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What to know, how to tell if you’re covered

(NEXSTAR) – Insurance coverage has changed for as many as 56 million Americans when it comes to popular GLP-1 drugs used to promote weight loss.

Medicare announced it is offering certain GLP-1s for $50 per month starting in July 2026 through a new trial called the Medicare GLP-1 Bridge.

The program is temporary for now; It is only planned to last until the end of 2027. Yet this is an opportunity for millions of older Americans to access a medication that would otherwise be prohibitively expensive out of pocket.

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Of the more than 70 million Americans enrolled in Medicare, at least 10 million are overweight or obese, Juliette Cubanski, vice president and director of the Medicare policy program at health research nonprofit KFF, told The Associated Press. But a narrower segment of this group will have access to this program, he said.

Who is eligible for the GLP-1 Bridge program?

For starters, only people with Part D prescription drug coverage through Medicare will qualify. (About 56 million people had Medicare drug coverage in 2025.)

However, eligibility will also be determined by weight and other factors. To qualify, you must meet one of the following requirements when starting GLP-1 therapy:

A BMI (body mass index) of 35 or higher
A BMI between 30 and 34.99 with one or more additional conditions:
- Uncontrolled high blood pressure/hypertension
- Chronic kidney disease, stage 3a or higher
- Previous heart attack or stroke
- Blockage of arteries in the arms or legs with symptoms
A BMI between 27 and 29.99 with one or more additional conditions:
- Previous heart attack or stroke
- Blockage of arteries in the arms or legs with symptoms

Medicare beneficiaries with sleep apnea, diabetes, or fatty liver disease cannot access the program, but their Medicare Part D insurance may cover their GLP-1 separately depending on those diagnoses.

There’s no clear figure on how many people will benefit, and Dr. Mehmet Öz refused to speculate on this figure.

If you think you may qualify, the first step is to contact your healthcare provider, CMS’s website says. The provider must send a prescription for one of the covered GLP-1 drugs to the pharmacy and complete a prior authorization form.

You can find more information about who qualifies at: Medicare website.

Only some GLP-1 is included

Drugs covered include drugmaker Eli Lilly’s Foundayo oral tablets and Zepbound KwikPens and Novo Nordisk’s Wegovy injections and tablets. These GLP-1s are approved by the Food and Drug Administration for weight loss, Cubanski said.

The cost for program participants is $50 per month, regardless of dosage. However, these payments will not contribute to insurance deductibles or out-of-pocket maximums. This is because Medicare, rather than the Part D insurance company, subsidizes the prescription.

Regardless of the brand name, all GLP-1 medications work similarly. The drugs mimic a hormone that lowers blood sugar, slows digestion and tricks the brain into thinking it stays full longer.

The Associated Press contributed to this report.

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