Medicare launches $50 monthly Wegovy program with strict eligibility criteria
Starting July 1, 2026, Medicare will offer a $50 copay for certain GLP-1 drugs, including Wegovy, but only beneficiaries who meet specific BMI and health-condition requirements and are enrolled in an eligible Part D plan can access the benefit.
From July 1, 2026, Medicare’s new GLP-1 Bridge demonstration will allow qualifying beneficiaries to obtain Wegovy, Zepbound or Foundayo for a fixed $50 monthly copay. The program runs nationwide alongside, but outside, Part D and will end on December 31, 2027. Enrollment in a Medicare drug plan is required, although the drug does not need to be on the plan’s formulary.
Eligibility is limited to adults 18 or older who are enrolled in an eligible Medicare prescription-drug plan, such as a standalone PDP, most MA-PD HMO or PPO plans, Special Needs Plans, or employer/union waiver plans. Beneficiaries must meet one of three BMI-based tiers combined with designated comorbidities: a BMI of 35 or higher; a BMI of 30 or higher plus heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or higher; or a BMI of 27 or higher plus prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease. A physician must certify the diagnosis and submit a prior-authorization request, and the prescription must be for weight reduction or maintenance alongside nutrition and exercise.
"Uncontrolled hypertension is defined as blood pressure above 140 mm Hg systolic or 90 mm Hg diastolic despite treatment with two antihypertensive medications," the Centers for Medicare & Medicaid Services (CMS) states.
The bridge does not apply to beneficiaries who have received a GLP-1 through Part D in 2026 or who are prescribed the drug for conditions already covered by Part D, including type 2 diabetes, moderate-to-severe obstructive sleep apnea, or non-cirrhotic metabolic dysfunction-associated steatohepatitis with moderate-to-advanced liver fibrosis. Those individuals must rely on their Part D coverage, where cost-sharing varies by tier, deductible and formulary status.
Because the bridge sits outside Part D, the $50 copay does not count toward the Part D deductible or the annual out-of-pocket limit. Beneficiaries still pay their regular Part D premium and any applicable income-related monthly adjustment amount (IRMAA). The $50 amount is not reduced by the Extra Help program and cannot be spread through the Medicare Prescription Payment Plan.
Eligible retirees should verify Part D enrollment, confirm that their BMI and qualifying diagnoses meet the program’s tiers, and ensure the prescribing clinician submits complete documentation. Those excluded from the bridge should consult their Part D plan to determine formulary placement and possible exceptions for GLP-1 therapy.