A quick guide to Medicare’s new GLP-1 coverage

A new federal program will provide increased access to GLP-1 drugs for Medicare beneficiaries. Medicare, through Part D, currently covers the medications only for patients with type 2 diabetes, obstructive sleep apnea, or noncirrhotic metabolic dysfunction-associated steatohepatitis. Part D will continue to cover the meds for those patients, but the new Medicare GLP-1 Bridge program will expand GLP-1 coverage to certain patients who want to reduce excess body weight or maintain weight reduction. The program is scheduled to run from July 1, 2026, through Dec. 31, 2027.

To be eligible, patients must be enrolled in a standalone Part D prescription drug plan or Medicare Advantage coordinated care plan that offers prescription drug coverage. They must be at least 18 years of age and meet one of the following clinical criteria:

• Body mass index (BMI) greater than or equal to 35 when initiating GLP-1 therapy,
• BMI greater than or equal to 30 when initiating therapy and a diagnosis of one or more of the following: heart failure with preserved ejection fraction, uncontrolled hypertension (defined as systolic blood pressure above 140 mm Hg or diastolic blood pressure above 99 mm Hg, despite concurrent treatment with two antihypertensive medications), or chronic kidney disease stage 3a or above,
• BMI greater than or equal to 27 when initiating therapy with a diagnosis of one or more of the following: prediabetes (as defined by the American Diabetes Association), previous myocardial infarction, previous stroke, symptomatic peripheral artery disease.

Physicians can refer patients to the program by submitting a prescription with a diagnosis code for overweight or obesity from the E66 family of ICD-10 codes to the patient’s pharmacy. The prescription must include “SEND TO BRIDGE FOR WEIGHT MANAGEMENT.” The pharmacy will then send an electronic prior authorization (ePA) request to the prescribing physician, typically within 24 to 72 hours. You can also submit the form via fax, but Medicare strongly recommends submitting an ePA. You will receive notification within 72 hours of submission. Patients will not require a new prior authorization for refills but will need one if they switch GLP-1 drugs.

Drugs available through the Bridge program include all formulations (injection and tablets) of Fondayo and Wegovy, and the KwikPen formulation of Zepbound. Beneficiaries will have a $50 copay.

Additional information for physicians is available on the Medicare GLP-1 Bridge webpage and the prescriber factsheet. Patients can learn more on Medicare.gov or this fact sheet.

— Erin Solis, Manager, Practice & Payment at the American Academy of Family Physicians

Posted on July 1, 2026