Before July 1, 2026
Medicare covered GLP-1s only for type 2 diabetes, cardiovascular disease risk reduction, or obstructive sleep apnea under Part D.
Comprehensive, empathetic healthcare — with GLP-1 support*
GET MEDICARE TO COVER GLP-1S
Medicare coverage for GLP-1 weight loss medications
Comprehensive, empathetic weight management care that sees more than a number on the scale
WHAT’S ON THIS PAGE
WHAT’S ON THIS PAGE
Cost & Coverage
Cost & Coverage
What does coverage cost?Who qualifies for Medicare GLP-1 coverage?Which Medicare beneficiaries are eligible to participate?Program Specifics
Program Specifics
Medicare GLP-1 Bridge Program vs. Medicare Part DHow to get your GLP-1 covered by MedicareWhat is Medicare Part D?Medications Covered
Medications Covered
Which specific medications are included?Medicare GLP-1 coverage timelineFrequently asked questionsCOST & COVERAGE
What is the Medicare GLP-1 Bridge Program?
Starting July 1, 2026, Medicare will cover weight loss drugs.
Medicare will cover weight loss drugs for eligible Part D beneficiaries through December 31, 2027. This is a major shift. Medicare previously covered GLP-1s only when prescribed for type 2 diabetes, cardiovascular disease risk reduction, or moderate to severe obstructive sleep apnea. It did not cover them for obesity or weight management alone.
That changes with the Medicare GLP-1 Bridge program. Eligible Medicare Part D enrollees — including many Medicare Advantage plans with drug coverage — can now access GLP-1 medications for a $50 monthly copay.
What does Medicare GLP-1 coverage cost?
It depends on which coverage pathway applies to you.
Through the Medicare GLP-1 Bridge: You pay a flat $50 per monthly supply, every fill, regardless of which phase of your Part D benefit you're in.
Through Medicare Part D: Each Medicare part D plan uses a list of approved drugs (drug formulary) which may differ from plan to plan. Your cost depends on your specific plan, your diagnosis, your deductible (up to $615 in 2026), and which tier the medication falls on in your plan's formulary.
Understand your out-of-pocket costs. Coverage doesn't mean free. Your cost will depend on your specific plan, diagnosis, deductible, and formulary tier. See the full comparison below.
Who qualifies for Medicare GLP-1 coverage?
To be eligible under the Medicare GLP-1 Bridge program, you must be enrolled in Medicare part D and meet at least one of the following BMI-based criteria. If you have questions about your specific coverage options you should contact 1-800-MEDICARE (1-800-633-4227) or your local State Health Insurance Assistance Program. Your knownwell clinician can also help assess your options at your visit. Book a visit with a knownwell clinician.
BMI ≥ 35
Qualifies on its own,
no additional diagnosis required
BMI ≥ 30
Plus one of:
- Heart failure with preserved ejection fraction (HFpEF)
- Uncontrolled hypertension
- Chronic kidney disease, stage 3a+
BMI ≥ 27
Plus one of:
- Pre-diabetes
- Prior myocardial infarction (MI)
- Prior stroke
- Symptomatic peripheral artery disease
Prior authorization will still be required.
Important exception
If you have a coverable condition under Part D, the Medicare GLP-1 Bridge programmay not apply.
For example, if you currently have an approved prior authorization through Part D for Zepbound prescribed for moderate to severe sleep apnea, Wegovy for cardiovascular risk reduction or noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), or all FDA-approved medications for treating Type 2 Diabetes (Ozempic, Mounjaro, etc.), the Medicare GLP-1 Bridge program will not cover your medication.
For these indications, drug coverage will continue under your standard Part D plan’s formulary.
Which Medicare beneficiaries are eligible to participate?
Only Medicare Part D beneficiaries who are enrolled in eligible plan typesand meet the Medicare GLP-1 Bridge Clinical Criteria above will be eligible.
