Does Medicare cover Wegovy or Zepbound?

Since 1 July 2026, yes, for eligible people, through a specific programme rather than through ordinary Part D coverage. If you were told no, that advice may simply be out of date.

The short answer

Wegovy, in injection and tablet form, and Zepbound KwikPen are both named by CMS among the products available through the Medicare GLP-1 Bridge, at fifty dollars a month for eligible Part D beneficiaries. Foundayo is also named.

The programme runs 1 July 2026 to 31 December 2027.

Why this needed a special programme

Medicare Part D historically did not cover medicines used for weight loss. That is the reason a generation of coverage guidance says these drugs are not covered, and why a great deal of published material still says so.

Rather than change that framework immediately, CMS created a demonstration that sits outside the normal Part D benefit flow. Your plan carries no risk and did not have to opt in.

Who is eligible

You need Part D drug coverage, through either:

• a standalone prescription drug plan, or
• a Medicare Advantage plan that includes prescription drug coverage.

CMS directs beneficiaries to check eligibility through Medicare.gov.

The fine print worth knowing

Three things, because they change the maths if you take other medicines.

• The Part D deductible does not apply.
• The fifty dollars does not count toward your true out of pocket total, so it does not move you toward the catastrophic phase where your other drug costs would drop.
• There is no low income subsidy attached, so Extra Help does not apply to this price.

What about Ozempic and Mounjaro

Different question, because those are the type 2 diabetes brands of the same two molecules.

Medicare Part D has long covered medicines for diabetes, so if you have type 2 diabetes and are prescribed a GLP-1 for it, that has generally been a coverage question about formularies and prior authorisation rather than a categorical exclusion.

The Bridge is specifically about the weight management indication.

What happens after 2027

The Bridge is time limited by design. CMS has said the extension through 2027 lets it gather utilisation data to share with Part D plan sponsors ahead of possible implementation of BALANCE.

Under BALANCE, CMS negotiates GLP-1 pricing on behalf of participating Part D plans and state Medicaid agencies. The Part D performance period runs 1 January 2027 to 31 December 2031, and participating sponsors must ensure no covered patient pays more than fifty dollars per 28 or 30 day supply in the initial coverage phase from an in-network pharmacy. It also includes a lifestyle support component.

So the likely direction is that a fifty dollar ceiling becomes ordinary coverage for participating plans rather than a temporary programme. Participation is voluntary, which means it will not be universal.

If you are on Medicare and currently paying cash

This is the practical point of the page. If you are a Part D beneficiary paying cash for a compounded GLP-1, check the Bridge before your next refill. Fifty dollars a month for an FDA approved product is a materially different proposition from a cash price for a product the FDA has not reviewed.

What to ask

• Am I enrolled in a plan type that qualifies?
• Which of the named products fits my situation?
• Does the true out of pocket exclusion affect my other drug costs this year?
• Will my plan participate in BALANCE from 2027?
• If I have type 2 diabetes, is the diabetes brand a better coverage route for me?

Sources

• Centers for Medicare and Medicaid Services, Medicare GLP-1 Bridge
• Centers for Medicare and Medicaid Services, press release on $50 monthly access to GLP-1 medications
• Centers for Medicare and Medicaid Services, BALANCE Model
• Medicare.gov, coverage of weight loss drugs
• Medicare.gov, Medicare GLP-1 Bridge, GLP-1 drugs for $50 a month

How we verify: see /how-we-verify.

Keep reading

The full detail on the Bridge and its fine print, at /guides/medicare-glp1-bridge.

All four ways to pay compared, at /guides/how-to-pay-for-glp1.