Does Medicare cover Ozempic, Wegovy or Zepbound?
Whether Medicare covers Ozempic or Wegovy finally has a better answer than 'only for diabetes.' Here is where Medicare stands as of September 2026, diagnosis by diagnosis, including the new $50 program and its fine print.
It depends on the diagnosis. Ozempic, Mounjaro and Rybelsus are covered under Medicare Part D when prescribed for type 2 diabetes, subject to each plan's formulary tier and prior authorization. Federal law bars Part D from paying for drugs used for weight loss alone, so Wegovy and Zepbound for obesity have not been covered; the exception is Wegovy prescribed to reduce heart-attack and stroke risk in people with cardiovascular disease and obesity, which Part D plans can cover under its 2024 FDA approval. What changed in 2026: the Medicare GLP-1 Bridge, running July 1, 2026 through December 31, 2027, lets Part D enrollees who meet CMS's clinical criteria (a BMI of 35 or more; 30 or more with heart failure with preserved ejection fraction, uncontrolled high blood pressure or chronic kidney disease stage 3a or worse; or 27 or more with pre-diabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease) get Wegovy, Zepbound (KwikPen) or Foundayo for a $50 monthly copay after their provider submits a prior authorization. The $50 doesn't count toward the Part D deductible or the $2,100 cap. The broader BALANCE model for 2027 was postponed indefinitely.
Diagnosis by diagnosis
| Drug and use | Covered? | How |
|---|---|---|
| Ozempic, Mounjaro, Rybelsus, Trulicity for type 2 diabetes | Yes | Part D (or Advantage drug coverage); plan formulary, usually a higher tier with prior authorization; counts toward the $2,100 cap |
| Wegovy to reduce heart-attack and stroke risk in adults with cardiovascular disease and obesity or overweight | Yes, where the plan covers it | Part D, under the 2024 FDA indication; prior authorization; plans may add it mid-year or at January 1 |
| Wegovy, Zepbound or Foundayo for weight loss | Not through Part D | Federal law excludes weight-loss drugs from Part D. From July 1, 2026 to December 31, 2027, the Medicare GLP-1 Bridge: $50 a month for eligible Part D enrollees via provider prior authorization, outside the Part D benefit |
| Zepbound for obstructive sleep apnea with obesity | Plan by plan | An FDA-approved medical use (December 2024); Part D plans may cover it with prior authorization |
| Compounded semaglutide or tirzepatide | No | Compounded drugs are not Part D drugs |
The Medicare GLP-1 Bridge, in plain terms
- When: July 1, 2026 through December 31, 2027 (extended in April 2026 from an original end date of December 31, 2026).
- Who: enrollees in a stand-alone Part D plan or a Medicare Advantage plan with drug coverage (HMO, HMO-POS, PPO, including Special Needs Plans and employer group plans; not private fee-for-service or PACE) who meet CMS's clinical criteria, which are stricter than the ones first reported: a BMI of 35 or more; a BMI of 30 or more with heart failure with preserved ejection fraction, uncontrolled high blood pressure despite two medications, or chronic kidney disease stage 3a or worse; or a BMI of 27 or more with pre-diabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease. The drugs are covered for weight management only.
- What: all formulations of Wegovy (injection and pill) and Foundayo, and Zepbound KwikPen.
- Cost: $50 a month. It does not count toward the Part D deductible or the $2,100 out-of-pocket cap, because the program sits outside the Part D benefit; your plan doesn't have to participate for you to use it.
- How: your prescriber completes the CMS prior authorization form and hands it to your pharmacy, which submits it. There is no beneficiary application, and the prescriber doesn't have to be Medicare-enrolled.
- What it isn't: a permanent benefit. The BALANCE model that was to make GLP-1 coverage for obesity part of Part D in 2027 was postponed indefinitely; the Bridge is the interim answer, and the rules could change again.
What this means when choosing a plan
For diabetes, the plan's formulary decides everything: which GLP-1 is preferred, the tier, prior authorization, and whether a year's supply gets you to the $2,100 cap (2026; $2,400 in 2027) where your cost stops. Two plans with the same premium can differ by thousands a year on a single GLP-1 prescription, which is why I price your drugs through the plans sold in your county with Medicare's Plan Finder, which shows every plan including the ones I can't enroll you in, rather than reading premiums. I can enroll you only in the plans I'm authorized to offer; if the best answer is one I don't offer, I'll say so and point you to it or to HIICAP (1-800-701-0501). For weight loss, the Bridge works with any Part D or Advantage drug plan, so the plan choice turns on your other drugs, your doctors and your hospital. See Part D plans and how to choose a plan.
Help with the cost
People with limited income get GLP-1s for diabetes at Extra Help copays ($12.65 for a brand-name drug in 2026; see Extra Help), and New York's EPIC program cuts Part D copays for incomes up to $75,000 single or $100,000 married. Manufacturer copay cards can't be used with Medicare, but manufacturer patient-assistance programs for low incomes can. Ask and I'll check which applies.
