Medicare GLP-1 Bridge Pricing Guide 2026: $50/mo Copay for Eligible Seniors
Medicare GLP-1 Bridge, live since July 1, 2026: $50/mo copay for Wegovy, Zepbound KwikPen, and Foundayo. Humana processes claims. Runs through Dec 31, 2027.
The Medicare GLP-1 Bridge has been live since July 1, 2026. Eligible Medicare Part D members pay a flat $50 copay for each 30-day supply of Wegovy (injection or pill), Zepbound KwikPen, or Foundayo. Part D is Medicare's prescription drug benefit. The Bridge runs outside it, so no deductible applies and the $50 does not count toward the Part D out-of-pocket cap. Medicare pays the rest of a $245 net monthly price, about $195 per fill. That $245 comes from the most-favored-nation (MFN) deal the White House signed with Eli Lilly and Novo Nordisk on November 6, 2025. MFN pricing ties what Medicare pays to the lowest price paid in other wealthy countries.
There is no signup form. Your doctor and pharmacy do the work. The prescriber files a prior authorization, a coverage request the payer must approve before the pharmacy can fill. It goes to Humana, which the Centers for Medicare & Medicaid Services (CMS) picked as the single central processor for the whole program. Humana already runs Medicare's Limited Income Newly Eligible Transition (LI NET) program, and CMS reused that plumbing. A decision is due within 72 hours. The prescriber does not need to be enrolled in Medicare. The pharmacy then bills a Bridge-specific routing code (BIN 028918, PCN MEDDGLP1BR) instead of the patient's regular Part D plan. That last step caused the first stumble. Medical Daily reported on July 6 that eligible seniors were leaving pharmacies empty-handed because claims went to the regular Part D plan, which rejects them on sight. Those were billing errors rather than eligibility denials.
The bill is large even at low uptake. KFF, the health policy research group, estimates about 3.8 million Medicare beneficiaries meet the clinical criteria. At $195 a month in net federal cost, the 18-month program would run $1.3 billion if 10% of them enroll and $10 billion at 75%. As of late July, CMS had not published enrollment counts.
The Bridge ends December 31, 2027, and the plan for what follows has slipped. That end date is a year later than first scheduled. CMS had expected the BALANCE Model, a broader voluntary GLP-1 coverage program for Medicaid and Medicare Part D, to take over. State Medicaid agencies can still join BALANCE between May 2026 and January 1, 2027. But CMS now says BALANCE will not launch in Medicare in 2027, and its page calls a Part D rollout "potential" with no date attached. That is why the Bridge got the extra year.
For a walkthrough of the eligibility tiers and the pharmacy workflow, see the Medicare GLP-1 Bridge patient guide. For prices across every channel, see GLP-1 Drug Pricing: September 2026. For employer, PBM, and Medicaid rules, see the GLP-1 insurance and prior authorization guide.
Patient cost and what Medicare pays
Every eligible fill costs the patient $50 for a 30-day supply, whichever of the four drugs is prescribed. Medicare pays the manufacturer the rest of a $245 net price, so the federal share is about $195 a month. Because the Bridge runs outside Part D, the deductible does not apply, the $50 does not count toward the yearly out-of-pocket cap, and the Extra Help low-income subsidy does not reduce it. For comparison, the list price (WAC, or wholesale acquisition cost) for Wegovy is $1,349 a month.
| Channel | Price | Source |
|---|---|---|
| Patient copay (Bridge) | $50/mo | CMS |
| Medicare net price (MFN) | $245/mo | White House |
| Net federal payment after copay | $195/mo | KFF |
| Part D deductible and out-of-pocket cap | Do not apply | CMS |
| Comparison: Wegovy self-pay (NovoCare) | $349/mo | NovoCare Pharmacy |
| Comparison: Wegovy list price (WAC) | $1,349/mo | White House |
Who qualifies: three BMI tiers
Eligibility runs on body mass index (BMI) plus, for the two lower tiers, a paired diagnosis. CBS News and the National Council on Aging published the same three tiers CMS uses. Members of standalone Part D plans and of Medicare Advantage plans with drug coverage both qualify. Two groups are routed elsewhere: anyone who already got a GLP-1 through Part D, and anyone whose prescription is for diabetes, sleep apnea, or the liver disease MASH, because Part D already covers those uses.
| Channel | Price | Source |
|---|---|---|
| Tier 1: BMI 35 or higher | Eligible | CBS News |
| Tier 2: BMI 30 or higher | Eligible with condition | CBS News |
| Tier 3: BMI 27 or higher | Eligible with condition | National Council on Aging |
| Plan type | PDP or MA-PD | Humana |
| Prior GLP-1 use through Part D | Not eligible | CMS |
| Diabetes, sleep apnea, or MASH prescriptions | Regular Part D | Novo Nordisk PR |
| Estimated eligible population | ~3.8 million | KFF |
Covered drugs
CMS covers four branded products when they are prescribed to reduce and maintain body weight. The list was last updated April 6, 2026, to add Foundayo and to make clear that only the KwikPen version of Zepbound counts; Zepbound vials and single-dose pens are excluded. Novo Nordisk confirmed all doses of both Wegovy forms are in, including the 7.2 mg HD injection. Compounded copies made by 503A or 503B pharmacies (patient-specific and bulk compounders) are not eligible.
