The Medicare GLP-1 Bridge Program is a temporary program from the Centers for Medicare & Medicaid Services (CMS) that allows eligible Medicare Part D beneficiaries to access certain weight-loss GLP-1 drugs for $50 per month from July 1, 2026 through December 31, 2027.
It operates outside of Medicare Part D, meaning plans do not process claims or bear any risk. The program only covers GLP-1 medications that the FDA approves for weight loss, and beneficiaries must meet BMI and prior authorization requirements.
What are the key takeaways of the GLP-1 Program?
- The Medicare GLP-1 Bridge Program starts July 1, 2026
- The program is temporary and ends December 31, 2027
- Offers select weight-loss GLP-1 drugs for $50/month
- Operates outside of Medicare Part D, but requires you to have a Part D plan
- Requires BMI + health conditions + prior authorization
- Future access depends on the implementation of the upcoming BALANCE Model
- The program excludes some GLP-1 medications, like Ozempic.
What Is the Medicare GLP-1 Bridge Program?
The Medicare GLP-1 Bridge Program is a temporary program created by the Centers for Medicare & Medicaid Services. It is a short-term program that gives Medicare Part D beneficiaries access to certain GLP-1 weight-loss drugs that Medicare normally does not cover. Since 2003, Medicare Part D has legally prohibited coverage for drugs prescribed solely for weight loss.
Medicare implemented the Bridge Program after delaying the BALANCE Model, which would provide similar access to GLP-1 weight-loss drugs through participating Part D plans. The GLP-1 Bridge Program operates outside of Medicare Part D plans.
How Does the Bridge Program Work?
CMS directly handles processing, approval, and implementation of the GLP-1 Bridge Program.
- The government negotiates lower GLP-1 rates directly with drug companies.
- A doctor must certify a Medicare beneficiary meets the BMI and conditions requirement.
- Doctor requests prior authorization directly from CMS, not the Part D plan.
- CMS processed and approves or denies the prior authorization.
- If approved, the beneficiary pays $50 per month for approved GLP-1 medication starting July 2026.
- The Bridge Program does not go through the Part D plan and has no effect on the Part D maximum out-of-pocket costs.
The Medicare GLP-1 Bridge Program operates and processes directly through CMS. CMS negotiated GLP-1 weight-loss drug prices with manufacturers to offer eligible Medicare beneficiaries a flat $50 monthly copay. Only beneficiaries enrolled in a Medicare Part D plan can access the program. However, even though Part D plan enrollment is a requirement, the Bridge Program operates outside of Part D. This means that any copay amounts paid through the program do not count toward your Part D deductibles or maximum out-of-pocket.
If you already hit the catastrophic phase of your Part D plan, you still have a $50 per month copay for GLP-1 prescriptions through the Bridge Program. You must first get prior authorization through your doctor to participate. Your doctor will certify directly with CMS, verifying that you meet all CMS health requirements to participate
Who Qualifies for the GLP-1 Bridge Program?
To qualify for the GLP-1 Bridge Program, you must be enrolled in a Part D plan and meet one of three BMI (Body Mass Index) and health condition tiers. Specific Bridge Program requirements are below. See below about BMI caclulations.
1. Enrolled in a Medicare Part D Plan. This can be a standalone Part D plan or a Medicare Advantage with Part D coverage.
2. A doctor must certify that you meet one of the qualifying eligibility tiers.
- Tier 1: A BMI of 35 or higher (no other qualifying conditions)
- Tier 2: A BMI of 30 or higher AND one of the following qualifying conditions: Heart failure (preserved ejection fraction), Uncontrolled hypertension (despite 2+ medications), Chronic kidney disease (Stage 3a or higher)
- Tier 3: A BMI of 27 or higher AND one of the following qualifying conditions: Pre-diabetes, Prior heart attack, Prior stroke, Peripheral artery disease
3. You are not already taking the GLP-1 for another qualifying condition covered by your Part D plan.
4. Doctors prescribe GLP-1 medications alongside ongoing lifestyle changes, including structured nutrition and physical activity.
* The program calculates BMI based on when you first started using a GLP-1 medication for weight-loss management, not when the Bridge Program begins. For example, if you started GLP-1 therapy in 2025 with a body mass index (BMI) of 37, but your BMI drops to 34 by the time your doctor submits a prior authorization request in July 2026, your provider should confirm that you met the BMI 35 or higher requirement when treatment began.
