---
type: entity
entity_type: research_program
name: Medicare GLP-1 Bridge Program
domain: health
status: active
start_date: 2026-07-01
end_date: 2026-12-31
parent_organization: Centers for Medicare & Medicaid Services (CMS)
---

# Medicare GLP-1 Bridge Program

A temporary demonstration program providing Medicare Part D coverage for GLP-1 receptor agonists (Wegovy and Zepbound) for obesity treatment from July 1 to December 31, 2026.

## Program Structure

**Eligibility:**
- BMI ≥35 alone, or ≥27 with clinical criteria
- Must be enrolled in Medicare Part D
- Estimated ~14 million Medicare beneficiaries had diagnosed overweight/obesity in 2020 (potential eligible pool)

**Cost-sharing:**
- Fixed $50 copayment per prescription
- Copay does NOT count toward Part D deductible or $2,100 out-of-pocket cap
- Low-Income Subsidy (LIS) cost-sharing subsidies do NOT apply to prescriptions filled under this program

**Legal Architecture:**
- Operates outside standard Part D benefit structures because Medicare is statutorily prohibited from covering weight-loss drugs
- Requires CMS demonstration authority, not legislative change
- Temporary exception, not durable coverage

## Structural Issues

The program's placement outside Part D cost-sharing structures makes Low-Income Subsidy (LIS) protections inapplicable, creating a $50 copay barrier for the lowest-income beneficiaries despite inclusive eligibility criteria. This represents a structural misalignment where coverage expansion and coverage restriction occur simultaneously through different layers of program design.

## Relationship to Other Programs

- **BALANCE Model (Medicare Part D):** Longer demonstration launching January 2027
- **BALANCE Model (Medicaid):** Begins May 2026
- Beneficiaries seeking continued coverage in 2027 may need to switch Part D plans during open enrollment

## Timeline

- **2026-04** — Program details announced by CMS
- **2026-07-01** — Program begins
- **2026-12-31** — Program ends

## Sources

- KFF Health Policy analysis (April 2026)
- CMS program documents