Medicares GLP-1 Bridge Program and Its Exceptions

Obesity is a health problem that contributes to heart disease, diabetes, and various other ailments. According to the United Health Foundation, 29.5 percent of adults age 65 and older have a body mass index (BMI) of 30.0 or higher. The CDC categorizes this as obese.According to the Mayo Clinic, glucagon-like peptide-1 (GLP-1) is an effective, clinically proven drug for losing weight. However, the cost has been prohibitive for many seniors. Out-of-pocket expenses often range from $800 to $1,200 per month, and insurance coverage has been inconsistent.In the past, Medicare provided limited coverage. But starting July 1, 2026, a temporary program called Medicare GLP-1 Bridge provides limited coverage for certain weight-loss drugs. These drugs include specifically named GLP-1s.Medicare Had Limited Coverage Before July 2026Prior to July 2026, according to Wellcare, Medicare only covered GLP-1 medications prescribed for FDA-approved medical conditions like Type 2 diabetes, obstructive sleep apnea, or cardiovascular risk reduction.Under federal law, Medicare excludes drugs used solely for weight loss, including GLP-1s. It would require Congress to act to change that law. However, according to the Medicare Rights Center, the Centers for Medicare & Medicaid Services (CMS) has the authority to test coverage changes and other statutory demonstration authorities. The Medicare Bridge Program is that test.What GLP-1s Are Covered Under Medicare BridgeUnder the Medicare Bridge Program, GLP-1s such as Fondayo® (tablet), Wegovy (injection or tablet) and Zepbound (KwikPen only) are covered. The single-dose Zepbound pen and Zepbound vials are not covered.Cost for GLP-1s Under the Bridge ProgramYour cost for these GLP-1s under Bridge is $50 per month. Your income level isn’t a factor.The $50 you pay each month under the Bridge Program doesn’t count toward your Part D annual out-of-pocket cap. According to the National Council on Aging, the cap in 2026 is $2,100.It also doesn’t count toward your Medicare Part D deductible, which is no more than $615 per year.These drugs aren’t eligible for the Medicare Prescription Payment Plan.Eligibility for the Medicare Bridge ProgramMedicare has stipulations as to who is eligible for the Bridge Program. For example, you must have Part D drug coverage under either a standalone Medicare Drug Plan or a Medicare health plan that includes drug coverage.Requirements for the Bridge PlanYou must have a BMI of 35 or higher to be on the Bridge plan for obesity.If your BMI is 30 or higher but not 35, you must also have certain types of diseases, including:heart failurehigh blood pressure that’s hard to controlchronic kidney disease (stage 3a or above)You also are eligible if your BMI is 27 or higher, and you have prediabetes or you’ve had a heart attack, stroke, or blocked arteries in your legs or arms.Who Isn’t Eligible for the Bridge Plan?You’re not eligible for the Bridge Plan if you have special coverage plan types like private fee-for-service plans, cost contract plans or a PACE organization plan.If you’ve been using a GLP-1 drug paid for by your Medicare drug plan for reasons other than weight, you need to keep receiving your GLP-1 through your plan.If you have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, those conditions may already be covered under your Medicare drug plan.What’s the Process to Participate in the Bridge Program?Have a discussion with your doctor about whether GLP-1s are right for you. Your physician can determine whether you qualify for the Bridge Program.If one of the approved drugs is right for you, your doctor will send it to the pharmacy. Once the pharmacy receives confirmation that you are eligible for the Medicare Bridge Program, your doctor must submit a form requesting Medicare coverage approval.Once it has final approval, you’ll receive a letter from Medicare, letting you know your GLP-1 is covered.You don’t need approval for a refill if you stay on the same drug. This includes any dosage adjustments.Your $50 covers a one-month supply.How Long Will the Bridge Program Last?The original Bridge Program was slated to run from July 1, 2026, until December 31, 2026, according to the Medicare Rights Center.The plan for Medicare’s coverage of GLP-1s was to implement the Balance Model, which stands for Better Approaches to Lifestyle and Nutrition for Comprehensive Health starting January 1, 2027. It would have replaced the Bridge Program.According to the CMS, as part of a voluntary model, under the Balance Model, it would negotiate drug pricing and coverage terms with manufacturers of GLP-1 medications on behalf of state Medicaid agencies and Medicare Part D plan sponsors.The Bridge Program was meant to “bridge” the gap between no coverage and coverage via the Balance Model. However, according to the Obesity Medicine Association, the Balance Model has been delayed.Because of this delay, the Bridge Program has been extended until December 2027.The Epoch Times copyright © 2026. The views and opinions expressed are those of the authors. They are meant for general informational purposes only and should not be construed or interpreted as a recommendation or solicitation. The Epoch Times does not provide investment, tax, legal, financial planning, estate planning, or any other personal finance advice. 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