Quick answer: The Medicare GLP-1 Bridge is a CMS demonstration that runs from July 1, 2026 to December 31, 2027. Eligible people with Medicare drug coverage pay a $50 copay a month for Foundayo, Wegovy (injection or pill) or the Zepbound KwikPen. To qualify you need to be 18 or older, be prescribed the drug only for weight loss with a diet and activity program, and have a BMI of 35 or more, 30 or more with certain heart or kidney conditions or uncontrolled blood pressure, or 27 or more with prediabetes, a previous heart attack or stroke, or peripheral artery disease with symptoms. People with type 2 diabetes, moderate to severe sleep apnea, or noncirrhotic MASH with moderate to advanced liver scarring (fibrosis) are eligible to receive GLP-1s through their Part D plan and are not eligible for the Bridge.
The criteria the checker uses, word for word
CMS publishes the criteria in its FAQs for Part D plans, providers and pharmacies. The checker applies each one below and nothing else. "For a beneficiary to qualify for the Medicare GLP-1 Bridge, a provider must submit a prior authorization request that attests the beneficiary meets the following criteria:" (CMS, Medicare GLP-1 Bridge: Information for Part D Plans)
- "The beneficiary is prescribed the requested drug to reduce excess body weight and maintain weight reduction in combination with current and ongoing lifestyle modification including structured nutrition and physical activity consistent with the applicable FDA approved label, AND" (CMS, Medicare GLP-1 Bridge: Information for Part D Plans)
- "The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to thirty-five (≥35) at the time of initiation of GLP-1 therapy, or" (CMS, Medicare GLP-1 Bridge: Information for Part D Plans)
- "The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to thirty (≥30) at the time of initiating GLP-1 therapy with a diagnosis of one or more of the following: (A) heart failure with preserved ejection fraction, (B) uncontrolled hypertension (defined as systolic blood pressure above 140 mm Hg or diastolic blood pressure above 90 mm Hg, despite concurrent treatment with two antihypertensive medications), or (C) chronic kidney disease stage 3a or above, or" (CMS, Medicare GLP-1 Bridge: Information for Part D Plans)
- "The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to twenty-seven (≥27) at the time of initiating GLP-1 therapy with a diagnosis of one or more of the following: (A) pre-diabetes (as defined by American Diabetes Association guidelines), (B) previous myocardial infarction, (C) previous stroke, or (D) symptomatic peripheral artery disease." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans)
When the BMI counts. "Eligible beneficiaries must meet the clinical criteria at the time of GLP-1 therapy initiation. This includes beneficiaries who initiated therapy prior to enrolling in Medicare Part D and/or prior to the July 1, 2026 launch of the Medicare GLP-1 Bridge." (CMS, Medicare GLP-1 Bridge: Information for Providers) "For example, if a beneficiary initiated GLP-1 therapy in September 2024 with a body mass index (BMI) of 37 and has a BMI of 34 at the time of a July 2026 prior authorization request, the prescribing provider should attest that the beneficiary met the BMI ≥35 criterion at the time therapy was initiated." (CMS, Medicare GLP-1 Bridge: Information for Providers)
Diagnoses that go to Part D. "Type 2 diabetes, moderate to severe obstructive sleep apnea, and noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver scarring (fibrosis) indications are eligible for Part D coverage." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans) "Beneficiaries with these diagnoses are eligible to receive GLP-1s through their Part D plan and therefore are ineligible to receive them through the Medicare GLP-1 Bridge, even if they otherwise meet the Medicare GLP-1 Bridge clinical criteria." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans)
