Starting July 1, 2026, Medicare Part D will cover GLP-1 medications — including semaglutide products — when prescribed for weight management through the Medicare GLP-1 Bridge program.If your GLP-1 is already covered under Part D for another diagnosis, you may not be eligible for the bridge program separately.

Yes. Both Wegovy (semaglutide) and Zepbound (tirzepatide) are FDA-approved for weight management will be covered under the Medicare GLP-1 Bridge program starting July 1, 2026, for eligible patients.

Coverage is subject to prior authorization approval and your plan's formulary. Note: only the KwikPen formulation of Zepbound is included in the Bridge — the single-dose vial and pen are not.

Starting July 1, 2026, Medicare will cover GLP-1 medications — including semaglutide products like Wegovy — for weight management through the Medicare GLP-1 Bridge program.

Ozempic (semaglutide) is FDA-approved for type 2 diabetes, not weight management, so it is not included in the Bridge program. Wegovy, the weight-management formulation of semaglutide, is covered.

If your GLP-1 is already covered under Part D for another diagnosis (such as cardiovascular disease or sleep apnea), the Bridge program may not apply separately.

The Medicare Bridge program covers patients based on BMI and clinical criteria:

• BMI 35 or higher — no additional diagnosis required

• BMI 30 or higher — with heart failure with preserved ejection fraction (HFpEF), uncontrolled hypertension, or chronic kidney disease (stage 3a+)

• BMI 27 or higher — with pre-diabetes, prior heart attack (MI), prior stroke, or symptomatic peripheral artery disease

Your knownwell clinician will confirm which criteria apply at your visit.

Possibly, yes. If you were already prescribed a GLP-1 for weight management before July 1, 2026, you may still qualify — even if your current BMI has changed since you started. Your knownwell clinician will attest in the prior authorization that you met the eligibility criteria when you first began the medication.

For example, if you started a GLP-1 in 2024 with a BMI of 37 but now have a BMI of 33 due to weight loss, your clinician can document the original qualifying BMI to support your PA.

No, not yet. The current coverage with the Medicare Bridge program is running through December 31, 2027. After that, Centers for Medicare & Medicaid Services will evaluate outcomes and make a decision on extending coverage.

Advocates and the obesity medicine community are pushing for permanent coverage through legislation like the Treat and Reduce Obesity Act (TROA).

Yes, if your Medicare Advantage plan includes drug coverage (called an MA-PD plan). Most Medicare Advantage plans include Part D drug coverage, which means you are eligible for the Medicare GLP-1 Bridge program if you meet the clinical criteria.

Check with your plan directly or call knownwell to confirm. If you're unsure whether you have a standalone Part D plan or Medicare Advantage with drug coverage, look at your plan card or call 1-800-MEDICARE.

Yes, if your Medicare Advantage plan includes drug coverage (called an MA-PD plan). Most Medicare Advantage plans include Part D drug coverage, which means you are eligible for the Medicare GLP-1 Bridge program if you meet the clinical criteria.

Check with your plan directly or call knownwell to confirm. If you're unsure whether you have a standalone Part D plan or Medicare Advantage with drug coverage, look at your plan card or call 1-800-MEDICARE.

If your GLP-1 prior authorization is denied, you have the right to appeal.

At knownwell, our prior authorization team handles the behind-the-scenes work — gathering documentation, coordinating with your clinician, and advocating for your coverage — so you can stay focused on your health.

Yes — starting July 1, 2026, for eligible patients who meet the BMI criteria above, even without a diabetes diagnosis. This is the major shift: previously, Medicare coverage required a diabetes or cardiovascular diagnosis. The Bridge program extends coverage to obesity management as a standalone indication.

This change comes through the Medicare GLP-1 Bridge program, a demonstration authorized by the CMS Innovation Center (CMMI) under the Social Security Act's Section 1115A. The program is designed to test whether covering these medications reduces hospitalizations, improves outcomes, and lowers long-term Medicare costs.

The Treat and Reduce Obesity Act (TROA), long advocated by obesity medicine specialists, has pushed for exactly this kind of coverage expansion for years. This demonstration is the first concrete step toward making it a permanent benefit.

Through the Medicare GLP-1 Bridge, you pay a flat $50 per monthly supply. Through standard Medicare Part D, your cost depends on your specific plan, your diagnosis, your deductible, and which tier the medication falls on in your plan's formulary.

Once you get started with knownwell, our team can help you understand which pathway applies to you and what to expect for your costs.