Weight Loss

Starting July 1, 2026, Medicare is launching a new nationwide pilot program called the Medicare GLP-1 Bridge. For the first time, eligible Medicare Part D and Medicare Advantage beneficiaries can access select, FDA-approved weight-loss medications for a flat $50 monthly copay. 

This temporary program runs through December 31, 2027. Because the program is processed through a single, central federal system, your specific Part D plan doesn't change, but strict clinical prior authorization rules still apply. 

• Wegovy® (Both the subcutaneous injection and the new oral tablet formulation)
• Zepbound® (Approved only for the KwikPen® formulation; single-dose vials are excluded)
• Foundayo® (The recently approved daily oral weight-loss tablet) 

(Please note: Ozempic® and Mounjaro® are not covered under this weight-loss program. They remain covered strictly under standard Medicare Part D for Type 2 Diabetes management). 

To qualify for the $50/month copay, CMS rules state you must have an active Medicare Part D plan and meet one of the following health tiers: [1, 7, 10]

• Tier 1: A Body Mass Index (BMI) of 35 or higher.
• Tier 2: A BMI between 30 and 34.99, plus at least one of these conditions:

Per federal guidelines, you cannot participate in this specific program if you: 

• Already have GLP-1 drugs covered directly through your standard Part D plan.
• Have a diagnosis of Type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (though you may still qualify for coverage through standard Part D pathways outside the Bridge). [1]

Prior authorization is required before pharmacies can process the $50 copay. If you are an East County Internal Medicine patient and believe you meet the criteria, please schedule a consultation. We will review your metabolic profile, calculate your current BMI, check for qualifying co-morbidities, and submit the necessary clinical paperwork to CMS.