Who qualifies for the Medicare GLP-1 Bridge, and how do I get Wegovy or Zepbound for $50 a month?

Answer the five questions below, in the order Medicare applies them. The check runs in your browser: nothing you enter is sent or saved.

You must be 18 or older, have Part D drug coverage through an eligible plan, not already have a GLP-1 covered by that plan, and meet one of three clinical criteria at the time you start the drug. Your prescriber certifies this on a prior authorization form, along with the fact that you are using the drug as part of a lifestyle program focused on diet and exercise (Medicare.gov, CMS, information for providers).

The trap most people miss: being covered elsewhere disqualifies you. If your Medicare drug plan already covers a GLP-1 for you, because you have type 2 diabetes, sleep apnea or MASH, you are not eligible for the Bridge and keep using your plan, at your plan's cost-sharing (Medicare.gov).

Moderate-to-severe obstructive sleep apnea is one of the conditions CMS routes to your Part D plan instead of the Bridge (CMS). That can work in your favour: Zepbound is FDA-approved for moderate-to-severe sleep apnea in adults with obesity, and Part D plans can cover it for that use. What to ask your prescriber, how to check plans before Open Enrollment closes on December 7, and what to do if your sleep apnea is mild: denied for the Medicare GLP-1 Bridge because of sleep apnea.

Three: Foundayo (tablet), Wegovy (injection or tablet) and Zepbound, in the KwikPen only. The program does not cover single-dose Zepbound vials or single-dose pens, and it does not cover Ozempic or Mounjaro, which are type 2 diabetes drugs handled by your regular Part D plan (Medicare.gov). CMS says the list of covered drugs may be updated while the program runs (CMS, information for pharmacies).

Only the Zepbound KwikPen. Medicare.gov states that the program does not cover single-dose Zepbound vials or pens (Medicare.gov). This matters because the vials are the form most people know from LillyDirect's cash price, and they are the form that is excluded. If you qualify for the Bridge and want tirzepatide, ask your prescriber to write the prescription for the KwikPen.

Not through the regular Part D benefit, which by law excludes drugs used for weight loss. From July 1, 2026, the Medicare GLP-1 Bridge covers Wegovy, in injection or tablet form, for eligible Part D enrollees at a $50 monthly copay after a prior authorization (Medicare.gov). Separately, Part D plans can cover Wegovy when it is prescribed to reduce the risk of heart attack and stroke in adults with established cardiovascular disease and excess weight; that goes through your plan, with your plan's cost-sharing, not the Bridge (CMS, information for providers). Price checked Oct 25, 2026 · medicare.gov

You do not apply yourself, and you do not need a telehealth company or any paid service. The order matters: CMS tells prescribers to send the prescription first and wait for the pharmacy to request the prior authorization, because a form sent before the pharmacy claim comes back "patient not found" (CMS, information for providers).

1. See your prescriber and get a prescription for a covered form: Wegovy, Foundayo, or Zepbound KwikPen. Bring a current height and weight, your weight when you started if you are already on a GLP-1, and records of the qualifying condition if your BMI is under 35.
2. Fill it at your usual pharmacy. The pharmacy bills the Bridge's central processor, not your Part D plan; pharmacies do not need to sign up (CMS, information for pharmacies).
3. When the pharmacy asks, your prescriber submits the prior authorization, electronically or by fax, usually within one to three days of the pharmacy's request. CMS aims to decide within 72 hours and sends the decision to you and your prescriber (CMS).
4. Your prescriber certifies the lifestyle program: that you use the drug alongside ongoing diet and physical activity changes (Medicare.gov).
5. Pay $50 per fill. Each fill is a one-month supply of 28 or 30 days, depending on the drug; 60- and 90-day fills are not available. An approval lasts through December 31, 2027, including refills and dose changes, unless you switch to a different GLP-1 (CMS, information for pharmacies). Price checked Oct 25, 2026 · medicare.gov

There is no appeals process under the Bridge; if a request is denied, your prescriber can resubmit it with corrected or added information (CMS). Questions about your own case: 1-800-MEDICARE (1-800-633-4227), or your State Health Insurance Assistance Program (SHIP) for free counselling.

$50 for each one-month fill. Over 52 weeks that is $650 for a weekly pen (13 fills of 28 days) or about $607 for a daily tablet, whose fills last 30 days. The copay does not count toward your Part D deductible or your yearly out-of-pocket limit, because the Bridge runs outside the regular Part D benefit (Medicare.gov, CMS, information for pharmacies). Medicare.gov also says Extra Help does not lower it and it cannot be spread out with the Medicare Prescription Payment Plan. Price checked Oct 25, 2026 · medicare.gov

Savings cards and coupons do not apply. CMS says no coupon or discount program can be used on a Bridge claim (CMS, information for pharmacies), and both manufacturers' savings cards exclude anyone enrolled in Medicare in their own terms. More on the cards and on appeals: when insurance won't cover Wegovy or Zepbound.

Nobody knows yet. The Bridge ends December 31, 2027. It was meant to hand over to the Part D side of CMS's BALANCE Model, but CMS says the model is not launching in Medicare in 2027; it extended the Bridge through the end of 2027 instead, ahead of a "potential" BALANCE start in Part D, and has not given a date (CMS, BALANCE Model). The law that bars Part D from covering weight-loss drugs is unchanged. Plan as if the $50 price could stop at the end of 2027: the fallbacks then are whatever your plan covers and the self-pay routes below. This page will be updated when CMS announces what follows. Price checked Oct 25, 2026 · medicare.gov

• Dates, copay, covered drugs, clinical criteria, exclusions, deductible and out-of-pocket rules: Medicare.gov, Weight loss drugs, and the fact sheet Medicare GLP-1 Bridge (publication 12234), read 2026-09-25.
• Program design, plan types, prior authorization sequence, fills, coupons, appeals, BALANCE: CMS, Medicare GLP-1 Bridge, Information for providers, Information for pharmacies and BALANCE Model, read 2026-09-25.
• Brand self-pay prices: the official LillyDirect, NovoCare and TrumpRx pages linked in the full price table; each price shows the date it was last checked. Compounded prices: the site's provider file; sources on every provider we track. Each price shows the date it was last confirmed.
• Weight loss used for cost per pound: SURMOUNT-1 (NEJM 2022), STEP 1 (NEJM 2021).