Eligible plan types: To qualify for coverage, Medicare beneficiaries must be enrolled in a standalone prescription drug plan (PDP) or Medicare Advantage (MA) coordinated care plan (i.e., HMO, HMOPOS, and Local and Regional PPO plans) that offers prescription drug coverage (MA-PD plans).
Part D beneficiaries in Special Needs Plans (SNPs), employer/union group waiver plans (EGWPs), and the Limited Income Newly Eligible Transition (LI NET) program are eligible to participate.
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PROGRAM SPECIFICS
Medicare GLP-1 Bridge Program vs. Medicare Part D
If you have Medicare and are prescribed a GLP-1 medication, your cost and coverage will depend on which pathway applies to you — the Medicare GLP-1 Bridge or your Part D plan.
How to get your GLP-1 covered by Medicare
Getting coverage requires a prior authorization (PA) — a formal request from your clinician to your Medicare plan confirming you meet the eligibility criteria. Here'show to move forward:
1. Don't wait for your plan to each out. Medicare won't automatically enroll you in the Bridge program. You need to work with a clinician who can assess your eligibility and submit a prior authorization (PA) on your behalf.
2. Confirm your eligibility criteria. Review the BMI and diagnosis thresholds above. Your clinician will document the qualifying diagnosis in your PA. Bring your most recent lab work and a list of current diagnoses to your visit.
3. Prior Authorization. Your clinician will need to get approval before prescribing medications. PAs must be submitted on or after July 1, 2026 to be valid under this program. Submitting early will result in denial. The knownwell team handles submitting your PA for you.
4. Understand your out-of-pocket costs. Coverage doesn't mean free. Your cost will depend on your specific plan, diagnosis, deductible, and formulary tier. Learn more in Medicare GLP-1 Bridge vs. Medicare Part D.
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Prior authorization process for Medicare Bridge
Prior authorization is a step that requires your clinician to confirm you meet specific eligibility criteria before your medication is covered. Here’s a quick overview of the process:
STEP 1
Meet with a knownwell clinician to review program eligibility and clinical criteria. If eligible under Medicare Bridge, your clinician will begin the process.
STEP 2
Clinician sends prescription to the patient’s preferred pharmacy.
STEP 3
Pharmacy processes prescription and sends knownwell a request for prior authorization. This may appear as a rejection to patients, but its to be expected. Patients do not need to do anything.
STEP 4
knownwell submits prior authorization to Humana, the central processor for the Medicare GLP-1 Bridge program.
STEP 5
knownwell notifies patient of determination. If approved, patients should reach out to their pharmacy to confirm prescription is ready for pick up.
What is Medicare Part D?
Medicare part D helps cover the cost of prescription drugs. Part D is optional and offered to everyone who qualifies for Medicare. There are two ways to get Medicare Part D prescription drug coverage:
- If you have Medicare Part A and Part B (Original Medicare), you may choose to add a Part D prescription drug plan.
- If you have a Medicare Part C plan (Medicare Advantage Plan), you may have part D coverage already included.
Part D is offered through private insurance companies approved by the federal government. Drug costs and coverage may vary from plan to plan.
Learn more with Dr. Angela Fitch
Angela Fitch, MD, FACP, FOMA, Dipl. ABOM co-founder and Chief Medical Officer of knownwell, is one of the leading voices in obesity medicine. Watch her explain what the Medicare GLP-1 Bridge program means for patients — and how to know if you qualify.
If you think you might qualify, knownwell can help. Our care team has experience navigating the Medicare GLP-1 Bridge program and can assess your eligibility at your first visit. Book a visit.
If you think you might qualify, knownwell can help. Our care team has experience navigating the Medicare GLP-1 Bridge program and can assess your eligibility at your first visit. Book a visit.
MEDICATIONS COVERED
Which specific medications are included?
The bridge program covers FDA-approved GLP-1 receptor agonists indicated for weight management. At knownwell, our clinicians prescribe only FDA-approved medications. Coverage and formulary placement will vary by your specific Medicare Part D plan.
