Translate the insurance terms
A plan calls its list of medicines it covers a formulary. Prior authorization is the plan's agreement in advance, given after it reviews the request.
- Ask whether the proposed product is on that list for your stated use.
- Ask what records are needed and who sends them.
- Ask what you would owe and whether the visit has a separate charge.
- Ask how a declined request would change your bill.
Check regular Medicare drug coverage first
As of September 26, 2026, Medicare's regular drug benefit, called Part D, does not pay for medicine used only for weight loss. Other accepted uses can qualify, including treatment of type 2 diabetes or a lower risk of heart attack and stroke for people who have both heart disease and excess weight.
- The plan still checks its medicine list and must approve the request in advance. A use that can qualify does not guarantee payment.
- Ask your plan which program can pay for the exact medicine and reason on your prescription.
Ask about a separate temporary Medicare program
The Medicare program guide names a separate temporary program: the Medicare GLP-1 Bridge. From July 1, 2026 through December 31, 2027, people who qualify pay $50 for each month's supply of medicine.
- As of September 26, 2026, the Bridge includes semaglutide (Wegovy) injections and tablets. Its health and plan rules decide who qualifies.
- The health rules use your age and BMI when treatment began. Height and weight are used to calculate the number called BMI. People must be at least 18. The weight rule can be met with a BMI of 35 or more, with no other listed illness needed.
- With a BMI of 30 or more, certain heart failure, blood pressure, or kidney conditions can qualify. People whose BMI is 27 or more can qualify with pre-diabetes, certain leg blood-flow problems, or a past stroke or heart attack.
- Ask the clinician to check your exact diagnosis against the program rules. Bring your age, height, weight, and records from when treatment began.
- People with type 2 diabetes use regular Medicare drug coverage instead of the Bridge, as of September 26, 2026. Certain sleep-breathing and liver illnesses, or a prescription to reduce heart attack and stroke risk, also go through regular coverage.
- In 2026, the Bridge is unavailable to anyone whose plan under Part D has already paid for a GLP-1 medicine in that same year.
- The Bridge accepts a Medicare Advantage coordinated care plan with drug coverage, or a Part D plan that covers medicines separately. A prescription and advance approval are needed, along with a continuing plan covering eating and physical activity.
- Ask your plan: is my type of plan included in the Medicare GLP-1 Bridge?
- Ask the clinician who will send the request for approval.
- The $50 paid for the Bridge is excluded from the yearly Part D limit on your own spending. Extra Help does not lower the Bridge payment, even for people with low incomes.