GLP-1 Bridge Program Begins

Over the years, many of our clients have asked about GLP-1 medications for weight loss and expressed disappointment that Medicare generally did not cover these drugs for individuals without diabetes. Beginning July 1, 2026, that will start to change.

The Centers for Medicare & Medicaid Services (CMS) is launching the Medicare GLP-1 Bridge Program, a temporary demonstration scheduled to run through December 31, 2027. The program will provide eligible Medicare beneficiaries access to certain GLP-1 medications prescribed specifically for obesity and weight loss.

Who May Qualify?

To qualify, beneficiaries must meet CMS eligibility requirements related to:

• Age

• Body Mass Index (BMI)

• Use of the medication as part of a comprehensive weight management program that includes lifestyle modifications

Interested individuals should work with their healthcare provider, who must submit a prior authorization request directly to CMS.

Important Things to Know

• This program is completely separate from Medicare Part D.

• If approved, participants will pay a $50 copayment at the pharmacy.

• The pharmacy must bill the Medicare GLP-1 Bridge Program directly.

• Claims submitted to a Medicare Part D plan for weight-loss use under this program will generally be rejected.

• Costs paid through the GLP-1 Bridge Program do not count toward your Medicare Part D out-of-pocket spending limit.

Existing Part D Coverage

GLP-1 medications prescribed for covered conditions such as:

• Diabetes

• Cardiovascular risk reduction

• Sleep apnea

may continue to be covered through a beneficiary's Medicare Part D prescription drug plan.

As always, our team will continue monitoring Medicare updates and keep you informed of any important changes that may affect your coverage.