Part D GLP-1 fills. "CMS has said that a beneficiary who has received a GLP-1 through Part D in CY 2026 is not eligible for the Medicare GLP-1 Bridge." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans) "In 2026, CMS will review utilization during Calendar Year 2026. CMS has not yet determined the relevant lookback period that it will apply during 2027." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans)
Weight loss only, and heart risk. "The Medicare GLP-1 Bridge was designed to increase access to GLP-1s for beneficiaries who seek the drug solely to reduce excess body weight or maintain weight reduction." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans) "If the drug is being prescribed in order to reduce the risk of major adverse cardiovascular events (regardless of whether the drug is also prescribed in order to reduce excess weight and maintain weight reduction), that prescription should be routed to the Part D plan." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans)
Plan types. "Eligible plan types: To qualify for coverage of eligible GLP-1 drugs via the Medicare GLP-1 Bridge, 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) in CY 2026." (CMS, Medicare GLP-1 Bridge: Information for Providers) "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." (CMS, Medicare GLP-1 Bridge: Information for Providers) "Beneficiaries enrolled in private fee-for-service plans, section 1876 cost contract plans, section 1833 health care prepayment plans, PACE organizations, fallback plans, and religious fraternal benefit plans are not eligible to participate, unless also enrolled in a standalone PDP, as applicable." (CMS, Medicare GLP-1 Bridge: Information for Providers)
No drug coverage yet? The Bridge is not a drug plan. "Beneficiaries in need of prescription drug coverage should contact 1-800-MEDICARE (1-800-633-4227) or their local State Health Insurance Assistance Program (SHIP)." (CMS, Medicare GLP-1 Bridge: Information for Providers)
Which drugs the Bridge covers
"At this time, for the purposes of the Medicare GLP-1 Bridge, an eligible GLP-1 drug is any of the following products when used to reduce excess body weight and maintain weight reduction: Foundayo®, Wegovy® (injection and tablets), and Zepbound® (KwikPen®)." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans) "The single-dose vial and single-dose pen formulations of Zepbound® will not be available through the Medicare GLP-1 Bridge." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans) "This list of products and NDCs may be updated over the course of the Medicare GLP-1 Bridge." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans)
Medicare.gov lists the same three: Foundayo (tablet), Wegovy (injection or tablet) and "Zepbound® (KwikPen® only. The program doesn’t cover single-dose Zepbound® vials or pens)." (Medicare.gov, Weight loss drugs) Ozempic and Mounjaro are not among the products CMS lists.
If your answers line up: what happens next
- The pharmacy asks first. CMS says "the prescriber should send the prescription to the pharmacy and wait for the pharmacy to request the prior authorization." (CMS, Medicare GLP-1 Bridge: Information for Providers)
- Your prescriber attests. "Your provider must certify that you're using the GLP-1 drug as part of a lifestyle program that focuses on diet and exercise." (Medicare.gov, Weight loss drugs)
- The decision. "The prior authorization approval or denial will be mailed to your patient and sent to the prescriber through the ePA portal or by fax within 72 hours of submission." (CMS, Medicare GLP-1 Bridge: Information for Providers) "There is no appeals process under Medicare GLP-1 Bridge." (CMS, Medicare GLP-1 Bridge: Information for Providers) CMS adds that a prescriber can resubmit the form with corrected or new information.
