GLP-1 insurance change impacts millions of Americans: What to know, how to tell if you’re covered

Skip to content

(NEXSTAR) – Insurance coverage just changed for as many as 56 million Americans when it comes to the popular GLP-1 medications used to promote weight loss.

Medicare announced it is offering certain GLP-1s for $50 a month through a new trial called Medicare GLP-1 Bridge starting in July 2026.

The program is temporary for now – only slated to run until the end of 2027. Still, it’s an opportunity for millions of older Americans to access a drug that’s otherwise very expensive out-of-pocket.

Of the more than 70 million Americans enrolled in Medicare, at least 10 million are overweight or obese, said Juliette Cubanski, vice president and director of the program on Medicare policy at the healthcare research nonprofit KFF told the Associated Press. But, she said, a narrower slice of that group will have access to this program.

Who qualifies for the GLP-1 Bridge program?

Only people with Part D prescription drug coverage through Medicare will qualify, for starters. (About 56 million people had Medicare drug coverage in 2025.)

But eligibility will also be determined by weight and other factors. To qualify, you need to meet one of the following requirements when starting GLP-1 treatment:

A BMI (body mass index) of 35 or higher

A BMI between 30 and 34.99, with one or more additional conditions:

Diastolic heart failure

Uncontrolled high blood pressure/hypertension

Chronic kidney disease, stage 3a or higher

Prediabetes

Previous heart attack or stroke

Blocked arteries in arms or legs with symptoms

A BMI between 27 and 29.99, with one or more additional conditions:

Prediabetes

Previous heart attack or stroke

Blocked arteries in arms or legs with symptoms

Medicare beneficiaries who have sleep apnea, diabetes or fatty liver disease can’t access the program, but their Medicare Part D insurance might cover their GLP-1s separately based on those diagnoses.

There aren’t any hard numbers on how many people will benefit, and Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, declined to speculate on a figure.

If you think you might qualify, the first step is to contact your health care provider, CMS says on its website. The provider must send a prescription for one of the covered GLP-1 drugs to a pharmacy and fill out a prior authorization form.

More information on who qualifies can be found on the Medicare website.

Only some GLP-1s are included

The covered medications include drugmaker Eli Lilly’s Foundayo oral tablets and Zepbound KwikPens and Novo Nordisk’s Wegovy injections and tablets. Those GLP-1s have been approved by the Food and Drug Administration for weight loss, Cubanski said.

For those in the program, the cost is $50 per month, regardless of dosage. But those payments won’t contribute to their insurance deductibles or out-of-pocket maximums. That’s because Medicare, rather than the Part D insurer, is subsidizing the prescription.

All of the GLP-1 medications, regardless of brand name, work in a similar way. The drugs mimic a hormone that lowers blood sugar, slows digestion, and tricks the brain into thinking its fuller for longer.

The Associated Press contributed to this report.

Tags

Mehmet Oz

Copyright 2026 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.