Check coverage for the proposed use

Ask about the product and the purpose

Give the plan the exact medicine name and the reason the clinician is proposing it. Ask what records the plan needs before deciding.

A plan calls its list of covered medicines a formulary. Prior authorization is a request for the plan’s approval to pay before a prescription is filled.

Medicare has separate routes

Medicare’s prescription drug benefit is called Part D. As of September 26, 2026, its ordinary coverage still excluded drugs used only for weight loss.

Part D can pay for semaglutide to treat type 2 diabetes or for certain other accepted medical uses. One example is Wegovy to reduce the risk of a heart attack or stroke in adults who already have heart or blood vessel disease and are overweight or have obesity.

Medicare sets which medical uses can qualify. Your drug plan then applies its own medicine list and approval rules.

Eligible for coverage does not mean your plan has agreed to pay. Its medicine list and approval rules still apply.

Your share of the bill for a covered medicine is called a copay.

As of September 26, 2026, the temporary Medicare GLP-1 Bridge offered eligible people certain weight medicines for a $50 monthly copay. The program began July 1, 2026 and was to continue through December 31, 2027.

GLP-1 names a group of medicines that act like a gut signal involved in appetite and blood sugar.

For semaglutide, the Bridge includes Wegovy (semaglutide) tablets and injections; it does not include Ozempic (semaglutide) for weight loss.

For the Bridge, you must be at least 18. Being older than 65 does not by itself rule you out. You need a separate Part D drug plan, or Medicare Advantage coverage that includes medicines and coordinates your care. Ask your plan whether it is one of these types.

Your clinician must check your body mass index, or BMI, which is calculated from your height and weight. For the Bridge, the relevant BMI and health conditions are those you had at the start of this treatment.

The weight rule is met at a BMI of 35 or higher, without needing one of the additional conditions below.

At a BMI of 30 or higher, one of three health conditions is also required. One is heart failure with preserved ejection fraction, a type where the heart’s squeeze is preserved. Another is blood pressure that remains above 140 for the top number or 90 for the bottom number while taking two blood pressure medicines. The third is long-term kidney disease at stage 3a or higher. Ask your clinician which condition and stage your records show.

At a BMI of 27 or higher, you need one of four health conditions. The four are pre-diabetes, meaning blood sugar raised toward diabetes; a heart attack in the past; a stroke in the past; or narrowed limb arteries that cause symptoms.

People with type 2 diabetes must ask about ordinary Part D instead. The same applies to moderate or severe breathing pauses during sleep. Ordinary Part D also applies to MASH, a type of fatty liver disease with moderate or advanced scarring and no cirrhosis, a later scarring stage. Ask the clinician to check the exact diagnosis. A prescription to reduce heart attack or stroke risk also goes through ordinary Part D.

Receiving Part D payment for a GLP-1 medicine at any point in 2026 makes you ineligible for the Bridge in 2026. The corresponding rule for 2027 had not been set as of September 26, 2026.

To use the Bridge, you also need approval before payment, a prescription and a continuing plan for eating and physical activity.

The yearly Part D limit is the most you pay yourself for medicines covered through Part D. The Bridge’s $50 payment is separate and does not help you reach that limit. Reaching the limit on your other medicines does not remove the Bridge’s $50 monthly charge. Coupons cannot reduce it.

Ask which route the request is taking

For other health plans, ask about your own coverage. A description of someone else’s benefit does not settle yours.

Reading for this question

• Medicare’s explanation of weight-drug coverage

  A consumer starting point for the temporary Bridge. Eligibility and the proposed product both matter.

• CMS details for Bridge requests

  CMS is the agency that runs Medicare. Its detailed criteria explain which request route applies.