Program details can change. Confirm with Medicare or your plan before relying on this information.
The basics
| Item | Details |
|---|---|
| Start date | July 1, 2026 |
| End date | End of 2027 (extended from an original 6 months) |
| Copay | $50 a month |
| Medications | Wegovy (injection and pill), Foundayo, Zepbound KwikPen |
| Who runs claims | Humana administers claims and prior authorization on Medicare's behalf |
Who may qualify
You need a stand-alone Part D plan with Original Medicare, or a Medicare Advantage plan with drug coverage, and be 18 or older. You also need to meet one of these clinical criteria:
- BMI of 35 or higher, or
- BMI of 30 or higher with stage 3a or worse chronic kidney disease, heart failure with preserved ejection fraction, or high blood pressure not controlled on two medications, or
- BMI of 27 or higher with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease.
People with type 2 diabetes, obstructive sleep apnea or MASH are not eligible for the bridge, because their GLP-1s may be covered through Part D for those conditions.
How it works
- Your clinician submits a prior authorization request, with a 72-hour target turnaround.
- Refills generally don't need a new approval unless you switch medications.
- The $50 copays don't count toward Part D deductibles or the 2026 out-of-pocket cap.
Medicaid
The separate BALANCE model for GLP-1 coverage launched in Medicaid in May 2026. Coverage depends on your state.
If you don't qualify
Manufacturer self-pay prices start around $149 a month for the lowest doses of the Wegovy pill and Foundayo. See LillyDirect vs NovoCare and GLP-1 costs in 2026.
Sources
GLP1Rated is for general information only and is not medical advice. GLP-1 medications are prescription drugs with real risks and side effects. Talk to a licensed clinician before starting, stopping or changing any medication or supplement.