Eli Lilly CEO Dave Ricks updated investors on Oct. 29 about Medicare’s $50-a-month weight-loss drug program. Since the program opened July 1, he said on the company’s third-quarter earnings call, “more than half a million people have filled a prescription” for a Lilly drug through it.
That program is the Medicare GLP-1 Bridge. It lets eligible enrollees get Wegovy, Foundayo or the Zepbound KwikPen for a flat $50 copay per one-month supply, regardless of income. Ricks put the number of older Americans who gained access at about 20 million.
Plenty of enrollees who want in will not qualify, though, and the reasons have little to do with income. The Medicare fact sheet sets four requirements for the $50 price, and a fifth rule limits how that price counts toward your other drug costs.
1. You need the right kind of Medicare drug coverage
The Bridge is only for people with Part D coverage, either through a stand-alone drug plan or a Medicare Advantage plan that includes drugs. Enrollees whose only coverage is a private fee-for-service plan, a cost plan or PACE (Program of All-Inclusive Care for the Elderly) are left out.
That matters during open enrollment, which ends Dec. 7. With Part D premiums climbing in 2027, some people may be tempted to drop drug coverage. Doing so also ends eligibility for the Bridge.
2. Your weight and health history must fit one of three profiles
Medicare uses body mass index, or BMI, plus certain conditions.
You qualify with a BMI of 35 or higher. A BMI of 30 or higher works if you also have certain types of heart failure, hard-to-control high blood pressure or chronic kidney disease at stage 3a or above. A BMI of 27 or higher works with prediabetes, or a prior heart attack, stroke or blocked arteries in the legs or arms.
Your doctor sends the prescription, the pharmacy confirms you have the right coverage, and then the doctor submits a form for Medicare approval. A letter from Medicare confirms you are in. Refills on the same drug do not need a new approval, even if the dose changes.
3. Diabetes, sleep apnea and fatty liver disease send you to your plan instead
People with type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease cannot use the Bridge. Medicare tells them to check with their drug plan, which may already cover a GLP-1 for those conditions.
Going through the plan means paying whatever the plan charges for that drug tier, which can differ sharply from $50. Even when Medicare negotiates a lower price, your copay may not drop.
4. Filling a GLP-1 through your plan first can shut the door
Anyone already getting semaglutide, tirzepatide, orforglipron, dulaglutide or liraglutide through a Medicare drug plan must keep getting it there. According to KFF, that includes people covered for a Medicare-approved use such as reducing cardiovascular risk or treating sleep apnea, who stay in their Part D plan rather than switching to the Bridge.
If you are just starting, ask your doctor which route applies before the first prescription goes out. Lilly USA President Ilya Yuffa told investors that about 80% of people treated under the Bridge had not been on this class of drugs before.
5. The $50 does not count toward your yearly limit
Bridge copays do not count toward your Part D deductible or your yearly out-of-pocket cap, which rises to $2,400 in 2027. The cost of these drugs also cannot be spread out over the year through the Medicare Prescription Payment Plan, which lets enrollees pay drug costs in monthly installments.
Extra Help, the federal program that lowers drug costs for people with limited income, does not reduce the Bridge copay either. At $50 a month, the drug costs $600 a year no matter what else you spend on prescriptions.
The $50 deal has an expiration date
The Bridge was first set to end Dec. 31, 2026, and now runs through Dec. 31, 2027. A broader plan to build similar pricing into Part D plans for 2027 did not go forward, and the government has not announced a replacement.
Ricks made clear where Lilly wants this to land, telling investors that “the right way to do that is put this into the Part D benefits.”
He added that he expects the company to work with drug plans on the 2028 calendar year. Nothing guarantees that happens, so anyone starting a GLP-1 under the Bridge should know the price is locked only through 2027.
If you do not qualify and are tempted by cheaper online versions, check whether the pharmacy making it is licensed first. You may also find other ways to pay less for medications Medicare does not fully cover.
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