Covered for what, and under which plan?

As of September 26, 2026, Medicare drug coverage could include semaglutide for certain approved diabetes, heart or liver uses.

The plan’s drug list still matters. So does any approval the plan requires before it pays.

This advance approval is called prior authorization.

Give the plan the exact medicine name and the health problem it would treat. Ask what information the prescriber needs to send.

As of September 26, 2026, eligible people in the Medicare GLP-1 Bridge paid $50 for a monthly supply of covered weight medicines.

GLP-1 is the gut hormone copied by semaglutide; Bridge is the name of this temporary Medicare program.

The published start was July 1, 2026. The end was December 31, 2027.

Semaglutide (Wegovy injection and tablets) was included for weight use; semaglutide (Ozempic) for weight use was not, as of September 26, 2026.

Patients had to be 18 or older under the Bridge rules reviewed September 26, 2026.

BMI is calculated from a person’s height and weight. The weight rules use this number.

The program checks weight and health at the time GLP-1 treatment began.

Ask the prescriber for your BMI and which of the following weight and health rules fits your record.

A BMI of 35 or higher meets the program’s weight rule.

A BMI of 30 or higher can meet the rule with certain health problems. These are the named heart-failure type, high blood pressure despite treatment, or kidney disease at stage 3a or higher.

The heart-failure type is called “preserved ejection fraction.” Ask the doctor if your record names that type.

The blood-pressure rule applies when two blood-pressure medicines still leave the top reading above 140 or the bottom reading above 90 mm Hg.

The letters mm Hg name the unit used to measure blood pressure. For kidney disease, ask the doctor which stage is in your record.

A BMI of 27 or higher can meet the rule when certain health problems are present. These are pre-diabetes, a previous heart attack or stroke, or artery disease with arm or leg symptoms.

With pre-diabetes, blood sugar is above the normal range. It is still below the range for diabetes.

A separate Medicare Part D drug plan can qualify. So can a Medicare Advantage “coordinated care plan” that manages medical care and includes drug coverage.

Have the plan check whether your particular type of plan allows use of this program.

A prescription and the program’s approval before payment are required. Treatment must include planned help with food and physical activity.

You could not use the Bridge in 2026 if a Medicare drug plan had paid for your GLP-1 medicine during that year.

People with type 2 diabetes were routed to ordinary Medicare drug coverage rather than the Bridge under those rules.

These are starting checks. Other health and plan rules can affect whether you qualify. Ask the plan and prescriber to check all the rules for you.

Bridge payments did not help you reach the yearly limit in your Medicare drug plan. These were the rules checked September 26, 2026.

That limit caps your share of covered medicine costs.

For example, twelve monthly Bridge payments of $50 would cost $600. None of that $600 would help you reach your drug plan’s yearly limit.

Ask the plan to show your expected Bridge payments beside your other medicine costs.