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Medicare Covers Weight Loss Drugs for $50 Copay
6 May
Summary
- Medicare beneficiaries can get GLP-1s for $50 copay starting July 2026.
- Pilot program runs July 2026 through December 2027.
- Eligibility requires BMI of 27+ with conditions or BMI of 35+.
Beginning July 1, 2026, Medicare beneficiaries may access weight management medications like Wegovy, Zepbound, and Foundayo for a $50 copay. This initiative, the Medicare GLP-1 Bridge, is a limited-time pilot program set to conclude on December 31, 2027. It requires enrollment in a Medicare Part D plan. Eligibility criteria include a body mass index (BMI) of 27 or higher coupled with specific health conditions, or a BMI of 35 or higher.
The pilot program covers specific GLP-1 medications, including injectable and pill formulations of Wegovy, the KwikPen formulation of Zepbound, and the Foundayo pill. Prior authorization will be necessary, with doctors submitting requests to a central CMS contractor. This new benefit offers a predictable $50 copayment, regardless of dosage, making these treatments more affordable than current cash prices ranging up to $699 monthly.
However, the $50 copay does not count towards the Part D deductible or the annual out-of-pocket cap. Beneficiaries receiving low-income subsidies cannot use that assistance for these drugs. Those already on GLP-1s for conditions like diabetes will continue using their standard Part D plans, potentially paying more than the Bridge copay. The program's extension through December 2027 aims to provide insurers with more data while the long-term strategy is developed.
