Does Medicare cover Ozempic, Wegovy or Zepbound?
The most-asked drug question of the last three years 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 the clinical criteria (BMI 30 or more with a weight-related condition, 27 or more with diabetes or heart disease, or 25 or more with MASH) 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: Part D enrollees 18 or older who meet one of three tests: BMI 30 or more with a weight-related condition; BMI 27 or more with diabetes or cardiovascular disease; BMI 25 or more with metabolic dysfunction-associated steatohepatitis (MASH).
- 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 provider submits a prior authorization. There is no beneficiary application.
- 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 every drug through every plan in your county rather than reading premiums. 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.
- 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
Common questions
Short answers to what people ask before they 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 submits a prior authorization confirming you're 18 or over, enrolled in Part D, and meet one of the criteria: BMI of 30 or more with a weight-related condition; 27 or more with diabetes or cardiovascular disease; or 25 or more with metabolic dysfunction-associated steatohepatitis. 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.
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 which Part D and Advantage plans in your county cover it, what the tier and prior authorization look like, and whether the $50 Medicare GLP-1 Bridge applies to you.