Medicare GLP-1 Bridge 2027: $50 Copay Rules

The Medicare GLP-1 Bridge has been running since July 1, 2026, and it now runs through December 31, 2027. That is an 18-month extension on what was first announced, and it changes what you need to do during open enrollment. The copay is $50 a month. Here's who qualifies and what to check before December 7.

Who This Helps

This is for you if you're on Medicare and want a GLP-1 for weight management, or you're already getting one at $50 and want to keep it through 2027. If a claim has already been rejected, our guide to Bridge rejections walks through the codes.

The end date moved, and so did the plan you need

The Bridge was first set up to end December 31, 2026, with a separate Part D model taking over in 2027. That is no longer the plan. CMS extended the Bridge through December 31, 2027 and paused the Part D portion of the BALANCE model for 2027, telling plan sponsors not to indicate participation for that year (CMS).

So there is no replacement plan to shop for this fall, which is a change from what was expected when the program was first announced. What matters instead is your plan type, covered below.

Who qualifies

The criteria are judged at the point you start therapy, for adults 18 and over, prescribed for weight reduction alongside lifestyle changes (CMS):

BMI 35 or higher. No additional condition needed.
BMI 30 or higher plus heart failure with preserved ejection fraction, uncontrolled high blood pressure (above 140 systolic or 90 diastolic despite two medications), or chronic kidney disease stage 3a or worse.
BMI 27 or higher plus prediabetes, a prior heart attack, a prior stroke, or symptomatic peripheral artery disease.

Because the test is applied at initiation, losing weight later doesn't end your coverage. CMS uses the example of someone starting at BMI 37 who drops to 34.

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Three diagnoses go somewhere else

Type 2 diabetes, moderate to severe obstructive sleep apnea, and noncirrhotic MASH with moderate to advanced liver scarring are routed to your Part D plan rather than the Bridge, even if you otherwise meet the weight criteria. A prescription written to reduce cardiovascular risk also goes to Part D. That routing holds regardless of which one costs you less (CMS).

Which drugs, and which versions

Covered: Foundayo, Wegovy in all formulations including the tablet, and the Zepbound KwikPen. Not covered: the Zepbound single-dose pen, Zepbound single-dose vials, pen needles, and any compounded product. Fills are 28 or 30 days only, so no 90-day supplies (CMS).

Check your plan type before you switch

Plans don't opt in to the Bridge, so calling to ask whether yours participates gets you nowhere. What matters is the category your plan falls into. Eligible: standalone Part D plans, Medicare Advantage drug plans in the HMO, HMO-POS, Local PPO and Regional PPO forms, Special Needs Plans, employer group plans and LI NET.

Not eligible on their own: private fee-for-service plans, cost plans, health care prepayment plans, PACE, fallback plans and religious fraternal benefit plans. If you're in one of those and also carry a standalone Part D plan, you're fine. Switching into one of them in open enrollment would end your Bridge refills.

Two separate things can rule you out

These get run together constantly, including by us in an earlier version, so here they are apart. They are checked at different moments and either one alone is enough.

Your diagnosis. Checked when the prior authorization is reviewed. If you have type 2 diabetes, moderate to severe sleep apnea or noncirrhotic MASH with moderate to advanced fibrosis, or the prescription is written to reduce cardiovascular risk, Part D is your route and the authorization is denied. That holds whether or not your plan actually covers a GLP-1 for it (CMS).

A Part D fill during 2026. Checked earlier, when the pharmacy submits the claim, against Medicare data. Any GLP-1 received through your Part D plan this calendar year ends Bridge eligibility, and CMS says that applies even where the plan covered it as supplemental weight-management coverage rather than for a medical condition (CMS).

For most people the two overlap, because the conditions Part D covers are the same ones routed to Part D. They can also fire independently, which is why neither is worth trying to work around. CMS is separately monitoring plans to make sure they aren't moving people onto the demonstration.

Paying cash is not the same as a Part D fill

This is the distinction that matters if you started before the program opened. Medicare says someone who began a GLP-1 for weight loss through a self-pay program, rather than through their Medicare drug coverage, before July 1, 2026 may still be eligible (Medicare.gov). Manufacturer self-pay pricing doesn't run through your plan, so it doesn't register as a Part D fill. It also earns you nothing toward your out-of-pocket maximum.

What the $50 does not do

It doesn't count toward your Part D out-of-pocket maximum, which rises to $2,400 in 2027 from $2,100 this year (Medicare.gov). Your deductible doesn't apply either. Extra Help doesn't lower the $50, and the Medicare Prescription Payment Plan can't spread it across the year. Manufacturer coupons and discount cards can't be applied to a Bridge claim at all.

Final Takeaway

The Bridge runs another 15 months, which takes the pressure off this open enrollment more than it adds to it. Two things to do before December 7: confirm your 2027 plan is a type the Bridge accepts, and don't let a GLP-1 run through Part D in the meantime. Open enrollment closes December 7 and changes start January 1 (Medicare.gov).

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Frequently Asked Questions

Does the Bridge still end at the end of 2026?

No. CMS extended it through December 31, 2027. Your prior authorization stays valid through that date unless you switch to a different covered GLP-1.

Should I pick a BALANCE plan during open enrollment?

There isn't one to pick. The Part D portion of that model is paused for 2027 and sponsors were told not to indicate participation. Check your plan type instead.

Can I use a savings card to get below $50?

Not on a Bridge claim. Coupons and discount programs can't be applied. Manufacturer self-pay pricing is a separate route, and paying cash that way earns no credit toward your Medicare out-of-pocket maximum.

What's changed since we first published this

We first covered this in March 2026, three months before the program opened, and CMS has published guidance in stages ever since. Updated September 29, 2026. Three things have moved:

The end date. The program was announced to run through December 2026. An April memo extended it by a full year, to December 31, 2027.
What happens in 2027. Coverage was expected to move to a separate Part D model next year. CMS has delayed that component pending further evaluation, so there is no replacement plan to choose during this open enrollment.
The eligibility detail. CMS has since published the full criteria, the three diagnoses routed to Part D instead, and the exact covered product list. All of it is reflected above.

Foundayo was added to the covered list in April, and the plan-type and prior-fill rules were published in the summer. We'll keep this current as CMS publishes. Next scheduled review: January 2027.

Medicare Covers GLP-1s for $50: What to Know Before December 7 (Updated Sept 2026)