Two different programs, easy to confuse

In 2026 you will hear about two separate Medicare GLP-1 efforts. They are not the same thing, and mixing them up leads to a lot of confusion at the pharmacy counter.

The Medicare GLP-1 Bridge

The Bridge is a time-limited demonstration that runs July 1, 2026 through December 31, 2027. It gives eligible Part D members a flat $50-per-month copay for weight-management GLP-1s: Wegovy, the Zepbound KwikPen, and Foundayo. Your doctor submits a prior authorization to CMS, and the $50 does not count toward your deductible or your annual out-of-pocket cap. It does not cover Ozempic or Mounjaro. See which drugs the Bridge covers.

The BALANCE Model

The BALANCE Model is a broader, longer-running effort to expand GLP-1 access across Medicare and Medicaid, including the diabetes GLP-1s like Ozempic and Mounjaro. Rather than a single flat copay for weight-loss drugs, it works through participating plans and is aimed at improving access and managing cost over a longer horizon.

Side by side

  • Who runs it: Bridge — a central CMS demonstration. BALANCE — a model that works through plans across Medicare and Medicaid.
  • What it covers: Bridge — weight-loss drugs (Wegovy, Zepbound KwikPen, Foundayo). BALANCE — a broader set of GLP-1s, including diabetes brands.
  • Your cost: Bridge — a flat $50/month if eligible. BALANCE — depends on your plan.
  • Timeline: Bridge — July 1, 2026 to December 31, 2027. BALANCE — a longer-running model.

Which one applies to you?

  • Want a weight-loss GLP-1 at a predictable price? The Bridge is the one to ask about — check if you qualify.
  • Taking a GLP-1 for diabetes, or curious about broader access? That is where the BALANCE Model and your plan's regular coverage come in.

Program details can change. Always verify the current rules at Medicare.gov or CMS.gov, and confirm specifics with your own plan.