| Channel | Price | Source |
|---|---|---|
| Wegovy injection (semaglutide) | Covered | Novo Nordisk PR |
| Wegovy pill (oral semaglutide) | Covered | Novo Nordisk PR |
| Zepbound KwikPen (tirzepatide) | Covered (KwikPen only) | CMS |
| Foundayo (orforglipron) | Covered | CMS |
| Compounded semaglutide or tirzepatide | Not eligible | Foley & Lardner |
How enrollment works: Humana, prior authorization, and the 72-hour clock
CMS chose Humana as the single central processor because it already runs the LI NET program for low-income Medicare members. The prescriber submits the prior authorization electronically (through an ePA system such as CoverMyMeds) or by fax on the CMS form. Humana must notify the prescriber and patient of the decision within 72 hours. The pharmacy bills with the patient's Medicare number plus the Bridge-specific BIN and PCN, the routing codes that tell a claim where to go.
| Channel | Price | Source |
|---|---|---|
| Central processor | Humana | CMS |
| Prior authorization submission | Electronic or fax | CMS PA form |
| Decision turnaround | 72 hours | CMS |
| Prescriber Medicare enrollment | Not required | CMS |
| Pharmacy billing codes | BIN 028918 / PCN MEDDGLP1BR | CMS |
| Pharmacy help | Nearly 8,000 Walgreens stores | Walgreens |
The July billing disconnect: denials that were not denials
Within the first week, eligible seniors were being turned away at pharmacy counters. Medical Daily traced the problem on July 6 to routing: pharmacies sent Bridge claims to the patient's regular Part D plan, which rejects them automatically because the Bridge sits outside Part D. The fix is to resubmit with BIN 028918 and PCN MEDDGLP1BR. CMS has asked Part D plans to answer misdirected requests with a message pointing the provider to Humana.
| Channel | Price | Source |
|---|---|---|
| Cause of early rejections | Wrong payer routing | Medical Daily |
| Fix at the counter | Rebill to BIN 028918 / PCN MEDDGLP1BR | Medical Daily |
| Misdirected prior authorization | Redirect to Humana | CMS |
| First-fill prior authorization | Required before first fill | Medical Daily |
What the Bridge costs Medicare: KFF projections
KFF published its cost model on June 29, 2026. It starts from 3.8 million eligible beneficiaries and a $195 monthly federal payment per person, then varies the share who actually enroll. Part D plan sponsors carry none of this cost; the money flows from CMS through Humana to pharmacies.
TrumpRx and the MFN deal behind the $245
The $245 Medicare price and the $50 copay were set in the November 6, 2025 agreement between the White House, Eli Lilly, and Novo Nordisk. The same deal created TrumpRx, a cash-pay federal website that launched February 5, 2026 and does not take insurance. TrumpRx prices are for people paying out of pocket; the $245 is what Medicare pays inside the Bridge.
| Channel | Price | Source |
|---|---|---|
| Medicare price: Ozempic, Wegovy, Mounjaro, Zepbound | $245/mo | White House |
| Medicare beneficiary copay | $50/mo | White House |
| TrumpRx: Wegovy injection | Avg $350/mo, from $199 | White House |
| TrumpRx: Zepbound | Avg $346/mo, from $299 | White House |
| TrumpRx: Wegovy pill | From $149/mo | White House |
| TrumpRx starting doses over time | $350 trending to $245 | CNBC |
After December 31, 2027: the BALANCE Model
The Bridge was first scheduled to end December 31, 2026. CMS extended it a full year because the BALANCE Model, the voluntary program meant to carry GLP-1 coverage into Medicare Part D, will not launch in Medicare in 2027. BALANCE is moving ahead on the Medicaid side, where states can opt in through January 1, 2027. If neither BALANCE nor Congress acts before the Bridge ends, Part D reverts to the 2003 law that bars coverage of drugs used only for weight loss.
| Channel | Price | Source |
|---|---|---|
| Bridge end date | December 31, 2027 | CMS |
| BALANCE in Medicare Part D | Not in 2027 | CMS |
| BALANCE in Medicaid | State opt-in May 2026 to January 1, 2027 | CMS Innovation Center |
| BALANCE participation | Voluntary | CMS Innovation Center |
| Default if nothing replaces the Bridge | Part D exclusion returns | HHS ASPE |