Make the plan explain its terms
A formulary lists the medicines your plan covers. The plan's agreement to pay before coverage begins is called prior authorization.
- Does my plan list this exact medicine as covered for this use?
- Is prior authorization needed?
- What does the prescriber need to send?
- What will I pay if it is approved?
- What happens if the plan says no?
For Medicare, separate the routes
Part D is Medicare's prescription drug benefit.
As of September 2026, ordinary Part D excludes drugs when used for weight loss.
Under September 2026 rules, Part D can cover these drugs for certain other conditions, subject to the plan's list and approval steps.
- Ask which use the prescription is for.
- Ask which coverage route applies to that use.
- Ask for the plan's answer about the exact product.
The separate Medicare Bridge
GLP-1 is a hormone, a signal in the body, that affects appetite and blood sugar.
Medicines that copy this body signal are called GLP-1 drugs.
Your share of a covered cost is called a copay.
The Medicare GLP-1 Bridge offers certain weight medicines to eligible people for a $50 copay each month, under the September 2026 terms.
Under the September 2026 terms, July 1, 2026, is the Bridge start date; its end date is December 31, 2027.
Bridge eligibility under September 2026 rules depends on your Medicare plan, any payment Part D made for a GLP-1 medicine earlier in 2026, and your age, weight, and health problems when treatment starts.
You still pay the Bridge's $50 each month even after reaching Part D's yearly limit on your own drug costs, under the September 2026 terms.
What you pay through the Bridge does not count toward that yearly limit.
Those September 2026 terms also bar adding coupons to the Bridge payment.
- Ask whether the Bridge or ordinary Part D applies.
- Ask whether you meet the program's rules and what approval is needed.
- Check that the exact product is included.
Who can use the Bridge?
Under September 2026 rules, Bridge users must be 18 or older and fit one of the weight and health groups below at the start of treatment.
The program uses BMI, a number comparing weight with height. Ask your prescriber for your number and which group, if any, fits you.
- BMI of at least 35.
- BMI of at least 30 with heart failure that has preserved pumping strength, blood pressure still uncontrolled despite two medicines, or a medical record of kidney disease at stage 3a or later.
- BMI of at least 27 with prediabetes (high blood sugar before diabetes), an earlier heart attack or stroke, or artery disease with symptoms.
- Type 2 diabetes belongs with ordinary Part D coverage instead of the Bridge.
- Certain sleep and liver illnesses also belong with ordinary Part D; the exact diagnosis matters.
- You cannot use the Bridge in 2026 if Part D paid for your GLP-1 medicine in 2026.
- You need Part D in a separate plan, or a Medicare Advantage plan offering coordinated care plus drug coverage; some other plan types are excluded.
- Ask the prescriber to check the exact heart, blood pressure, sleep, kidney or liver condition against the program's rules.