Does Medicare Cover Zepbound?

GLP-1 drugs can help you manage your weight and improve your health. Starting July 1, 2026, Medicare covers these GLP-1 drugs:

• Foundayo® (tablet)
• Wegovy® (injection or tablet)
• Zepbound® (KwikPen® only. The program doesn’t cover single-dose Zepbound® vials or pens).

Medicare covers certain GLP-1 drugs under the Medicare GLP-1 Bridge program. This temporary program is available nationwide (including all states and U.S. territories) to certain people with Medicare drug coverage (Part D), including:

• A standalone Medicare drug plan (PDP)
• A Medicare Advantage (MA) coordinated care plan with drug coverage (including HMO, HMOPOS, and Local and Regional PPO plans) (MA-PD)
• A Special Needs Plan (SNP)
• An Employer/union group waiver plan (EGWP)
• The Limited Income Newly Eligible Transition (LI NET) program

You must be 18 or older and meet one of these requirements when you start GLP-1 therapy:

• You have a body mass index (BMI) of 35 or higher.
• You have a BMI of 30 or higher and you have at least one of these conditions:
• Diastolic heart failure (also called heart failure with preserved ejection fraction)
• Uncontrolled high blood pressure (also called hypertension)
• Chronic kidney disease at stage 3a or higher
• You have a BMI of 27 or higher and have at least one of these conditions:
• Prediabetes
• A previous heart attack (also called myocardial infarction) or stroke
• Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms

You aren't eligible if you:

• Already get GLP-1 drugs covered through your Medicare Part D plan.
• Have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (but your Part D plan might cover your GLP-1s).

If you’re eligible, your doctor or other health care provider must send a prescription for a covered GLP-1 drug to the pharmacy and when requested, complete a prior authorization. Your provider must certify that you're using the GLP-1 drug as part of a lifestyle program that focuses on diet and exercise.

Your pharmacy may ask for your Medicare Number or the last 4 digits of your Social Security Number to help them process your prescription. If you suspect fraud call 1-800-MEDICARE (1-800-633-4227) or find other ways to report fraud. TTY users can call 1-877-486-2048.

You'll get a letter in the mail letting you know your GLP-1 drug is covered under Medicare GLP-1 Bridge.

Your prior authorization is valid (including for refills and dose changes) through December 31, 2027, unless you change GLP-1s.

You’ll pay a $50 copayment to the pharmacy for a one-month supply (either 28 or 30 days, depending on drug).

Since a separate Medicare program covers this drug (not your regular drug coverage), your copayment:

• Doesn’t count towards your yearly Medicare drug plan deductible or out-of-pocket limit and won’t appear on your Part D Explanation of Benefits (EOB).
• Won’t appear on any Medicare Summary Notice (MSN).
• Can’t be lowered by programs like Extra Help (a Medicare program that helps people with limited income and resources pay Part D costs).
• Can’t be spread across multiple months using the Medicare Prescription Payment Plan.