Medicare launches temporary GLP-1 drug program with $50 monthly copay
A new Medicare demonstration will let eligible beneficiaries obtain GLP-1 medications for weight management at a flat $50 monthly fee, running from July 2026 through December 2027.
Starting July 1, 2026, Medicare will run a time-limited demonstration that allows certain Part D enrollees to receive GLP-1 drugs for a $50 monthly copay. The program, which will end on Dec. 31, 2027, is intended for beneficiaries who lack a Medicare-covered indication for the drugs, such as a diabetes diagnosis, and who meet specific body-mass-index and health-condition criteria.
To join, a prescriber must submit a prior-authorization request and a prescription for one of the approved medications—Wegovy, Zepbound or Foundayo. The pharmacy forwards the prescription to a central processor, and a detailed authorization form must confirm the patient does not have Type 2 diabetes, moderate-to-severe obstructive sleep apnea or MASH fatty liver disease. Claims will not be processed until the program’s start date.
Eligibility requires enrollment in a standalone prescription-drug plan, a Medicare Advantage coordinated-care plan, or certain other Medicare plans, and beneficiaries must be at least 18 years old with a BMI of 27 or higher plus an additional qualifying condition. Those with a BMI of 35 or more are eligible without an extra diagnosis.
CMS officials say the demonstration will test whether a uniform negotiated price for GLP-1 products can improve health outcomes and lower long-term Medicare spending. The $50 copay does not count toward deductibles or out-of-pocket limits.
Regulators have noted the program operates outside the usual Medicare coverage rules, raising concerns about potential fraud and the role of telehealth providers. A CMS spokesperson said cost estimates and enrollment projections have not been released, and the program’s payment structure differs from standard Part D benefits.