Ask your health plan about the exact medicine.

Ask about the list and the approval step.

A formulary lists which medicines a health plan pays for.

Prior authorization is the plan’s required approval for payment before a pharmacy provides the medicine.

Ask whether the exact product is listed, what information is needed, and what your own payment would be.

Then ask what happens if the request is refused.

For Medicare, the reason for use matters.

Medicare Part D is Medicare’s usual drug coverage. It excludes medicines when used for weight loss. This rule was checked on September 26, 2026.

For some uses apart from weight loss, Medicare drug plans can pay for treatment such as diabetes care or reducing heart risks. Each plan has rules. This was checked on September 26, 2026.

Even for a use Medicare allows, payment by your plan is not assured.

A separate temporary payment option

GLP-1 is a hormone, a chemical messenger the body makes. It helps manage hunger and blood sugar. GLP-1 medicines imitate that action.

A temporary payment programme called the Medicare GLP-1 Bridge serves some people who have Medicare drug coverage. Its rules were checked on September 26, 2026.

The programme’s dates are July 1, 2026 to December 31, 2027. The payment is $50 per monthly supply.

The programme covers semaglutide (Wegovy injections and tablets), tirzepatide (Zepbound KwikPen injections), and orforglipron (Foundayo tablets).

Who can qualify?

To qualify, you must be 18 or older and satisfy the programme’s weight and health rules when GLP-1 treatment began.

The weight rules use body mass index, or BMI: a number that compares weight with height. Ask your clinician what your BMI was when treatment began.

For the weight rule, a BMI at or above 35 is enough without any health condition listed below.

With a BMI at or above 30, certain health conditions can qualify you: heart failure with preserved ejection fraction, a type of heart failure, or kidney disease at stage 3a or higher.

At that BMI, blood pressure can also qualify if two blood-pressure medicines still leave either the top reading above 140 or the bottom above 90.

At a BMI of at least 27, qualifying conditions include pre-diabetes (raised blood sugar before diabetes), a previous heart attack or stroke, or disease causing symptoms in the arteries of the legs or arms.

Ask your clinician whether your records match these exact health conditions. These are programme checks, not a way to diagnose yourself.

When the usual drug plan applies

People who have type 2 diabetes cannot use the Bridge. It also excludes people with moderate to severe obstructive sleep apnea, a condition in which breathing stops repeatedly while asleep.

The Bridge also excludes a specific fatty-liver disease called MASH when there is moderate to advanced scarring but no cirrhosis, the most severe scarring. Having a fatty-liver diagnosis alone does not make you ineligible.

These uses go through the usual Medicare drug plan instead. A prescription to reduce the risk of heart attack or stroke also goes to that plan.

Your drug coverage must come from either a separate Medicare Part D plan or a Medicare Advantage plan of a qualifying type that includes drugs. Ask the plan to verify that it qualifies.

You cannot use the Bridge in 2026 if you already received a GLP-1 medicine paid for by your Part D plan that year. The rule about earlier coverage for 2027 was not yet set when checked on September 26, 2026.

A prescription and approval before payment are required. Treatment also needs a continuing plan covering food choices and physical activity.

What the payment does not count toward

The $50 is separate from your usual Medicare drug costs. It is excluded from the Part D deductible—the amount paid before the plan begins sharing costs. It is also excluded from the annual cap on your own payments for covered drugs.

Medicare’s low-income subsidy, also called Extra Help, does not reduce this programme’s $50 payment. Coupons cannot reduce that payment either.

Ask the person writing your prescription and your health plan to check these rules for you and the exact medicine.