Does insurance, Medicare or Medicaid cover GLP-1 weight-loss drugs?

The short version (as of September 2026)

• Medicare Part D plans still cannot cover drugs when they are used for weight loss alone. They can cover the same drugs for other FDA-approved uses.
• The Medicare GLP-1 Bridge, a temporary federal program, started July 1, 2026. It runs through December 31, 2027, and has a $50 monthly copay for eligible Part D enrollees.
• Medicaid coverage for weight loss is a state choice. KFF counted 13 states covering GLP-1s for obesity as of January 2026.
• Employer and marketplace plans vary plan by plan.

This area is changing fast, so this page is reviewed monthly.

Why Medicare Part D doesn't normally cover weight-loss drugs

The Part D law excludes drugs "which may be excluded from coverage or otherwise restricted under section 1927(d)(2)" (Social Security Act §1860D-2). That list begins with "agents when used for anorexia, weight loss, or weight gain."

The exclusion depends on the reason the drug is prescribed, not on the drug itself. CMS told Part D plans that they must keep covering GLP-1s for uses that Part D can cover. Its examples include:

• Zepbound to treat moderate to severe obstructive sleep apnea in adults with obesity
• Wegovy to reduce the risk of major cardiovascular events in adults with established cardiovascular disease and either obesity or overweight
• type 2 diabetes
• noncirrhotic MASH (a liver disease) with moderate to advanced fibrosis

For these uses, the plan's own formulary and prior authorization rules apply.

The Medicare GLP-1 Bridge

CMS describes the Bridge as a short-term demonstration that runs outside the regular Part D benefit.

Covered drugs: Medicare.gov lists Foundayo tablets, Wegovy (injection or tablet), and Zepbound KwikPen only. Zepbound single-dose vials and pens are not covered.

Cost: a $50 copayment for a one-month supply. This copay:

• does not count toward your Part D deductible or out-of-pocket limit
• is not lowered by Extra Help
• cannot be spread out through the Medicare Prescription Payment Plan

Plan types: the program is open to people with a standalone Part D plan, or with a Medicare Advantage coordinated care plan that includes drug coverage. Special Needs Plans, employer group waiver plans and the LI NET program are also included.

Clinical criteria: Medicare.gov lists criteria that must be met when therapy starts. These include body mass index thresholds and certain health conditions. The page also lists who is not eligible:

• people who already get GLP-1 drugs covered through their Part D plan
• people with type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease, whose Part D plan might cover a GLP-1 instead

CMS adds that anyone who received a GLP-1 through Part D in 2026 is not eligible for the Bridge.

How it works: your clinician sends the prescription and completes a prior authorization when asked. The clinician must certify that you are using the drug as part of a diet and exercise lifestyle program. Medicare says an approved authorization is valid through December 31, 2027, including refills and dose changes, unless you switch GLP-1 drugs. Questions go to 1-800-MEDICARE.

Under the program, manufacturers supply these drugs at a net price of $245 per monthly supply.

The BALANCE Model

The BALANCE Model is a voluntary CMS Innovation Center model. Under it, CMS negotiates GLP-1 prices and coverage terms with manufacturers on behalf of state Medicaid agencies and Medicare Part D plans.

• Medicaid: state Medicaid agencies can join between May 2026 and January 1, 2027. CMS accepted state applications through July 31, 2026.
• Medicare Part D: on April 21, 2026, CMS said it would delay the Part D part of BALANCE for 2027 "pending further evaluation and data collection." It extended the Bridge through December 31, 2027 instead.

As of September 17, 2026, the CMS model page listed BALANCE as "Announced" and did not name participating states.

Medicaid: it depends on your state

Federal law lets state Medicaid programs exclude or restrict drugs used for weight loss, so coverage varies by state.

KFF, a health policy research group, reports that 13 state Medicaid programs covered GLP-1s for obesity under fee-for-service as of January 2026. That was down from 16 in its October 2025 survey. KFF says California, New Hampshire, Pennsylvania and South Carolina ended coverage. North Carolina dropped coverage in October 2025 and reinstated it in December 2025.

States that join BALANCE could change their coverage during 2026 and 2027. To find out where your state stands, ask your state Medicaid agency or Medicaid managed care plan:

• whether GLP-1s are covered for weight management, and which ones
• what criteria and paperwork apply
• whether the state is taking part in BALANCE

Employer and marketplace plans

Private plans make their own coverage choices, and two plans from the same insurer can differ. Before you or your clinician start a prescription, it helps to ask your plan:

• Is the specific drug and form (pen, vial or pill) on the formulary for weight management?
• Is prior authorization required, and what documentation does it need?
• Are there quantity limits, step requirements or a required lifestyle program?
• Must you use a particular pharmacy?
• What will your copay or coinsurance be after the deductible?

If your plan does not cover the drug, manufacturer self-pay programs are a separate route. See brand-name self-pay options.