# Medicare GLP-1 Bridge Program

**Type:** Federal demonstration program  
**Domain:** Health policy, obesity treatment, Medicare coverage  
**Status:** Active (July 1 - December 31, 2026)  
**Parent Agency:** Centers for Medicare & Medicaid Services (CMS)  

## Overview

The Medicare GLP-1 Bridge Program is a temporary demonstration program providing coverage for GLP-1 receptor agonists (Wegovy and Zepbound) for obesity treatment in Medicare Part D beneficiaries. The program operates from July 1 through December 31, 2026, as a bridge to the longer BALANCE Model demonstration launching in January 2027.

## Program Structure

**Eligibility:**
- BMI ≥35 alone, or
- BMI ≥27 with clinical criteria
- Must be enrolled in Medicare Part D

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

**Covered Medications:**
- Wegovy (semaglutide)
- Zepbound (tirzepatide)

## Legal Architecture

Medicare is statutorily prohibited from covering weight-loss drugs under standard Part D benefits. The Bridge program operates as a temporary exception requiring CMS demonstration authority, not durable legislative change. This legal constraint forced the program to operate outside standard Part D benefit structures, which creates the LIS exclusion.

## Eligible Population

Up to ~14 million Medicare beneficiaries had diagnosed overweight/obesity in 2020, representing the potential eligible pool.

## Continuity Planning

Beneficiaries who want continued GLP-1 coverage in 2027 may need to switch Part D plans during open enrollment, as the Bridge program is temporary and does not guarantee continued coverage.

## Related Programs

- **BALANCE Model (Medicare Part D):** Launches January 2027 as longer-term demonstration
- **BALANCE Model (Medicaid):** Launches May 2026

## Timeline

- **2026-04** — Program announced by CMS
- **2026-07-01** — Program begins
- **2026-12-31** — Program ends
- **2027-01** — BALANCE Model (Medicare Part D) launches

## Sources

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