Key Takeaways

• Timeline & Eligibility: Starting July 1, 2026 through December 31, 2027, Medicare Part D beneficiaries may qualify for the Bridge if they meet one of three clinical requirement tiers based on BMI and comorbidities.

• Affordable Pricing: Just $50/month copay Medicare covers the rest of the cost for Wegovy, Foundayo, or Zepbound.

• Seamless Support: Mochi handles your prior authorization so you don't have to navigate insurance back-and-forth.

If you've been on the fence about trying a GLP-1 medication like Wegovy or Zepbound because of the cost, we have news. Starting July 1st, 2026, Medicare is rolling out a temporary program specifically designed to make these medications accessible and affordable for millions of Part D beneficiaries. Here's everything you need to know.

What Is the Medicare GLP-1 Bridge Program?

GLP-1 medications have been proven to help people lose weight and improve their health. But here's the catch: they've been expensive. Many Medicare beneficiaries use compounded GLP-1s to avoid paying thousands out of pocket.

The Medicare GLP-1 Bridge is CMS's answer to that problem. It's an 18-month program: starting July 1, 2026 and running through December 31, 2027. that gives Medicare Part D beneficiaries access to GLP-1 medications for weight loss at a price that's actually manageable. It is a temporary solution that gets you access now, before Medicare's bigger weight-loss medication program (the BALANCE Model) launches in 2028.

This Bridge represents a significant shift in how Medicare approaches weight loss treatment. It's no longer just for people with diabetes. It's for anyone who qualifies and wants to lose weight.

Medicare GLP-1 Bridge Eligibility Requirements

Eligible beneficiaries must meet the clinical criteria at the time of GLP-1 therapy initiation. This includes beneficiaries who initiated therapy prior to enrolling in Medicare Part D and/or prior to the July 1, 2026 launch of the Medicare GLP-1 Bridge. 

You may qualify if you meet one of these clinical criteria:

Option 1: BMI of 35 or higher No other health conditions required. 

Option 2: BMI of 30-34.9 AND you have one of these conditions:

• Heart failure with preserved ejection fraction

• Uncontrolled high blood pressure (140/90 or higher on 2+ blood pressure medications)

• Chronic kidney disease (stage 3a or higher)

Option 3: BMI of 27-29.9 AND you have one of these:

• Pre-diabetes

• History of heart attack

• History of stroke

• Symptomatic peripheral artery disease

If any of this sounds like you, there's a good chance you're eligible. In fact, based on our analysis of synthetic Medicare data(1), roughly 38% of Medicare beneficiaries with Part D coverage qualify for the Bridge. That's nearly 22 million people(2).

What GLP-1 Medications Does Medicare Cover?

The Bridge covers four GLP-1 medications:

• Wegovy (semaglutide injection)

• Wegovy (semaglutide oral tablet)

• Foundayo (orforglipron)

• Zepbound KwikPen (tirzepatide)

These medications are specifically covered for weight loss, not for diabetes management or other conditions. If you're taking a GLP-1 for diabetes or other reasons, that's still covered under your regular Part D plan.

How Much Do GLP-1s Cost With Medicare?

Here's the part that makes this program special: your copay is just $50 per month. That's it. Whether you're getting the injection or the oral tablet, whether it's Wegovy or Zepbound or Foundayo, the cost is $50.

However, this cost does NOT count toward your Part D deductible or out-of-pocket maximum. 

For context, these medications can cost hundreds of dollars without insurance. The fact that Medicare negotiated a price and is covering the bulk of it? That's a game-changer.

What Happens After the Medicare GLP-1 Bridge Ends?

The Bridge runs through the end of 2027. Then what?

In 2028, Medicare is hoping to launch the BALANCE Model as a more permanent solution for GLP-1 coverage. The good news: if you're already on a medication and it's working for you, you'll have a path forward. The slightly less certain part is that you'll need to enroll in a Medicare Part D plan that participates in BALANCE to keep your coverage.

How can Mochi Help?

Step 1: Join Mochi. Chat with a Mochi Medical provider. Tell them you're interested in a GLP-1 medication. They'll assess whether it's right for you and whether you meet the clinical criteria for the Bridge.

Step 2: Check your eligibility Your Mochi Medical provider will confirm that you meet one of the three tiers and that your Medicare plan qualifies.

Step 3: Request a prior authorization Before you can get the medication, Mochi will submit a prior authorization (PA) to Medicare . This just means getting approval from the program before you fill your prescription. Mochi Health handles the prior authorization process for you. We work with your provider to gather the information Medicare needs, submit it on your behalf. 

Step 4: Get your prescription filled Once you're approved, you'll pick up your medication at your local pharmacy for your $50 copay.

Ready to Get Started?

If you think the Bridge might be for you, the first step is simple: check your eligibility with Mochi

If you are eligible for medication, but Medicare doesn’t approve, Mochi offers compounded GLP-1 medications starting at just $99/month. Your provider can walk you through your options and help you choose what's best for you.

If you're not quite ready to dive into the Bridge but still interested in GLP-1 treatment, Mochi is here to help you access medications affordably right now, before the Bridge even launches.

FAQs

Will I be covered if my BMI was more than 35 a while ago?

Eligible beneficiaries must meet the clinical criteria at the time of GLP-1 therapy initiation. This includes beneficiaries who initiated therapy prior to enrolling in Medicare Part D and/or prior to the July 1, 2026 launch of the Medicare GLP-1 Bridge. For example, if a beneficiary initiated GLP-1 therapy in September 2024 with a body mass index (BMI) of 37 and has a BMI of 34 at the time of a July 2026 prior authorization request, the prescribing provider should attest that the beneficiary met the BMI ≥35 criterion at the time therapy was initiated. 

Does Medicare cover Zepbound for weight loss? 

Yes! The Zepbound KwikPen will be covered with Medicare Bridge.

Does Medicare cover Wegovy for weight loss? 

Yes! Both the oral and injectable versions will be covered.

Does Medicare cover weight loss drugs? 

Yes! Zepbound, Foundayo, and Wegovy will be covered.

When will Medicare cover weight loss drugs in 2026?

Medicare will cover weight loss drugs starting July 1st, 2027.

References

1. https://data.cms.gov/collection/synthetic-medicare-enrollment-fee-for-service-claims-and-prescription-drug-event

2. https://www.kff.org/medicare/analyzing-changes-in-medicare-part-d-enrollment-for-2026/