Coverage rules as of September 16, 2026. Drug coverage is medical territory: whether a GLP-1 is right for you is between you and your doctor; this page covers only how Medicare pays.
By county: Albany · Saratoga · Schenectady · Rensselaer · Warren · Washington · Montgomery · Fulton · Columbia · Greene · Schoharie · Otsego · Herkimer · Hamilton · Essex · Ulster · Dutchess. Town pages: every town, grouped by county. Anywhere else in New York.
- Medicare GLP-1 Bridge (CMS) — July 1, 2026 – Dec 31, 2027; $50 copay; outside the Part D payment flow; BALANCE not launching in 2027; no low-income subsidy applies; re-checked October 16, 2026 (page last modified July 13, 2026)
- Medicare GLP-1 Bridge: information for providers (CMS) — clinical criteria (BMI 35; 30 with HFpEF, uncontrolled hypertension or CKD 3a+; 27 with pre-diabetes, prior MI/stroke or symptomatic PAD); eligible drugs Foundayo, Wegovy, Zepbound KwikPen; eligible plan types; prior authorization via the pharmacy
- Medicare GLP-1 Bridge: information for pharmacies (CMS) — nationwide in all states and territories; pharmacies don't need to opt in; 28- or 30-day fills; prior authorization decision within 72 hours, approvals through Dec 31, 2027; read October 16, 2026
- What to know about the BALANCE model and the Medicare GLP-1 Bridge (KFF, May 11, 2026) — July 1, 2026 – Dec 31, 2027; $50 copay; BMI criteria; BALANCE delayed
- Medicare starts offering $50 GLP-1 doses in July (AARP)
- Some Medicare beneficiaries can now get obesity drugs for $50 a month (NPR, May 6, 2026)
- Drug coverage, Part D: what's covered (Medicare.gov) — weight-loss drugs excluded from Part D
- Medicare costs 2026 (Medicare.gov) — $2,100 Part D cap
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 81 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (TTY 1-877-486-2048) is available 24 hours a day, 7 days a week. Insurers' legal names and home offices: carriers page.
Common questions
Short answers to what people ask before they call.
Still have a question? Call (518) 902-8822 or book a call.
Does Medicare Part D cover Ozempic?
Yes, when it's prescribed for type 2 diabetes, which is its FDA-approved use. Most Part D and Advantage drug plans list Ozempic, Mounjaro and Rybelsus on a higher tier with prior authorization and sometimes step therapy (trying metformin first). Your share depends on the plan's tier and on whether you've reached the yearly $2,100 out-of-pocket cap (2026), after which covered drugs are $0.
Does Medicare cover Wegovy or Zepbound for weight loss?
Not through regular Part D coverage; the Part D law excludes drugs used for weight loss. Two routes exist. Wegovy can be covered under Part D when prescribed to reduce the risk of heart attack and stroke in adults with established cardiovascular disease and obesity or overweight (FDA approval, March 2024). And from July 1, 2026 through December 31, 2027, the Medicare GLP-1 Bridge provides Wegovy, Zepbound KwikPen and Foundayo for $50 a month to Part D enrollees who meet the BMI and condition criteria, through a provider's prior authorization request; it runs outside the Part D benefit, so the $50 doesn't count toward the deductible or the cap.
How do I get the $50 GLP-1 Bridge price?
You don't enroll yourself. Your prescriber fills in the CMS prior authorization form and gives it to your pharmacy, which sends it to the program's central processor; the form confirms you're enrolled in an eligible Part D plan and meet CMS's clinical criteria: a BMI of 35 or more; a BMI of 30 or more with heart failure with preserved ejection fraction, uncontrolled high blood pressure despite two medications, or chronic kidney disease stage 3a or worse; or a BMI of 27 or more with pre-diabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease. If approved, the pharmacy charges $50 a month for the covered formulations. Ask your doctor's office whether they're submitting Bridge requests; not every practice has started.
Is the $50 Medicare GLP-1 Bridge available in New York?
Yes. CMS runs the Bridge nationwide, in every state and territory, so a Part D enrollee anywhere in New York uses it the same way: the prescriber sends the prior authorization through the pharmacy, a decision is due within 72 hours, and an approval lasts through December 31, 2027. Pharmacies don't have to sign up to take part, and each fill is a single 28- or 30-day supply at $50. Because the program sits outside Part D, Extra Help does not lower the $50.
What happened to the BALANCE model for 2027?
CMS announced an indefinite delay in the Part D BALANCE model, which would have covered GLP-1s for obesity through participating Part D plans from January 2027, because too few plans signed up. The Bridge program was extended a year instead, to the end of 2027. The Medicaid side of BALANCE went ahead in May 2026.
On a GLP-1, or hoping to be?
Tell me the drug and the diagnosis and I'll show how the plans I offer in your county cover it (tier, prior authorization, yearly cost), whether a plan I don't offer would do better, and whether the $50 Medicare GLP-1 Bridge applies to you.