CMS is running a time-limited demonstration named the Medicare GLP-1 Bridge. The agency says it starts July 1, 2026 and now runs through December 31, 2027, after the planned BALANCE Part D model did not launch in 2027.
Eligible members pay a $50 copay for a one-month supply. The Bridge operates outside the normal Part D coverage and payment flow. The Part D deductible does not apply, the $50 does not count toward true out-of-pocket costs, and the low-income subsidy known as Extra Help cannot lower this amount.
Medicare.gov currently lists Foundayo tablets, Wegovy injections or tablets, and the Zepbound KwikPen. Single-dose Zepbound vials and pens are not included. CMS says the product list and National Drug Codes may change during the demonstration.
Eligibility depends on BMI and health criteria
Eligibility is narrower than having a prescription for weight loss. A person must be at least 18, have an eligible form of Part D coverage, use the medicine for weight management with ongoing lifestyle modification, and meet one of the Bridge's BMI and health-condition pathways. Those pathways include a BMI of at least 35; a BMI of at least 30 with certain heart-failure, blood-pressure, or kidney criteria; or a BMI of at least 27 with prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease.
A prescriber must send the prescription and complete prior authorization when requested. CMS says the pharmacy should submit the claim first so the Bridge can establish eligibility before the authorization is processed.
A Medicare member with Part D can use the official Medicare.gov eligibility page as a starting point and ask a clinician whether the Bridge's criteria and a listed medicine fit their situation. The clinician, pharmacy, and CMS central processor each have a role in the prescription and prior-authorization process.
The demonstration creates a defined access route outside the usual Part D payment flow. It does not require each Part D sponsor to opt in, but a beneficiary still needs an eligible plan type and must satisfy the clinical criteria.
The Bridge is not general Medicare coverage of every obesity medicine. People already receiving a GLP-1 through their Part D plan are not eligible for the demonstration. CMS also directs prescriptions for Part D-covered indications, including type 2 diabetes, moderate-to-severe obstructive sleep apnea, and qualifying MASH, through the Part D plan rather than the Bridge.
The Obesity Society supports broader access
On June 4, 2026, The Obesity Society sent CMS a letter backing the Bridge while calling it only a first step. TOS asked for wider access to FDA-approved obesity drugs, more nutrition and behavioral coverage, and a fix for TRICARE for Life beneficiaries who are left out.
The demonstration remains outside standard Part D
The $50 copay is not part of the normal Part D cost-sharing calculation. It does not count toward the deductible or out-of-pocket limit, cannot be reduced through Extra Help, and cannot be spread across months through the Medicare Prescription Payment Plan.
This is a demonstration, not a law change. CMS already moved the end date when BALANCE slipped, so the window can move again.
The program does not show that one listed medicine is better than another or better than bariatric surgery. It is a time-limited payment demonstration, not a permanent coverage law or an individual treatment recommendation.
It is not a compounding or gray-market pathway. It does not replace a conversation with a clinician or 1-800-MEDICARE about a specific plan.
Educational information only. This brief is not medical advice. Do not start, stop, or change treatment based on it.
Reporting note
OTN reviewed the linked sources and documents listed above. The article identifies estimates, projections, unresolved questions, and the limits of the evidence.
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