Medicare will cover weight-loss drugs for $50 a month starting July

CMS's GLP-1 Bridge program will let eligible Medicare beneficiaries pay $50 a month for Wegovy and Zepbound beginning July 1, 2026; the Bridge runs through Dec. 31, 2026 and the longer-term BALANCE option for Part D plans is voluntary starting in 2027.

CMS finalized the Medicare GLP-1 Bridge program in early March to allow some Medicare beneficiaries to access certain weight-loss drugs at a $50 monthly copay starting July 1, 2026. The program covers two drugs at launch and is administered centrally by CMS rather than through individual Part D plans. The Bridge is set to expire Dec. 31, 2026, and a separate program called BALANCE is scheduled to begin for Part D plans in January 2027 on a voluntary basis. Federal rules that barred Medicare from covering anti-obesity drugs date back to 2003, and this Bridge represents a temporary change in that policy. Key details: - Drugs covered: Wegovy (semaglutide) and Zepbound (tirzepatide), in both injectable and oral formulations at launch. - Administration and payment: CMS manages the program through a single central processor; prior authorization requests go to that processor and beneficiaries pay a $50 copay at the pharmacy while CMS reimburses pharmacies at wholesale acquisition cost minus the copay plus a dispensing fee. - Eligibility rules: Enrollment in a Part D plan for 2026 is required, and clinical eligibility is based on BMI and specific conditions (examples noted in guidance include BMI 35+; BMI 27+ with prediabetes or cardiovascular history; BMI 30+ with certain heart, blood-pressure, or kidney conditions). - Cost interactions: The $50 monthly copay under the Bridge does not count toward Part D deductibles or the Part D out-of-pocket cap, and Medicare’s Low-Income Subsidy (Extra Help) does not apply to Bridge payments. - Timing and transition risk: The Bridge expires Dec. 31, 2026; BALANCE is slated for January 2027 but plan participation is voluntary, creating the possibility that beneficiaries may need different Part D coverage to continue access. - Clinical note from published research: A New England Journal of Medicine study reported that participants who stopped semaglutide regained about two-thirds of the weight they had lost within a year. Summary: The Bridge program lowers the monthly copay for eligible beneficiaries to $50 and is centrally run by CMS for the two GLP-1 drugs named at launch. The program is temporary through the end of 2026, and continuation of coverage after that depends on whether Part D plans adopt the voluntary BALANCE program and on ongoing policy and pricing decisions. Undetermined at this time.