Which GLP-1 Brands Are Covered Under the Bridge Program?
The GLP-1 Bridge Program only includes GLP-1 medications that the FDA specifically approves for weight loss.
Drugs approved for weight loss include:
- Wegovy (injection and oral)
- Zepbound (KwikPen only)
- Foundayo (as listed in program guidance)
Drugs that are NOT approved for weight loss:
Ozempic and Mounjaro are not covered under the Bridge Program because the FDA approved them for diabetes treatment, not weight loss.
What happens when the GLP-1 Bridge Program expires?
After the Bridge program ends in December 2027, CMS will replace it with the BALANCE Model. The Balance Model will be slightly different than the Bridge Program, but will still provide access to GLP-1 for weight loss.
The BALANCE Model (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) is a Centers for Medicare & Medicaid Services (CMS) initiative that CMS originally planned to launch in 2026. The program aims to expand access to GLP-1 medications and healthy lifestyle interventions for people enrolled in Medicare. However, CMS delayed the program after fewer Part D carriers participated than expected. The Bridge Program is a temporary solution until BALANCE Model starts.
How Will the BALANCE Model Work?
With the Balance model, the program moves inside Part D, with the Part D plan administering it. Not every Part D plan will participate in the Bride Program. Only plans that opt in can process and give access to GLP-1 for weight loss. Therefore, you must choose a Part D plan that participates in the BALANCE Model to continue GLP-1 coverage for weight loss. Right now, fewer Part D plans have opted in than anticipated, citing the funding needed to implement it and the uncertainty of how many people will participate.
Since the BALANCE Model will operate inside Part D, it will count toward your deductible and maximum out-of-pockets. The deductible phase would be limited to $245 for a 30-day supply. The coverage phase costs would depend on the plan; $50 for enhanced plans and $125 for basic plans. Plan sponsors could choose to apply lower cost-sharing if they do so uniformly across all model drugs.
How does the BALANCE Model differ from the Bridge Program?
- BALANCE Model operates inside Part D plans
- Participation is optional for Part D plan. Not all plans will offer it!
- Requires you enroll in a plan that participates
- Copays will be $50 or $125 depending on the Part D plan (Basic or Enhanced, respectively)
- Copay WILL count toward Part D maximums,
- Health condition requirements vary for qualification tiers.
It will be more important than ever to review your Part D plan before BALANCE Model starts. This means you should meet with a licensed agent during the Annual Enrollment Period (10/15 to 12/7). A licensed agent can help you identify which plans will offer the BALANCE Model.
Bridge Program vs BALANCE Model
| Feature | Bridge Program | BALANCE Model |
| Timeline | 2026–2027 | 2028 – 2031 (tentative start) |
| Runs through | CMS directly | Part D plans |
| Plan participation | Not required | Required |
| Cost structure | Flat $50 | Plan-dependent |
| Count towards deductible/ Maximum out-of-pocket | No | Yes |
FREQUENTLY ASKED QUESTIONS ABOUT THE BRIDGE PROGRAM
The program begins July 1, 2026 and is scheduled to end December 31, 2027.
At this time, Wegovy (injection & Oral), Zepbound® (KwikPen only) and Foundayo are approved for the GLP-1 Bridge program.
Ozempic and Mounjaro current have FDA approval for diabetes. The program only includes GLP-1 with FDA approval for weight loss.
You must visit your doctor to get prior authorization first. Your doctor sends in the prior authorization to CMS to certify you meet the health and BMI requirements.
Yes. You must have either:
– A standalone Medicare Part D prescription drug plan, or
– A Medicare Advantage plan with Part D drug coverage
Eligible beneficiaries will pay a flat $50 per month for approved GLP-1 medications through the program.
The Bridge Program is expected to transition into the CMS BALANCE Model after December 31, 2027.
Hi, My name is Butterfly. I have been licensed, contracted and certified to assist with Medicare for over 10 years. I specialized in educating the public about Medicare enrollment rules, timelines, and coverage options. My goals is to help you understand your options and help you avoid common enrollment mistakes that can lead to penalties or gaps in coverage.
