Weight Loss Drug Coverage: Following new negotiations, Medicare now covers certain GLP-1 weight-loss medications (like Ozempic and Wegovy) when prescribed for weight management, with a maximum $50 copay for beneficiaries

Medicare coverage for GLP-1 weight-loss medications is expanding in 2026 under new administration agreements, though specific eligibility and timing rules apply:

 

• • $50 Monthly Copay: Eligible beneficiaries will pay a maximum $50 copay for a month’s supply of injectable GLP-1 drugs like Wegovy, Zepbound, and Ozempic.

• • Expansion for Weight Management: For the first time, Medicare will cover these medications when prescribed specifically for obesity, even without a secondary condition like diabetes.

• • Rollout Timing: A short-term “bridge” payment demonstration is scheduled to begin in July 2026. A broader pilot program, the BALANCE model, is expected to follow in 2027.

• • Eligibility Requirements: To qualify for the $50 copay under the pilot programs, beneficiaries typically must have:
    

     

    • • A BMI of 35 or higher.
    • • A BMI of 27 or higher with at least one qualifying condition, such as prediabetes, cardiovascular disease, or high blood pressure.

• • Existing Coverage: Before these 2026 changes, Medicare only covers these drugs for specific non-weight-loss indications, such as Ozempic for Type 2 diabetes or Wegovy to reduce cardiovascular risk. 

Beneficiaries can use the Medicare Plan Finder to check specific plan formularies and coverage details for 2026. 

This is for informational purposes only. For medical advice or diagnosis, consult a professional.