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Family Practice Associates of Lexington

Medicare GLP-1 Bridge: GLP-1 Drugs for $50 a Month

What You Need to Know for July 1, 2026

Starting July 1, 2026, Medicare has a new program called Medicare GLP-1 Bridge to help you pay for certain GLP-1 weight loss medicines. Medicare GLP-1 Bridge covers these GLP-1 drugs:

• Foundayo® (tablet)
• Wegovy® (injection or tablet)
• Zepbound® (KwikPen only): The single-dose Zepbound® pen and Zepbound vials are NOT covered.

Your cost for these drugs under this program is $50 per month, no matter your income level. This $50 payment doesn't count toward your Medicare drug plan deductible or yearly out-of-pocket limit. These drugs aren't eligible for the Medicare Prescription Payment Plan.



Am I Eligible?

To get the GLP-1 drugs listed above under this program, you must meet all four of these requirements:

• You have Medicare Part D drug coverage, under either a standalone Medicare Drug Plan or a Medicare health plan that includes drug coverage.
  You're not eligible if your only Medicare coverage is through certain special plan types (like private fee-for-service plans, cost contract plans, or a PACE organization). If you're not sure what type of plan you have, call 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048.
• You're not eligible to receive a GLP-1 drug through your Medicare drug plan.
  If you've been using a GLP-1 drug paid for by your Medicare drug plan for any reason, you need to keep getting your GLP-1 drug through your plan. GLP-1 drugs are defined as products with the following active ingredients: Semaglutide, Tirzepatide, Orforglipron, Dulaglutide, and Liraglutide.
• You don't have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease.
  If you have any of these conditions, contact your Medicare drug plan - they may already cover a GLP-1 drug for you.
• You're at least 18 years of age AND at least one of these is true:
• You have a Body Mass Index (BMI) of 35 or higher
• Your BMI is 30 or higher, and you have certain types of heart failure OR high blood pressure that's hard to control OR chronic kidney disease (stage 3a or above)
• Your BMI is 27 or higher, and you have prediabetes, OR you've had a heart attack, stroke, or blocked arteries in your legs or arms

*BMI (Body Mass Index) is a number your doctor calculates based on your height and weight. Ask your doctor what your BMI is if you don't know.

How to get GLP-1 drugs through Medicare GLP-1 Bridge

• Talk to your doctor about whether a GLP-1 drug is right for you and if you qualify for this program.
• If one of the drugs covered is right for you, your doctor will send a prescription to the pharmacy.
• Your pharmacy may reach out to you to request your Medicare ID number. The pharmacist needs your Medicare ID number (printed on your card) to process the prescription. If you don't have your card, the pharmacist can look up your number using the last four digits of your Social Security Number.
• After the pharmacy receives confirmation that you are eligible for Medicare GLP-1 Bridge, your doctor will need to submit a form to get approval from Medicare for coverage.
• You will also receive a letter from Medicare, letting you know your medicine is covered.
• Pick up your medicine at the pharmacy and pay $50 for a one-month supply. To get a refill, you don't need a new approval from Medicare as long as you stay on the same drug, even if your dose changes.

Visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for more information about Medicare GLP-1 Bridge. TTY users can call 1-877-486-2048.

This fact sheet is for general information only. Talk to your doctor to find out if this program is right for you.