- How long it lasts. "Medicare GLP-1 Bridge prior authorization approvals are valid through December 31, 2027. After the first fill is approved, subsequent fills won’t need a new prior authorization, unless the patient switches from one covered GLP-1 drug to a different one." (CMS, Medicare GLP-1 Bridge: Information for Pharmacies)
- The cost. "Eligible beneficiaries will have a $50 copay." (CMS, Medicare GLP-1 Bridge (FAQs)) "This means that the Part D deductible will not apply, no part of the $50 copay counts towards the beneficiary’s TrOOP costs, and there is no low-income subsidy (LIS) provided for LIS beneficiaries." (CMS, Medicare GLP-1 Bridge (FAQs)) Medicare.gov says the $50 is for a one-month supply, 28 or 30 days depending on the drug. "Sixty or ninety-day fills are not available under the Medicare GLP-1 Bridge." (CMS, Medicare GLP-1 Bridge: Information for Pharmacies)
- No coupons on top. "Coupons and discount programs may not be applied to Medicare GLP-1 Bridge claims." (CMS, Medicare GLP-1 Bridge: Information for Part D Plans)
- Zepbound KwikPen needles. "Pen needles are not covered by Medicare GLP-1 Bridge and should not be billed to Medicare GLP-1 Bridge or the patient’s Part D plan." (CMS, Medicare GLP-1 Bridge: Information for Providers)
- A later Part D fill, or a move to an ineligible plan type, ends it. "If a beneficiary receives a prior authorization approval and fills a prescription through the Medicare GLP-1 Bridge, but later fills a GLP-1 prescription through their Part D plan, they are no longer eligible for the Medicare GLP-1 Bridge because they are now receiving coverage through Part D." (CMS, Medicare GLP-1 Bridge: Information for Pharmacies) "Similarly, if a beneficiary receives a prior authorization approval from the Medicare GLP-1 Bridge and subsequently moves to an ineligible Part D plan type (e.g. private fee-for-service plans, section 1876 cost contract plans, section 1833 health care prepayment plans, and PACE organizations) they would no longer be eligible for the Medicare GLP-1 Bridge" (CMS, Medicare GLP-1 Bridge: Information for Pharmacies)
Where CMS and Medicare.gov word it differently
Medicare.gov's page is the plain-language version of the CMS rules. In a few places the two read differently. The checker follows CMS's wording, because CMS's is the text the prior authorization uses.
| Topic | CMS | Medicare.gov |
|---|---|---|
| December 31, 2027 | Both the program end ("between July 1, 2026, and December 31, 2027") and the prior-authorization end ("Medicare GLP-1 Bridge prior authorization approvals are valid through December 31, 2027.") | Only the prior-authorization end: "Your prior authorization is valid (including for refills and dose changes) through December 31, 2027, unless you change GLP-1s." It calls the Bridge a temporary program ("This temporary program is available nationwide") without an end date; our search of the page found no other 2027 date. |
| Earlier Part D GLP-1 | "CMS has said that a beneficiary who has received a GLP-1 through Part D in CY 2026 is not eligible for the Medicare GLP-1 Bridge." | You aren't eligible if you "Already get GLP-1 drugs covered through your Medicare Part D plan". Its quiz asks: "Have you taken a GLP-1 drug covered by your Medicare drug coverage?" |
| Liver disease | "noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver scarring (fibrosis)" | "Have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (but your Part D plan might cover your GLP-1s)." |
| Uncontrolled blood pressure | "systolic blood pressure above 140 mm Hg or diastolic blood pressure above 90 mm Hg, despite concurrent treatment with two antihypertensive medications" | "Uncontrolled high blood pressure (also called hypertension)". Our search of the page found no numeric definition. |
| A BMI of exactly 27 | "greater than or equal to twenty-seven (≥27)", with a listed condition | The eligibility list says "a BMI of 27 or higher"; the page's quick quiz offers both "27 or less" and "Between 27-29.9". The checker counts 27 as meeting the threshold, as CMS does. |
Medicare.gov also runs its own short eligibility quiz on the weight loss drugs page. This checker asks the same questions plus the plan type, what the drug is prescribed for, and the drug, and asks about the tier conditions directly. It shows the CMS text behind each answer.
What this checker does not do
It does not decide coverage, submit anything, or tell you whether a GLP-1 is right for you. It cannot check your Part D claims, your diagnoses or your plan's records; it only compares what you tell it with the published criteria. A diagnosis question you are unsure about goes to your prescriber, and a plan or claims question to 1-800-MEDICARE. CMS may update the criteria or the drug list during the program; this page was checked against the CMS and Medicare.gov pages on 2026-10-29.
Frequently asked questions
Who qualifies for the Medicare GLP-1 Bridge?
