Question: I would like to take one of those “weight loss drugs” but my Medicare plan doesn’t cover it. What options do I have?

Answer: Let me first define these newer, more common “weight loss drugs” you’ve been seeing are mostly medications called GLP-1’s. These are medications that were designed to treat diabetes, but we have discovered they are also an effective medication for weight loss. Right now, these GLP-1’s are covered under Medicare Part B when an individual has Diabetes AND diagnosis like heart disease and others. If you don’t have multiple diagnoses including Diabetes, your Medicare Part D plan will not cover the GLP-1’s.

The regulations and laws defining Medicare Part D covered medications exclude many categories of medications. For example, allergy medications, stool softeners, cough medications, dental toothpaste, erectile disfunction medications, vitamins, and many others are, by law, excluded from Medicare Part D coverage. Currently, GLP-1’s are excluded in the same way.

In order for Medicare to change those rules, it would require that Congress change the laws regarding Medicare Part D included medications.

But I do have some exciting news: Centers for Medicare and Medicaid Services (CMS) has just released details on a program called the Medicare GLP-1 Bridge Program. This program is a time-limited program that will provide eligible Medicare beneficiaries access to the GLP-1 medications outside of their Medicare Part D benefit. The GLP-1 Bridge Program is not changing the coverage rules of the GLP-1’s – instead it is allowing them to be filled outside of your Medicare Part D benefit.

The GLP-1 Bridge Program will begin July 1, 2026 and run through December 31, 2027.

The program will give eligible Medicare Beneficiaries temporary access to a defined list of “weight loss drugs.” This is a special program allowing availability during a defined length of time. This special program will not impact your Medicare Part D benefit in any way. If you request these medications and are approved to take them, then they will be filled outside of your Medicare Part D coverage and benefits.

The GLP-1 medications included in this special Medicare GLP-1 Bridge Program are defined as Wegovy (both injections and tables), Zepbound (KwikPen) and Foundayo. These are the only medications covered under this program.

In order to qualify for the program, the individual must be 18 years or older, and need the medication for weight loss or keeping weight off. This weight criteria is defined as one of three situations: BMI of 35 or higher; BMI of 30 or higher and have certain health conditions such as: Heart Failure, Uncontrolled Hypertension, Chronic Kidney Disease; or BMI of 27 or higher and have other health risks such as: Pre-diabetes, Heart Attack or Peripheral Artery Disease. The individual must have a Medicare Part D plan. Lastly, they must have prior authorization/approval from the Bridge Program.

If approved for the GLP-1 Bridge Program, individuals will pay a fixed $50 monthly copayment for the medication that is prescribed. This $50 copay will not in any way interact with your Medicare Part D benefit. The $50 copay will not be included in your Part D deductible, initial coverage or catastrophic spending limits of the Medicare Part D plan you are enrolled in.

This GLP-1 Bridge Program works more like a discount card or pharmaceutical company discount program. The copay of $50 is your cost share for the medication as long as the GLP-1 Bridge Program exists, which again is currently set to run from July 1, 2026 to December 31, 2027. The GLP-1 Bridge Program will be handled by a central system run by Medicare to approve, process claims, and pay pharmacies for the medications prescribed in this Program.

In order to use this benefit, individuals who meet the previously listed criteria can work with their physician after July 1, 2026 to submit a prior authorization request electronically or by fax using the appropriate forms provided by the Medicare GLP-1 Bridge Program. CMS will be working with providers to educate them and their staff on how to complete and submit these GLP-1 Bridge Program Prior Authorization forms.

This cannot be done prior to July 1, 2026 in anticipation of the program launch. This GLP-1 Bridge Program is an exciting opportunity for those eligible for Medicare to save money on this limited list of medications. This could be the beginning of controlling your weight and improving your health, and saving some money on the medication.

I suggest calling your physician and requesting an appointment after July 1 to review your eligibility and appropriateness for this GLP-1 Bridge Program. Once you have reviewed the program with your physician, you may get on your way to a healthier, lighter you!

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.