Medicare and GLP-1s for 2027: the $50 Bridge, open enrollment and what to check

Medicare’s annual open enrollment runs from October 15 to December 7, 2026, and this year it lands in the middle of the biggest change to weight-loss drug coverage Medicare has made. For the first time, people with Medicare can get Wegovy, Foundayo or the Zepbound KwikPen for weight management at a fixed $50 a month. But that benefit does not come from the Part D plan you choose this autumn, and it has an end date. This guide explains how the pieces fit, what to check before you switch plans, and what the cash route costs if you do not qualify.

The Medicare GLP-1 Bridge in one table

The Bridge is a temporary CMS demonstration that runs alongside Part D rather than inside it. CMS extended the planned six-month program to eighteen months in an April 2026 memo to plans, announced the dates in May 2026 and launched it on July 1, 2026. Its main terms:

The price behind the copay comes from the November 6, 2025 agreements between the White House, Eli Lilly and Novo Nordisk, which set a Medicare price of $245 a month for these drugs and a $50 beneficiary copay. Lilly’s release at the time said the $50 price could start “as early as April 1, 2026”; in practice the Bridge started on July 1.

Who qualifies

You must be enrolled in Medicare Part D drug coverage, either a stand-alone drug plan or a Medicare Advantage plan with drug coverage, and be 18 or older. CMS’s own pages describe the medical rules only as “clinical criteria”. The tiers published by the American Academy of Family Physicians and repeated in UnitedHealthcare’s provider notice are:

• Tier 1: a body-mass index of 35 or more.
• Tier 2: a BMI of 30 or more plus heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease stage 3a or higher.
• Tier 3: a BMI of 27 or more plus prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease. (Plan notices route established cardiovascular disease to Part D Wegovy coverage instead, so check which route applies.)

Pharmacy Times reports that private fee-for-service plans and PACE are excluded. We could not open the eligibility page on Medicare.gov, so confirm the current rules with your prescriber before relying on them.

Who is sent to Part D instead. If your plan can already cover the drug for a medically accepted use, the Bridge does not apply. CMS’s June 2026 memo gives two examples: Wegovy prescribed to reduce the risk of heart attack and stroke, and Zepbound for moderate to severe obstructive sleep apnea. UnitedHealthcare adds type 2 diabetes and MASH, the liver condition Wegovy gained accelerated approval for in August 2025. In those cases you pay your plan’s normal cost-sharing, which can be more than $50.

What happened to the BALANCE model

Earlier in 2026 the plan was for the Bridge to end in December and hand over to BALANCE, a voluntary CMS model under which Part D plans and state Medicaid programs could cover GLP-1s at negotiated prices. That changed in April. CMS told plans it was delaying the Part D portion of BALANCE for 2027 “pending further evaluation and data collection”, after major insurers did not commit to the 80% participation CMS wanted. The Medicaid portion continues: states could apply from May 2026 and coverage can start by January 1, 2027, though we have not found an official list of participating states.

The practical consequence: advice written in early 2026 telling you to pick a Part D plan that “joins BALANCE” no longer applies. KFF has warned that unless something replaces the Bridge, Medicare enrollees could lose this route to obesity coverage in 2028.

What to compare during open enrollment

Because the Bridge is run centrally, CMS has told Part D sponsors they do not opt in and must not suggest that Bridge access depends on enrolling in a particular plan. So for weight management alone, the plan you choose does not change your $50 copay. Plan choice still matters if you take a GLP-1 for a covered use. Check these five things in each 2027 plan’s formulary and documents:

1. Is the drug listed for your use? Look for Wegovy, Ozempic, Mounjaro or Zepbound and note the tier.
2. Prior authorization and step therapy. Plans may require you to try another drug first.
3. Your cost-sharing. Covered uses are billed at plan rates, not $50. For 2027, UnitedHealthcare and KFF report a Part D out-of-pocket cap of $2,400 and a maximum deductible of $700; we could not read the figures in CMS’s own rate announcement.
4. The negotiated semaglutide price. Under the Inflation Reduction Act, Medicare’s negotiated price for Ozempic, Rybelsus and Wegovy takes effect January 1, 2027; trade press reported it at $274 for a 30-day supply. That is separate from the $245 Bridge price.
5. Premiums. CMS expects the average Medicare Advantage premium to fall from $14.37 to $12.00 a month in 2027 and the average stand-alone drug plan premium to rise from $35.09 to about $36. The base beneficiary premium is $41.33.

If you do not qualify: the cash route

Medicare does not pay for compounded semaglutide or tirzepatide under any of these programs. If you pay cash, the main options as of October 14, 2026 are:

Manufacturer savings cards and copay coupons exclude people with government coverage, Medicare included. We found no source that says whether a Medicare enrollee may buy from LillyDirect or NovoCare at the self-pay price instead of using Medicare; ask the pharmacy before you order.

Compounded drugs are a legal option only when a pharmacy compounds them for you on a prescription, and they are not FDA-approved. Our compounded semaglutide price guide lists every program with its billing basis and read date, and the FDA policy explainer covers the 2026 rule changes.

A checklist for the next seven weeks

1. Ask your prescriber whether you meet a Bridge tier and whether your use is already a Part D-covered indication.
2. If you take a GLP-1 for diabetes, heart risk or sleep apnea, compare 2027 formularies on Medicare.gov’s plan finder before December 7.
3. If you use the Bridge, note that it ends on December 31, 2027 and that nothing has replaced it for 2028 yet.
4. If you pay cash, compare the brand self-pay programs with compounded options on the same monthly basis, and remember that coupons do not apply to Medicare enrollees.

Frequently asked questions

Informational only, not medical, legal or insurance advice. Compounded drugs are not FDA-approved. Wegovy® and Ozempic® are trademarks of Novo Nordisk; Zepbound®, Mounjaro® and Foundayo™ of Eli Lilly and Company.