prescription needs an obesity diagnosis code (E66 family) and the note "SEND TO BRIDGE FOR WEIGHT MANAGEMENT" so the pharmacy routes the claim to the Bridge instead of your Part D plan. This step is where new-program requests most often stumble — our packet gives your doctor these exact instructions.
Prior authorization, then your fill
The Bridge asks your doctor to complete a prior authorization (the pharmacy sends it, usually within 24–72 hours). Decisions come back within about 72 hours. After the first approved fill, refills don't need a new authorization unless you switch medications.
What it covers
- Wegovy — injection and tablets
- Zepbound — KwikPen only (single-dose pens and vials are not covered)
- Foundayo — tablets
- 28- or 30-day fills
Who it's for — the short version
Adults 18+ with Medicare drug coverage, seeking the medication for weight reduction or maintenance, who met a BMI pathway when starting therapy: BMI 35+, BMI 30+ with certain conditions, or BMI 27+ with certain risk conditions. People with type 2 diabetes, moderate-to-severe sleep apnea, or MASH route through their regular Part D plan instead — as do people who already received a GLP-1 through their Part D plan. Paying cash through LillyDirect, NovoCare, or a compounding pharmacy does not count against you. Full details in plain English on the criteria page.
What this site does and doesn't do
GLP-1 Bridge Help is an independent educational tool. We compare your answers to the published criteria and help you prepare — we don't prescribe, determine eligibility, submit prior authorizations, or guarantee coverage. Those decisions belong to your clinician and the program.
Sources and review status: Content reviewed June 12, 2026, based on published CMS materials including the prescriber fact sheet (CMS Product No. 12235). Check current CMS Medicare GLP-1 Bridge materials before relying on this information: CMS Bridge overview, beneficiary information, provider information.