Cost & Insurance

Medicare and Oral GLP-1s: Questions to Ask Before 2027

The law keeps weight-loss drugs out of Part D, a temporary program lets some back in, and Open Enrollment closes December 7.

October 31, 2026 · 7 min read · Last checked: October 31, 2026

Medicare drug plans are barred by law from covering drugs used for weight loss. A temporary CMS program, the Medicare GLP-1 Bridge, works around that from July 1, 2026 through December 31, 2027. It covers Foundayo and Wegovy (tablet or injection) for a $50 monthly copay, if you meet strict criteria.

Open Enrollment for 2027 Medicare plans runs October 15 to December 7, 2026. The Bridge sits outside your Part D plan, but you still need the right kind of plan to use it. These are the questions to settle before the deadline.

Why Part D usually skips weight-loss drugs

The Social Security Act defines what counts as a covered Part D drug. It leaves out drug classes that Medicaid may exclude under section 1927(d)(2). The first item on that list is drugs used for anorexia, weight loss, or weight gain.

That is why a Part D plan can cover a GLP-1 for one use and not another. The exclusion turns on how the drug is used, not on the molecule itself.

Medicare.gov notes that if you have type 2 diabetes, your Part D plan might cover a GLP-1 to treat it. Rybelsus, for example, is oral semaglutide whose FDA label covers blood-sugar control in adults with type 2 diabetes. Weight management is not among its labeled uses.

What the Medicare GLP-1 Bridge covers

CMS describes the Bridge as a short-term demonstration that runs outside the normal Part D benefit. Part D plans don’t carry financial risk for these drugs or need to opt in. CMS says a single central processor handles prior authorization, claims, and pharmacy payment.

Note what the Bridge is not. It is not a change to your Part D plan’s formulary, and it does not appear on your Part D Explanation of Benefits or Medicare Summary Notice. Keep your own record of each $50 fill.

Both FDA-approved weight-management pills are on the list. Lilly’s LillyDirect page also says eligible Part D patients with a weight-management prescription can get Foundayo through the Bridge. For background on that pill, see our Foundayo explainer.

Who qualifies for the Bridge

You must be 18 or older and enrolled in an eligible Medicare drug plan. Medicare.gov lists standalone Part D plans, Medicare Advantage coordinated care plans with drug coverage (HMO, HMO-POS, local and regional PPO), Special Needs Plans, employer group plans (EGWP), and LI NET.

Clinical criteria at the start of therapy

You must meet one of these when you begin:

• BMI of 35 or higher
• BMI of 30 or higher plus diastolic heart failure, uncontrolled high blood pressure, or chronic kidney disease stage 3a or higher
• BMI of 27 or higher plus prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease

Who is not eligible

• People whose Part D plan already covers their GLP-1
• People with type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease

Medicare.gov says people in that second group may get GLP-1 coverage through their regular Part D plan instead. That makes your 2027 plan’s formulary the deciding document for them.

How to use it, step by step

1. Talk with your prescriber. They decide whether a covered GLP-1 is appropriate and whether you meet the criteria.
2. Your prescriber certifies a lifestyle program. Medicare.gov says your provider must certify that you are using the drug as part of a diet and exercise program.
3. Prior authorization is completed. CMS links a dedicated prior authorization form on its Bridge page.
4. The prescription goes to a pharmacy. The pharmacy may ask for your Medicare Number or the last four digits of your Social Security number.
5. Watch your mail. Medicare says you will get a letter confirming coverage under the Bridge.

What Open Enrollment changes, and what it doesn’t

During Open Enrollment, October 15 to December 7, you can join, switch, or drop Medicare Advantage and Part D plans. The plan must receive your request by December 7, and coverage begins January 1.

The Bridge’s $50 copay is the same no matter which eligible plan you pick. What changes between plans is everything else: your other drugs, pharmacies, and premiums. Switching plans keeps you eligible only if the new plan is a type on Medicare’s list.

If you are already in Medicare Advantage, you get a second window. From January 1 to March 31 you can switch Advantage plans, return to Original Medicare, or join a separate drug plan.

Questions to ask before December 7

Use Medicare’s plan comparison tool on Medicare.gov, call 1-800-MEDICARE, or call the plan. Enter every drug you take, not only the GLP-1.

If you don’t qualify

Medicare.gov points to other options: manufacturer assistance programs, state drug-cost help, mail-order pricing, and TrumpRx.gov. It notes that discount programs like TrumpRx don’t count toward your deductible or out-of-pocket limit.

Manufacturer savings cards for commercial insurance won’t help. Both NovoCare and LillyDirect state that government beneficiaries are excluded from those offers.

What we know about 2028

Very little. CMS says it extended the Bridge through December 31, 2027 because its BALANCE Model is not launching in 2027. The extra year lets CMS collect GLP-1 use data to share with Part D plans before a possible BALANCE rollout.

Neither CMS nor Medicare.gov says what happens after 2027. Plan for 2027 as the known window, and recheck the official pages before Open Enrollment next fall. If you are just starting, our first 30 days on an oral GLP-1 guide covers the early weeks.

Commercial pages may contain paid referral links.