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3.8M qualify for Medicare GLP-1 Bridge at program's July start

With 3.8M Medicare enrollees qualifying for the GLP-1 Bridge, the program could lay the groundwork for future payment models for the weight loss drugs.

Jacqueline LaPointe
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Published: 01 Jul 2026

Millions of older adults could qualify for a GLP-1 for weight loss under a Medicare program launching today, according to new data from KFF.

CMS has kicked off the Medicare GLP-1 Bridge, a temporary model that will provide GLP-1 coverage for weight loss and management to certain Medicare beneficiaries in a Part D plan. Those who qualify will pay just $50 a month for either Wegovy, Zepbound or Foundayo based on their BMI (35 or more) alone or their BMI with other conditions, such as uncontrolled hypertension, pre-diabetes and late-stage chronic kidney disease.

Beneficiaries must also not have filled a prescription for a GLP-1 under their Part D plan in 2026 or otherwise qualify for GLP-1 coverage for a medically accepted indication.

CMS anticipates "single-digits" millions of beneficiaries to qualify under Bridge. KFF used 2023 Medicare claims data to provide a more exact estimate of just how many seniors could take part in the anticipated program over the next year.

Based on the 2023 data, KFF found that 9.7 million Medicare Part D enrollees met the clinical criteria for Bridge at the time. However, they said less than half of this group -- 3.8 million, or 39% -- would be eligible for Bridge now.

Researchers explained that these enrollees met the clinical criteria. They also did not have a claims-based diagnosis of type 2 diabetes, obstructive sleep apnea or metabolic dysfunction-associated steatohepatitis nor a GLP-1 prescription covered by their Part D plan in 2023.

Assuming no changes to their diagnoses now, these enrollees could be eligible for a GLP-1, KFF said.

What eligibility numbers mean for Medicare GLP-1 coverage

How many older adults qualify for expanded coverage of GLP-1s is key to Bridge's success and potentially longer-term coverage of the drugs in Medicare.

Currently, Medicare is prohibited by federal law from covering drugs for weight loss. But new indications for the popular drugs prompted CMS to develop a program through its Innovation Center to expand affordable access to GLP-1s in Medicare Part D and Medicaid.

That program, announced in 2025, is the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth, or BALANCE, Model. CMS also announced Bridge at that time as a short-term model to help enrollees access the drugs sooner at more affordable prices.

However, CMS benched the Part D component of BALANCE in April, stopping it from moving forward as planned in January 2027. CMS had wanted at least 80% of Part D sponsors to participate, but payers raised concerns about the financial risk around long-term coverage of GLP-1s for obesity.

Major insurers, including UnitedHealthcare and Aetna, opted out of BALANCE, although UnitedHealthcare said in its earnings call this spring that it would participate in Bridge this summer.

Bridge is shorter-term model, slated to run through December 2027, which would allow CMS and payers to generate real-world utilization data that could sway coverage decisions in the future.

After all, a primary concern among payers has been Part D budgets, which would grow with expanded coverage and likely increase premiums across the board. Part D sponsors will not carry risk for eligible GLP-1 drugs covered by Bridge, though, CMS explains on its website.

The demonstration model could also build the case for lawmakers to permanently extend coverage for seniors if the use of GLP-1s demonstrates cost-effectiveness and quality-of-life improvements.

KFF estimated in its latest analysis that Bridge would cost Medicare $1.3 billion to $3.3 billion if 10-25% of the nearly 4 million eligible enrollees participate when the program launches in July 2026 and fill a prescription each month for the program's 18-month duration.

Medicare's costs could soar to $10 billion if the participation rate reaches 75%, KFF added.

But the final tally will also depend on participants' drug adherence, which real-world studies have shown to be surprisingly low at just 20-35% of patients remaining consistently adherent by one year.

Costs could also be offset over time by savings from participants' health improvements, KFF stated.

Jacqueline LaPointe is an Executive Editor at Xtelligent Healthcare Media, covering revenue cycle management, healthcare payers, health policy and health IT since 2016.

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