Foundayo® (Orfoglipron) Pill
Foundayo® (orfoglipron) is the first oral, non-peptide GLP-1 receptor agonist approved by the FDA for chronic weight management in adults with obesity or excess weight and a related health condition.
Unlike injectable GLP-1s, orfoglipron is a pill taken once daily without food restrictions. In clinical trials, patients taking orfoglipron lost an average of 7.9–8.7% of their body weight over 36 weeks.
Wegovy® (Semaglutide) Injection
Wegovy® is a once-weekly injectable semaglutide approved by the FDA for chronic weight management. It works by mimicking GLP-1, a hormone that regulates appetite and blood sugar, helping patients feel fuller longer and eat less over time.
In the STEP clinical trials, adults using semaglutide lost an average of 15% of their body weight over 68 weeks. Wegovy® is also FDA-approved to reduce the risk of serious cardiovascular events in adults with cardiovascular disease and obesity.
Wegovy® (Semaglutide) Pill
The oral formulation of semaglutide offers the same active ingredient as the Wegovy® injection in a once-daily pill. It's an option for patients who prefer not to self-inject.
Clinical data shows meaningful weight reduction comparable to other GLP-1 formulations, with the added convenience of an oral format.
Zepbound® KwikPen (Tirzepatide) Injection
Zepbound® is a once-weekly injectable tirzepatide that works on two hormone pathways — GLP-1 and GIP — making it the first dual agonist approved by the FDA for weight management.
In the SURMOUNT clinical trials, patients lost an average of 20.9% of their body weight over 72 weeks at the highest dose, the most of any approved obesity management medication to date. Zepbound® is also FDA-approved for moderate-to-severe obstructive sleep apnea in adults with obesity.
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Bias-free weight care
We pair deep obesity medicine expertise with a more personal approach to care. Your knownwell care team works with you at every step, adjusting along the way to better support your health and help you reach your goals.
Medicare GLP-1 coverage timeline
July 1, 2026
Coverage via the Medicare GLP-1 Bridge program goes live. Prior authorizations can be submitted after this date.
December 31, 2027
The program is currently scheduled to end. The federal government will determine whether to extend, expand, or convert this to a permanent Medicare benefit.
Frequently asked questions
What BMI do you need for Medicare to cover a GLP-1?
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.
I'm already taking a GLP-1. Can I still use the Medicare GLP-1 Bridge?
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.
Is this Medicare GLP-1 coverage permanent?
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).
Does Medicare Advantage cover GLP-1s for weight loss?
Yes, if your Medicare Advantage plan includes drug coverage (called an MA-PD plan). Most Medicare Advantage plans include prescription 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 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.
Do I need a prior authorization for a GLP-1 under 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.
What if my GLP-1 prior authorization is denied?
If your authorization is denied because you don't meet the program's coverage criteria, we offer affordable cash-pay options for weight management medications.
If your prior authorization is incorrectly denied, we can resubmit or appeal on your behalf. Your clinician can discuss all your treatment options and help you find the best path forward for your care.
Does Medicare cover GLP-1s for people without diabetes?
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.
Why is Medicare covering GLP-1s now?
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.
How much will a GLP-1 cost with Medicare in 2026?
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.
What GLP-1 medications are covered by Medicare?
Medicare covers GLP-1s like Wegovy for certain clinical indications. The Bridge program is expanding the list of covered medications. The preferred medication depend on your diagnoses and specific plan's drug formulary.
For the Bridge Program, Wegovy and Zepbound are covered when prescribed for weight management. Other drugs like Ozempic or Mounjaro may be covered through your part D plan, but specific coverage varies by plan.
DISCLAIMERS & SOURCES
Disclaimers
This page is for informational purposes only and does not constitute medical or insurance advice. Coverage eligibility is determined by your Medicare Part D plan and requires clinician documentation. knownwell does not guarantee coverage outcomes. For personalized guidance, speak with a knownwell clinician or contact 1-800-MEDICARE.
Last updated: June 2026.
Last updated: June 2026.