Coverage for GLP-1’s with Medicare

Good news, Medicare does cover GLP-1 medications like Wegovy, Ozempic, Mounjaro, Foundayo, and others. However, actually getting them covered and how much you’ll pay is a trickier question to answer. Your cost and ability to get coverage for a GLP-1 depends on why you’re taking the medication.

There are 2 ways to get coverage for GLP-1’s: Either Part D or The BRIDGE Program

#1 ) Medicare Part D

Medicare Part D drug plans do cover GLP-1’s for certain diagnoses. This applies to both stand alone Part D plans which go with your Medicare supplement, and to Medicare Advantage plans that include a Part D drug benefit. In order to qualify you must be prescribed a GLP-1 for a condition like diabetes, or moderate to severe sleep apnea.

How much will it cost?

GLP-1’s are expensive, around $1,000/mo without insurance. If you qualify for coverage through one of the above conditions, you’ll pay for the prescription according to the tier and copay structure of your specific Part D plan. Many plans have drug deductibles, which can be up to $600+ per year. Then after the deductible you’ll pay a flat copay, or a percentage of the drug’s cost. This percentage can be as high as ~$200+ per month. Thankfully, the maximum amount you can pay for covered Part D drug costs in a year is $2,100 in 2026.

Part D Coverage Levels

Every Part D plan has 3 levels of coverage. You move from one level to another based on your drug expenses for the year.

  1. Deductible – You pay the full amount of your medications until you reach the plan’s yearly deductible.

    • For 2026, the maximum deductible is set at $615. Depending on the plan, your deductible may be less and may not apply to generic medications.

  2. Initial Coverage – You pay a co-pay or co-insurance for your medication depending on which “tier” it is.

    • Preferred Generics (Tier 1) cost less than Brand Name (Tier 4), which cost less than Specialty Drugs (Tier 5). 

  3. Catastrophic Coverage – In 2026, once you’ve paid $2,100 out-of-pocket on your Prescription Drugs for the year, you switch to the Catastrophic Coverage phase where you no longer have any cost-sharing for the rest of the year.

    • You’ll remain in this coverage level until January 1st when you reset back into the deductible.

#2 ) The GLP-1 BRIDGE Program

Medicare beneficiaries can get coverage for GLP-1’s under the BRIDGE Program, which started July 1st, 2026 and continues until the end of 2027. Under BRIDGE, qualifying recipients will pay just $50/mo for certain GLP-1’s including Foundayo, Wegovy, and Zepbound.

Qualifications

Unfortunately, many people will not qualify for coverage under the BRIDGE program. In order to qualify you must;

  1. Have Medicare Part D coverage

  2. Not have diabetes, or moderate to severe sleep apnea

  3. You meet the following Body Mass Index (BMI) guidelines

    • Your BMI is 35 or higher

    • Or your BMI is 30 or higher, and you have certain types of heart failure OR high blood pressure that’s hard to control OR chronic kidney disease (stage 3a or above)

    • Or your BMI is 27 or higher, and you have prediabetes OR you’ve had a heart attack, stroke or blocked arteries in your legs or arms

    This means if you have diabetes or sleep apnea, you are REQUIRED to get coverage for GLP-1’s under your Part D plan, not using the GLP-1 Bridge Program.

How do I find out if I qualify?

  • Always talk to your doctor first. They can help you understand if you may qualify for coverage under Part D, under the BRIDGE program, or not at all. Ultimately your doctor will submit the paperwork.

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