Does Medicare cover GLP-1s in 2026?

Partly — and the part that changed has a price on it. Since July 1, 2026, an eligible Medicare Part D enrollee can get Wegovy, the Zepbound KwikPen, or Foundayo for a $50 copay per monthly supply through a CMS demonstration called the Medicare GLP-1 Bridge, which runs through December 31, 2027¹. Part D itself did not change. The statute still excludes drugs used for weight loss, and the demonstration routes around that exclusion rather than lifting it. Everything below is the position as of August 2026, with the date attached to each rule, because this is a program with an expiration date on it.

Part D still excludes weight-loss drugs

CMS has read the same words the same way since Part D began. In its own summary: "Since the inception of the Part D program, CMS has interpreted the statutory exclusion of 'agents when used for weight loss' to mean that a drug, when used for weight loss, is excluded from the definition of a covered Part D drug," and anti-obesity medications are therefore "only coverable in Part D if the drug is being used to treat another condition that is a medically accepted indication other than weight loss or weight management"⁴. CMS proposed to reinterpret that language in a rule published November 26, 2024⁴ — and then did not carry it through. The final rule, issued April 4, 2025, states that CMS "is not finalizing" the provision on Part D coverage of anti-obesity medications and its application to Medicaid⁵. As of August 2026, CMS still describes the position in the present tense: Medicare and Medicaid "generally do not cover these drugs for the weight loss indication"⁸. So the exclusion is intact, and a demonstration was built beside it.

What the $50 program actually covers

CMS announced the demonstration on May 6, 2026, with the terms stated plainly: eligible beneficiaries get "certain GLP-1 medications for $50 per month beginning July 1, 2026, through December 31, 2027"⁹. The covered products are narrower than the drug names suggest. CMS lists Foundayo, Wegovy in both injection and tablet form, and Zepbound in the KwikPen only — the single-dose vial and single-dose pen formulations of Zepbound are not included, and CMS added Foundayo to the list on April 6, 2026, after its approval³.

The structure matters as much as the number. The demonstration operates outside the Part D benefit's coverage and payment flow, which has three consequences CMS spells out: the Part D deductible does not apply, none of the $50 counts toward your true out-of-pocket (TrOOP) total, and there is no low-income subsidy for LIS beneficiaries¹. CMS uses a single central processor — Humana, which already runs the Limited Income Newly Eligible Transition program — for prior authorization, claims, and payment to pharmacies, and coupons or discount programs may not be applied to these claims³. Your plan does not have to opt in for you to use it¹.

Who qualifies

Medicare publishes the criteria for beneficiaries directly. You must be 18 or older and, at the time you start GLP-1 therapy, meet one of three thresholds: a BMI of 35 or higher; a BMI of 30 or higher with diastolic heart failure, uncontrolled high blood pressure, or chronic kidney disease at stage 3a or above; or a BMI of 27 or higher with prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease². Your prescriber must send the prescription and, when asked, complete a prior authorization, and must certify that the drug is being used as part of a program of diet and exercise². Once granted, the prior authorization holds through December 31, 2027, including for refills and dose changes, unless you switch to a different GLP-1².

What changes when the same molecule is prescribed for something else

This is the part people get wrong, and it runs in the opposite direction from what you would expect. Type 2 diabetes, moderate-to-severe obstructive sleep apnea, and noncirrhotic MASH with moderate-to-advanced fibrosis are all indications eligible for regular Part D coverage — so a beneficiary with one of those diagnoses gets a GLP-1 through their plan and is, for that reason, ineligible for the $50 demonstration even if they meet every clinical criterion³. Medicare's beneficiary page says the same thing in plainer words: you are not eligible if you have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, "but your Part D plan might cover your GLP-1s"². Reducing the risk of major adverse cardiovascular events in adults with established cardiovascular disease and obesity or overweight is another indication CMS names as a medically accepted use other than weight loss⁴. What you pay in that lane is a formulary copay set by your plan, not $50, and it runs through the usual prior authorization — the mechanics of which we cover in the GLP-1 insurance coverage guide.

The negotiated price arriving January 1, 2027

Separately from the demonstration, Ozempic, Rybelsus, and Wegovy were selected for the second cycle of the Medicare Drug Price Negotiation Program. CMS published the result: a negotiated maximum fair price of $274 for a 30-day supply for calendar year 2027, against a $959 list price for a 30-day supply in calendar year 2024 — a 71% discount — going into effect January 1, 2027⁶. That $959 is a 2024 figure covering the three products as a group, not a current single-product list price, and CMS does not publish what any individual will pay at the counter in 2027. Worth noting what is not on the list: the third negotiation cycle, announced January 27, 2026 for 2028, selected Trulicity among 15 drugs and includes no tirzepatide product at all⁷. If you are pricing that molecule, our tirzepatide cost breakdown covers the cash and commercial pathways instead.

BALANCE, and the thing that did not happen

CMS announced a voluntary model called BALANCE on December 23, 2025, and said at the time that it would launch in Medicaid as early as May 2026 and in Medicare Part D in January 2027. The Medicare half did not happen. Both the BALANCE page and the demonstration's own FAQ now answer the question "What is the impact of the BALANCE Model not launching in Medicare in 2027?" — and the answer is that the $50 demonstration was extended through December 31, 2027 in its place¹. On the Medicaid side, state agencies can join the model from May 2026 through January 1, 2027, participation is voluntary for manufacturers, states, and plans, and CMS states outright that the model "will not guarantee coverage for any individual"⁸. Treat a state Medicaid benefit as something to confirm with your own state, not something to assume.

If none of this reaches you

Medicare's own page points people who do not qualify toward manufacturer assistance programs, state pharmaceutical assistance, mail-order pricing, and the Medicare Prescription Payment Plan, and it names TrumpRx.gov as a place to compare cash prices — with a caveat worth repeating, that discount cards "aren't considered creditable coverage" and what you spend through them does not count toward your Medicare deductible or out-of-pocket maximum². For the cash market outside Medicare entirely, our semaglutide cost breakdown and the cheapest GLP-1 pricing page track what providers currently publish. Prices and program terms in this article reflect what CMS and Medicare published as of August 2026; verify your own eligibility at Medicare.gov or by calling 1-800-MEDICARE before acting on any of it. This is coverage context, not medical or financial advice.