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Medicare GLP-1 Bridge (CMS)

Does Medicare GLP-1 Bridge (CMS) cover Wegovy for Weight Loss?

Yes. Medicare GLP-1 Bridge (CMS) covers Wegovy for weight loss with prior authorization if your BMI is 35 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicare Part D: Covered with requirements. See the qualification pathways below.

Earliest policy review July 8, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Weight Loss (1 plan type)

Applies to Medicare Part D plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

BMI ≥ 35 (no comorbidity required)

All of:

  • Age ≥ 18 years
  • Prescription is for weight reduction and maintenance of weight reduction only (not for any other approved indication)
  • Patient has Medicare Part D coverage and has NOT previously received a GLP-1 through their Part D plan
  • Patient does NOT have type 2 diabetes, moderate-to-severe sleep apnea, or MASH
  • BMI ≥ 35

BMI ≥ 30 with qualifying cardiometabolic comorbidity

All of:

  • Age ≥ 18 years
  • Prescription is for weight reduction and maintenance of weight reduction only (not for any other approved indication)
  • Patient has Medicare Part D coverage and has NOT previously received a GLP-1 through their Part D plan
  • Patient does NOT have type 2 diabetes, moderate-to-severe sleep apnea, or MASH
  • BMI ≥ 30

Plus any one of:

  • Diagnosis of heart failure with preserved ejection fraction
  • Diagnosis of uncontrolled hypertension (systolic BP > 140 mmHg or diastolic BP > 90 mmHg despite concurrent treatment with two antihypertensive medications)
  • Diagnosis of chronic kidney disease stage 3a or above

BMI ≥ 27 with qualifying cardiovascular or metabolic comorbidity

All of:

  • Age ≥ 18 years
  • Prescription is for weight reduction and maintenance of weight reduction only (not for any other approved indication)
  • Patient has Medicare Part D coverage and has NOT previously received a GLP-1 through their Part D plan
  • Patient does NOT have type 2 diabetes, moderate-to-severe sleep apnea, or MASH
  • BMI ≥ 27

Plus any one of:

  • Diagnosis of pre-diabetes
  • Previous myocardial infarction
  • Previous stroke
  • Symptomatic peripheral artery disease

Documentation to bring

  • Prescriber attestation (under penalty of perjury) that information provided is true and correct
  • Obesity diagnosis code (E66 family) on the prescription
  • Documentation that patient is ≥ 18 years of age
  • Documentation that the GLP-1 is prescribed to reduce excess body weight and maintain weight reduction only (not for any other approved indication)
  • Documentation that patient has not previously received a GLP-1 through their Medicare Part D plan
  • Documentation that patient does NOT have type 2 diabetes, moderate-to-severe sleep apnea, or MASH
  • Documentation of qualifying BMI (≥ 35, or ≥ 30 with HFpEF/uncontrolled HTN/CKD stage 3a+, or ≥ 27 with pre-diabetes/prior MI/prior stroke/symptomatic PAD)
  • Documentation of qualifying comorbidity if BMI < 35

Quantity limits

  • all covered strengths — 28-day or 30-day fills only

Approval and renewal

  • Renewal: Subsequent fills do not require a new prior authorization unless the patient switches from one covered GLP-1 drug to a different one.

Not covered when

  • Patients who have previously received a GLP-1 through their Medicare Part D plan are not eligible
  • Patients with type 2 diabetes must submit to their Part D plan (not eligible for Bridge)
  • Patients with moderate-to-severe sleep apnea must submit to their Part D plan (not eligible for Bridge)
  • Patients with MASH must submit to their Part D plan (not eligible for Bridge)
  • Patients enrolled in private fee-for-service plans, section 1876 cost contract plans, section 1833 healthcare prepayment plans, PACE organizations, fallback plans, and religious fraternal benefit plans are not eligible unless also enrolled in a standalone PDP
  • Prescription indicated for any approved indication other than weight reduction and maintenance of weight reduction is not eligible

Policy note: This is a short-term CMS demonstration program operating outside of Medicare Part D plan coverage, launching July 1, 2026. The program uses a central processor for PA, claims processing, and pharmacy payment. PA request is pharmacy-initiated (sent to prescriber within 24-72 hours after claim submission). Only 28-day or 30-day fills are covered. A new PA is required only if a patient switches from one covered GLP-1 to another. The program independently verifies patient information (e.g., checks Medicare data for T2DM). Prescriber must not be on the CMS Preclusion List. Wegovy injection and tablets are covered; oral semaglutide (Rybelsus) is not listed as covered. Only Wegovy, Foundayo (oral semaglutide tablets), and Zepbound KwikPen are covered — single-dose Zepbound pen and Zepbound vials are NOT covered.

Policy effective July 1, 2026 · verified July 8, 2026 · source: Medicare GLP-1 Bridge Prescriber Guide · View policy document (PDF)

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Questions people ask
Does Medicare GLP-1 Bridge (CMS) cover Wegovy?
Yes. Medicare GLP-1 Bridge (CMS) covers Wegovy for weight loss with prior authorization if your BMI is 35 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.
What does Medicare GLP-1 Bridge (CMS) require to renew Wegovy?
Weight Loss — Applies to Medicare Part D plans. Subsequent fills do not require a new prior authorization unless the patient switches from one covered GLP-1 drug to a different one.
How current is this information?
The oldest review date among the policies on this page is July 8, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Medicare GLP-1 Bridge (CMS): Zepbound

Wegovy under other plans: Aetna, Centene, Cigna, UnitedHealthcare, Alabama Medicaid, BCBS Alabama, BCBS Arizona, BCBS Arkansas

All insurance plans · All medications

Summary of Medicare GLP-1 Bridge (CMS)'s written policy, not a guarantee of coverage. Plans vary by employer and benefit design.