Medicare patients will be able to get Wegovy or Zepbound for $50 a month from next week
For years, millions of older Americans who wanted prescription weight-loss medication through Medicare were simply told no. Federal law explicitly prohibits Medicare Part D — the prescription drug benefit — from covering medications prescribed solely for weight reduction. That exclusion has applied regardless of how clinically effective the drugs are, how strongly a doctor recommends them, or how much a patient might benefit. The result was a stark divide: Medicare would pay for Wegovy if your doctor prescribed it to reduce cardiovascular risk in patients with existing heart disease, but not if the prescription was written to treat obesity.
From 1 July, that changes — at least partially, and with a time limit attached.
The Centers for Medicare and Medicaid Services (CMS) is launching what it calls the Medicare GLP-1 Bridge: a short-term federal demonstration programme that will give eligible Medicare Part D beneficiaries access to certain GLP-1 weight-loss drugs for a flat $50 copayment per monthly supply. The programme runs through 31 December 2027, and it operates entirely outside the standard Part D payment system — meaning enrollees do not need to check whether their specific plan’s formulary includes the drugs, and Part D insurers carry no financial risk for drugs dispensed under it.
Three drugs are covered. Wegovy, the semaglutide injection and tablet made by Novo Nordisk, is included in all formulations. Zepbound, Eli Lilly’s tirzepatide product, is included but only in the KwikPen version — the single-dose vials and single-dose pens are not covered under the Bridge. A third drug, Foundayo — an oral GLP-1 pill also from Eli Lilly that received FDA approval earlier this year, making it the first once-daily GLP-1 tablet approved for weight management — is covered in all formulations. Notably absent are Ozempic and Mounjaro, which are GLP-1 medications prescribed primarily for diabetes rather than weight loss specifically, and Saxenda.
The BMI thresholds for eligibility are tiered. Beneficiaries with a BMI of 35 or above qualify on that basis alone. Those with a BMI of 30 or above may qualify if they also have specific cardiovascular or kidney conditions. Those with a BMI of 27 or above may qualify with conditions including prediabetes or particular cardiovascular risk factors. There is an important detail for patients who have already been taking GLP-1 drugs and have lost weight as a result: CMS has said eligibility will be assessed based on BMI at the time therapy was initiated, not current BMI. So a patient who started Wegovy with a BMI of 37 and has since reached 34 through the treatment would still qualify.
Beneficiaries do not need to register or opt into the programme — access happens through a prescribing provider and a pharmacy. The process does require a prior authorisation request from the provider, submitted to a central processor being administered by Humana on CMS’s behalf. Those prior authorisation requests cannot be submitted before 1 July, so some delays are expected in the first days of the programme.
GLP-1 receptor agonists have become one of the most significant drug classes of the past several years. Originally developed to treat type 2 diabetes by lowering blood sugar levels, researchers found they also powerfully regulate appetite, slow digestion, and produce substantial weight loss. Clinical trials showed patients losing significant proportions of their body weight on sustained treatment. KFF research found that one in eight American adults currently uses a GLP-1 medication, and one in five has tried one at some point. The cash-pay price for a monthly supply of Wegovy, without coverage, runs well above $1,000.
The Bridge programme exists because a more comprehensive long-term solution fell through. CMS had announced a multi-year demonstration called the BALANCE Model — intended to allow Part D plans to opt into GLP-1 obesity coverage from January 2027. In May 2026, CMS announced indefinitely that the Part D portion of the BALANCE Model would be delayed. The Bridge was extended to cover 2027 as a result, providing continuity while the longer-term programme is redesigned.
The situation for Medicare patients is improving. For those on private insurance, the picture is more mixed. Several private insurers have moved in the opposite direction in 2026, cutting coverage for GLP-1s used for weight loss — while retaining it for diabetes — as the drugs’ costs hit plan budgets hard. Others have added prior authorisation requirements or step therapy, requiring patients to demonstrate they have tried and failed other treatments first. Patient assistance programmes from both Novo Nordisk and Eli Lilly exist for those without coverage, and pharmacists can check formularies and contact insurers directly. Whether the broader trend in private insurance reverses will partly depend on how the Medicare programme goes — the data CMS collects from the Bridge will feed into the design of whatever replaces it in 2028.
Changing the underlying Medicare exclusion on weight-loss drugs permanently requires an act of Congress. No such bill has cleared both chambers.
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