Starting in July, Medicare beneficiaries may be able to access selected GLP-1 medications for $50 per month through a pilot program, the Centers for Medicare & Medicaid Services (CMS) announced in early May.
The announcement comes as utilization of GLP-1 medications among Medicare beneficiaries continues to rise rapidly, according to CareSet’s analysis of CMS Chronic Conditions Data Warehouse data.
The selected GLP-1s included in the program for weight loss are both the pill and injectable formulations of Wegovy (semaglutide), the KwikPen formulation of Zepbound (tirzepatide), and the Foundayo (orforglipron) pill, which received FDA approval in April 2026.
To qualify for the coverage, Medicare beneficiaries must meet prior authorization criteria and be enrolled in a Medicare Part D plan. Once approved, beneficiaries will pay a flat $50 copayment at the pharmacy when filling the prescription. Since the Bridge program operates outside standard Part D coverage, the copayment will not count towards beneficiaries’ deductibles or annual out-of-pocket maximums.
The Medicare GLP-1 Bridge program was originally announced as a temporary pathway to provide beneficiaries with early access to weight-loss medications until the longer-term Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model launches in January 2027. Under BALANCE, CMS would negotiate lower GLP-1 prices with manufacturers for participating in private Medicare Part D plans and state Medicaid programs, with the model scheduled to run through December 2031.
However, in April 2026, CMS announced an indefinite delay of the Medicare portion of BALANCE and extended the Bridge through December 2027. The Medicaid component of BALANCE is proceeding, with state participation beginning as early as May 2026.
Under the BALANCE model, all formulations of Mounjaro (tirzepatide), Ozempic (semaglutide), Rybelsus (semaglutide), and Wegovy, along with the KwikPen formulation of Zepbound, and Foundayo, would have been included.
Although Medicare is barred by law from covering medications prescribed solely for weight loss, utilization and spending on GLP-1 drugs have risen sharply in recent years, according to CareSet’s analysis of CMS Chronic Conditions Data Warehouse data. Medicare currently covers GLP-1 medications for conditions including type 2 diabetes, cardiovascular disease, and sleep apnea.
Semaglutide products, branded as Ozempic, Rybelsus, and Wegovy, have dominated the GLP-1 market in recent years.
In March 2026, more than 866,000 Medicare Part D beneficiaries used Ozempic, which was approved by the FDA in 2017 to treat type 2 diabetes, up from roughly 96,000 beneficiaries in January 2022. Use of Mounjaro, which was approved in 2022 for type 2 diabetes, surpassed Ozempic in late 2025, reaching more than 1 million beneficiaries in March 2026. While use of these two newer GLP-1 drugs has increased, utilization of older medications such as Trulicity has declined.
In addition, several GLP-1 medications received expanded FDA approvals for additional indications. In March 2024, FDA approved Wegovy injection to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight. Later that year, Zepbound was approved for the treatment of moderate to severe obstructive sleep apnea in adults with obesity.
Gross Medicare Part D spending on Ozempic totaled $16.1 billion in 2025, nearly double the amount spent in 2023. Meanwhile, as Mounjaro utilization accelerated, spending on the medication surpassed Ozempic for the first time in 2026, reaching $4.2 billion between January and March 2026 alone.
Those gross spending figures do not account for rebates or discounts that the drug manufacturer provides directly to the Part D plan sponsors, according to CMS. A MedPAC analysis found that negotiated rebates for diabetic therapy under Part D equaled or exceeded 50% in 2023.
The Trump administration is pursuing multiple policy approaches to reduce the cost of GLP-1 drugs and expand access to them.
In November, the White House reached pricing deals with leading GLP-1 manufacturers, Eli Lilly and Novo Nordisk, which agreed to sell certain GLP-1 products at a lower cost through TrumpRx.
CMS followed in December with the announcement of the BALANCE model, saying the initiative aimed to “improve people’s long-term health, potentially preventing chronic disease and disability.”
To be eligible for the BALANCE model, beneficiaries must receive provider attestation that they meet specified clinical criteria. In addition to offering lower prices for GLP-1s, the model would also provide patients with access to lifestyle support programs at no cost.
However, amid pushback from health plans, CMS announced in an April memo that it would delay implementation of the model. The Wall Street Journal reported that major Medicare insurers signaled reluctance or unwillingness to participate.
Separately, Ozempic, Wegovy, and Rybelsus were also selected for Medicare drug price negotiation in 2025, with the negotiated price scheduled to take effect in 2027.
