The Medicare GLP-1 Bridge, and the four tests you have to pass

What it is

On 1 July 2026 Medicare began a programme called the Medicare GLP-1 Bridge. Eligible Part D beneficiaries pay $50 a month for certain GLP-1 weight-loss medicines — “no matter your income level”, in Medicare’s own words. Nothing else on this site comes close for a brand-name product.

It is worth being precise about what that $50 is, because it behaves oddly. It does not count toward your Medicare drug plan deductible, it does not count toward your yearly out-of-pocket limit, and these drugs are not eligible for the Medicare Prescription Payment Plan. So it is cheap, but it is money spent outside the structures that normally cap what you pay in a year.

The four tests

Medicare requires you to meet all four. The BMI test is the one people check first; tests two and three are the ones that quietly disqualify, because they turn on your existing coverage and your existing diagnoses rather than on anything you can look up about yourself.

1. You have Medicare Part D drug coverage

Either a standalone Medicare drug plan or a Medicare health plan that includes drug coverage. You are not eligible if your only Medicare coverage is through certain special plan types — private fee-for-service plans, cost contract plans, or a PACE organisation. If you are unsure which you have, Medicare directs you to call 1-800-MEDICARE.

2. You are not already able to get a GLP-1 through your plan

This is the one that catches people. The Bridge exists to reach beneficiaries whose plans do not cover these drugs. If you have been getting a GLP-1 paid for by your Medicare drug plan for any reason, Medicare says you need to keep getting it through your plan rather than switching to the $50 route. For this purpose GLP-1 drugs are defined by active ingredient: semaglutide, tirzepatide, orforglipron, dulaglutide and liraglutide.

3. You do not have type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease

Counter-intuitive, but logical once you see the design. Those conditions are ones for which a GLP-1 may already be covered by your plan on its own terms, so the Bridge steps aside. Medicare’s instruction is to contact your drug plan, because it may already cover a GLP-1 for you — which will usually be the better deal, since normal plan coverage does count toward your deductible and out-of-pocket limit.

4. You are 18 or over and meet one of the BMI conditions

• ◆BMI of 35 or higher; or
• ◆BMI of 30 or higher, with certain types of heart failure, or high blood pressure that is hard to control, or chronic kidney disease at stage 3a or above; or
• ◆BMI of 27 or higher, with prediabetes, or a previous heart attack or stroke, or blocked arteries in your legs or arms.

What to do if you fail one of the tests

Failing test three is good news dressed as bad. If you have type 2 diabetes, sleep apnea or fatty liver disease, ring your drug plan before doing anything else — a GLP-1 may already be covered for you under ordinary Part D terms, and unlike the Bridge that spending counts toward your deductible and your annual out-of-pocket cap.

Failing test one or four means the cash routes on this site are your comparison set. The brand-name floor is currently around $149 a month for the Wegovy pill at titration doses, through the manufacturer directly or through a retail pharmacy; injectable brand-name runs from roughly $299 to $499. That is three to ten times the Bridge price, which is the measure of what the programme is worth to those who can use it.