For more than two decades, federal law has barred Medicare's prescription drug program from covering medications used for weight loss. That rule left millions of older Americans unable to get blockbuster GLP-1 drugs such as Wegovy and Zepbound through Medicare unless they also had a qualifying condition like type 2 diabetes. Since July 1, 2026, that has changed, at least temporarily, through a new program called the Medicare GLP-1 Bridge [1][5].
How the Bridge works
The Bridge runs from July 1, 2026, through December 31, 2027. It was originally scheduled to end after 2026 and was later extended [1]. It covers Wegovy, Foundayo and the KwikPen formulation of Zepbound when they are prescribed to reduce excess body weight and maintain that reduction [1]. For eligible beneficiaries, the cost is a flat $50 copay per month, no matter where they are in their Part D benefit [1]. Behind the scenes, manufacturers Novo Nordisk and Eli Lilly agreed to a net price of $245 per 30-day supply, and they owe Medicare the difference between their list price and that amount [1]. For comparison, list prices for these drugs have historically been more than $1,000 a month. There are limits. A provider must submit a prior authorization confirming that the drug is being prescribed for weight reduction, and the patient must meet one of several criteria based on body mass index (BMI) and other health conditions [1]. Patients must be 18 or older. The $50 copay does not count toward the Part D deductible or the annual out-of-pocket cap, and the low-income subsidy known as Extra Help does not reduce it [1]. People who already receive these drugs through Part D for another condition, such as diabetes, keep getting them through their regular plan.
Where the deal came from
The Bridge grew out of agreements between the Trump administration and the two drugmakers, part of a broader push to lower prices on GLP-1 medications. Those agreements also set the stage for a longer-term program called the BALANCE Model, which was supposed to bring obesity drug coverage into both Medicare Part D and Medicaid on a more permanent basis [1][2].
The long-term model hits a wall
The Medicare side of BALANCE has run into trouble. The model was supposed to run in Part D from January 2027 through 2031, but it depended on private Part D plans volunteering to participate. CMS set a threshold requiring 80% of plans to sign on for
2027. That threshold was not met, with major plan sponsors reportedly reluctant or
unwilling to join, and on April 21, 2026, CMS announced it would not proceed with the Medicare portion in 2027 [1]. Its future start date is uncertain. That leaves a gap. KFF notes that unless the Bridge is extended again or BALANCE is eventually implemented, there is no clear path for Medicare coverage of obesity drugs after 2027 [1].
Medicaid: a voluntary state option
The Medicaid portion of BALANCE is moving forward, but on a state-by-state basis. States can join on a rolling basis between May 2026 and January 2027, and participation is voluntary [1]. States must sign agreements with CMS and supplemental rebate agreements with the manufacturers, and the price they pay is confidential [1]. Interest may be limited by budget pressures. As of January 2026, only 13 state Medicaid programs covered GLP-1 drugs for obesity, down from 16 in 2025 [1]. California, New Hampshire, Pennsylvania and South Carolina all ended coverage of the drugs for weight loss in January 2026, citing cost [3].
Why cost is the central question
GLP-1 drugs are already among the most expensive items in public health budgets, even before broad obesity coverage. In 2024, before rebates, Medicare spent $27.5 billion on 21.8 million GLP-1 claims, mostly for diabetes, and Medicaid spent $8.6 billion [1]. Estimates of the cost of covering obesity drugs in Medicare Part D have ranged from $25 billion to $35 billion over 10 years [1]. CMS has not published a projected cost for the Bridge [1]. Supporters argue that treating obesity can prevent costlier problems later, such as heart attacks, strokes and kidney disease, and that the negotiated $245 price makes coverage far more affordable than in the past. Skeptics note that evidence that these drugs reduce other medical spending in the short term is limited, and that patients often need to stay on them indefinitely to maintain weight loss [1]. Some advocates also argue the $50 copay could be a barrier for low-income beneficiaries because Extra Help does not apply [1]. KFF also notes that adding obesity coverage could eventually push Part D premiums higher, particularly for stand-alone plans [1].
A related change: Medicare's negotiated prices
The Bridge is separate from Medicare's drug price negotiation program, but the two overlap. Ozempic and Wegovy, both forms of semaglutide, were among the drugs selected in the second round of Medicare negotiations, and their negotiated prices take effect in 2027 [4]. Together, these efforts mark a significant shift in how the federal government handles a class of drugs that has transformed obesity treatment.
How patients get started
For beneficiaries interested in the Bridge, the first step is a conversation with a clinician, who must submit the prior authorization and confirm that the patient meets the program's criteria [1][2]. Prescriptions are filled through pharmacies like other Part D drugs. Because the Bridge operates outside the normal Part D benefit, patients pay the $50 copay even if they have already reached their plan's out-of-pocket maximum for other drugs [1]. Pharmacists and benefit counselors have urged beneficiaries to confirm coverage details before filling a prescription, since rules differ from regular Part D coverage [2].
Why it matters
About four in 10 American adults have obesity, and the rate among older adults is similar. For many Medicare beneficiaries, the Bridge is the first time they have been able to get these drugs at an affordable price through their insurance. But the program is temporary by design. Whether Medicare coverage of obesity drugs becomes permanent will depend on what happens after 2027, including whether Congress changes the law that has excluded weight-loss drugs from Part D since the program began.
Sources
- 1. "What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid," KFF, May 11, 2026. https://www.kff.org/medicare/what-to-know-about-the-balance-model-for-glp-1s-in-medicare-and-medicaid
- 2. "What You Need to Know Before the Medicare GLP-1 Bridge Goes Live," American Journal of Managed Care, June 2, 2026. https://ajmc.com/view/what-you-need-to-know-before-the-medicare-glp-1-bridge-goes-live
- 3. Akash Pillai, Elizabeth Williams and Robin Rudowitz, "Medicaid and Upcoming State Budget Debates," KFF, January 23, 2026. https://www.kff.org/medicaid/medicaid-and-upcoming-state-budget-debates/
- 4. "CMS moves forward with 3rd round of Medicare drug negotiations," Becker's Hospital Review, March 2026. https://www.beckershospitalreview.com/pharmacy/15-drugs-selected-for-medicare-negotiation-program/
- 5. "Does Medicare Cover GLP-1 Weight Loss Drugs Like Ozempic and Zepbound?" WTOP, July 2026. https://wtop.com/news/2026/07/does-medicare-cover-glp-1-weight-loss-drugs-like-ozempic-and-zepbound/ Information in this article is current as of October 10, 2026. Bracketed numbers refer to the sources listed above.