Medicare and GLP-1 Drugs:
What Will You Pay in 2026?

How to Use This Calculator

The Medicare GLP-1 Cost Estimator maps your specific situation to one of three distinct Medicare coverage pathways — the new Bridge program, regular Part D for diabetes, or no current coverage — and shows you exactly what you will pay starting July 1, 2026. The calculator also compares your Medicare cost against what you are paying now, so you can see your real annual savings in dollars rather than navigating CMS documents.

Question 1 — Drug selection is the most important input because it determines your pathway. Wegovy, Zepbound KwikPen, and Foundayo (orforglipron) are covered under the new Medicare GLP-1 Bridge program starting July 1, 2026 at a flat $50 per month copay. Ozempic and Mounjaro are not in the Bridge program — they carry diabetes indications and are covered under regular Part D for Type 2 diabetes patients, where costs typically run $20 to $100 per month depending on your plan's tier placement. Compounded semaglutide is not covered by Medicare under any pathway — if you are currently on compounded, the calculator shows you what switching to brand-name Wegovy through the Bridge would save you.

Question 2 — Diagnosis confirms which indication pathway applies. The Bridge program covers weight-loss and cardiovascular indications. Regular Part D covers diabetes indications. Sleep apnea with Zepbound has its own formulary pathway on some Part D plans. Question 3 is your current monthly cost — use the slider or preset buttons to set this accurately, since the annual savings figure is calculated directly from the gap between what you pay now and what you would pay through Medicare. Question 4 asks about Extra Help eligibility. If you receive Medicare's Low-Income Subsidy, your Bridge copay will likely be lower than $50 — consistent with your LIS benefit level.

Understanding the Medicare GLP-1 Bridge Program

The Medicare GLP-1 Bridge program is the single most important change in GLP-1 drug access in 2026. Starting July 1, 2026 and running through December 31, 2027, it provides a flat $50 per month copay for Wegovy (both injection and oral tablet formulations), Zepbound KwikPen, and Foundayo for eligible Medicare beneficiaries. Every Part D plan — both standalone Part D plans and Medicare Advantage plans with drug coverage — is required to participate. You do not need to switch plans or take any enrollment action beyond being in a Part D plan you are already in.

The Bridge copay has an important structural difference from regular Part D coverage: it does not count toward your Part D deductible or the $2,100 annual out-of-pocket maximum. This means your $50 monthly copay stays flat throughout the year at every phase of the Part D benefit — you will not pay more during the coverage gap or catastrophic phase the way you might with a Tier 4 drug under standard Part D rules. For most beneficiaries, this makes the Bridge program cost more predictable than standard formulary coverage.

Eligibility for the Bridge requires a BMI of 30 or above for obesity indication, or BMI of 27 or above with a qualifying comorbidity (cardiovascular disease, sleep apnea, hypertension, or dyslipidemia). Prediabetes as defined by ADA guidelines also qualifies under the Bridge's Tier 3 eligibility criteria. Prior authorization applies — your prescriber must submit documentation confirming your diagnosis and BMI — but the clinical criteria are straightforward and the approval rates for eligible patients are high.

The Three Medicare GLP-1 Pathways in 2026

Pathway 1 — The Bridge Program (Wegovy, Zepbound, Foundayo)

If you take Wegovy, Zepbound KwikPen, or Foundayo for obesity or cardiovascular risk reduction, the Bridge program covers your drug at $50 per month with no deductible. You access this through your existing Part D plan — no enrollment change is required. Humana processes Bridge claims centrally using BIN 028918 / PCN MEDDGLP1BR. For Medicare beneficiaries currently paying $349 or more per month out of pocket, this represents annual savings of $3,588 or more. For patients at list price, savings exceed $15,000 per year.

Pathway 2 — Regular Part D for Diabetes (Ozempic, Mounjaro, Rybelsus)

If you have Type 2 diabetes and take Ozempic, Mounjaro, or Rybelsus, these drugs are covered under your regular Part D formulary and have been since before 2026. Coverage varies by plan tier — Ozempic is typically Tier 3 or Tier 4, with out-of-pocket costs of $30 to $150 per month depending on your plan after meeting your deductible. The standard Part D cost-sharing rules apply, including counting toward your $2,100 annual out-of-pocket cap. If your diabetes drug spend pushes you toward the cap, costs drop significantly in the catastrophic phase.

Pathway 3 — No Current Medicare Coverage (Compounded drugs)

Medicare does not cover compounded semaglutide or compounded tirzepatide under any pathway. If you are currently using compounded GLP-1 drugs, the Bridge program represents a compelling reason to switch to brand-name Wegovy or Zepbound. At $50 per month through the Bridge versus $99 to $299 per month for compounded, FDA-approved Wegovy or Zepbound through Medicare is actually less expensive — and carries full FDA manufacturing oversight — making the switch financially and clinically straightforward for most patients.

What to Do Next

If you are newly eligible for the Bridge: contact your prescriber and ask them to submit a prior authorization for Wegovy or Zepbound under the Medicare Bridge program. The prior authorization uses your BMI and qualifying diagnosis. Most retail pharmacies will be able to process Bridge claims starting July 1. If your pharmacy is unfamiliar with the Bridge BIN and PCN, provide them with BIN 028918 and PCN MEDDGLP1BR — these are the claim routing numbers Humana uses to process Bridge payments at any participating pharmacy.

If you are on Ozempic or Mounjaro for diabetes: verify your current plan's formulary tier and copay for these drugs through your plan's online portal or member services line. If your current copay is above $100 per month, compare plans during Medicare open enrollment (October 15 through December 7) to find a plan with better Tier 3 or Tier 4 placement for your specific drug.

For the full picture of your GLP-1 costs, use our True Monthly Cost Calculator which covers all insurance scenarios including Medicare, or our Insurance Eligibility Screener to assess your prior authorization likelihood before submitting to your prescriber.

Sources: CMS Medicare GLP-1 Bridge program guidance April 2026, KFF "What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid" May 2026, Telehealth Ally Medicare Bridge Implementation FAQ April 2026, The RX Index Medicare GLP-1 Bridge Guide March 2026, MedSwitcher Medicare Part D GLP-1 Coverage Guide April 2026, Wellcare Medicare GLP-1 coverage documentation. Bridge program BIN/PCN confirmed May 2026. Coverage details subject to change — verify with your Part D plan before filling. This content is for informational purposes only and does not constitute insurance, medical, or financial advice.