CMS lists the criteria. You need Medicare drug coverage in an eligible plan type, you must be 18 or older, and the drug must be prescribed only to lose weight and keep it off, alongside a diet and activity program. You also need one of three BMI tiers when you started GLP-1 treatment: 35 or higher; 30 or higher with heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease stage 3a or above; or 27 or higher with prediabetes, a previous heart attack or stroke, or peripheral artery disease with symptoms. People with type 2 diabetes, moderate to severe sleep apnea, or noncirrhotic MASH with moderate to advanced liver scarring (fibrosis) are not eligible, and neither is anyone whose Part D plan paid for a GLP-1 in 2026. The Bridge's prior authorization, which your prescriber submits, decides.
Does Medicare cover Zepbound?
Through the Medicare GLP-1 Bridge, only the Zepbound KwikPen. CMS says: "The single-dose vial and single-dose pen formulations of Zepbound® will not be available through the Medicare GLP-1 Bridge." Separately, CMS gives Zepbound for moderate to severe obstructive sleep apnea in adults with obesity as an example of a use that Part D can cover, so people with that diagnosis go to their Part D plan, not the Bridge.
How much does the Medicare GLP-1 Bridge cost?
$50 for a one-month supply (28 or 30 days, depending on the drug), according to Medicare.gov. CMS says the Part D deductible does not apply, the $50 does not count toward your Part D out-of-pocket costs, and the low-income subsidy (Extra Help) does not lower it. Coupons and discount programs cannot be applied, and 60- or 90-day fills are not available.
Does the Bridge cover Ozempic or Mounjaro?
Ozempic and Mounjaro are not among the products CMS lists. The list is Foundayo, Wegovy (injection and tablets) and the Zepbound KwikPen, and CMS says it may be updated during the program. Both drugs are approved for type 2 diabetes, and CMS says people with type 2 diabetes are eligible to receive GLP-1s through their Part D plan and are not eligible for the Bridge.
I already take a GLP-1. Can I use the Bridge?
It depends on who has been paying. CMS says anyone who received a GLP-1 through Part D in 2026 is not eligible for the Bridge in 2026, and has not yet decided what lookback it will use in 2027. If you have been paying another way, CMS says the criteria apply at the time you started GLP-1 treatment: its example is someone who started with a BMI of 37 and now has a BMI of 34, whose prescriber attests the BMI of 35 or higher criterion.
When does the Medicare GLP-1 Bridge end?
CMS says the Bridge runs between July 1, 2026, and December 31, 2027. Medicare.gov puts the same date on the prior authorization: it is valid, including for refills and dose changes, through December 31, 2027, unless you change GLP-1s.
Is this checker a coverage decision?
No. It compares your answers with the criteria CMS and Medicare.gov publish. The Bridge's prior authorization decides: your prescriber sends the prescription to the pharmacy, the pharmacy asks for the prior authorization, and the decision is mailed to you and sent to your prescriber within 72 hours of submission (CMS). In 2026, CMS's central processor for the Bridge is Humana. The checker does not store your answers or send them as data.
Sources
- CMS, Medicare GLP-1 Bridge (FAQs), page last modified 07/13/2026. Read 2026-10-29.
- CMS, Medicare GLP-1 Bridge: Information for Part D Plans, page last modified 08/06/2026. Read 2026-10-29.
- CMS, Medicare GLP-1 Bridge: Information for Providers, page last modified 08/06/2026. Read 2026-10-29.
- CMS, Medicare GLP-1 Bridge: Information for Pharmacies, page last modified 08/17/2026. Read 2026-10-29.
- Medicare.gov, Weight loss drugs. Read 2026-10-29.
- CDC, Calculating BMI. Read 2026-10-29.
Safety: Foundayo, Wegovy and Zepbound are FDA-approved prescription medications. This tool is educational only. It compares your answers with the criteria CMS and Medicare.gov publish; it is not a coverage determination and does not recommend a drug or a treatment. The Medicare GLP-1 Bridge prior authorization decides coverage. Talk to a licensed healthcare provider about whether a GLP-1 is right for you.