The short answer changed in 2026. Federal law still excludes drugs used for weight loss from Medicare drug coverage, but since July 1, 2026 a temporary program called the Medicare GLP-1 Bridge has covered certain FDA-approved GLP-1 medicines for weight management, for a $50 monthly copay, if you meet its eligibility rules. Medicaid is different again: covering these drugs for obesity is optional, and each state decides. Compounded GLP-1s are not covered by either.
Here is how each piece works, as of October 2026.
Medicare: what the law excludes
Medicare Part D has never covered drugs used for weight loss. The exclusion is written into the law that defines a covered Part D drug, which borrows Medicaid’s list of drugs that may be excluded, including “agents when used for anorexia, weight loss, or weight gain” (42 U.S.C. 1396r-8(d)(2)(A)). In November 2024, CMS proposed reinterpreting that exclusion so obesity treatment could be covered. In April 2025 it announced it was not finalizing that proposal.
Medicare: what Part D does cover
The exclusion applies to weight loss as the use, not to the molecule. When a GLP-1 is prescribed for a different FDA-approved use, a Part D plan can cover it for that use. CMS lists type 2 diabetes, moderate to severe obstructive sleep apnea, and noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) as eligible for Part D coverage, and prescriptions to reduce the risk of major cardiovascular events also go to the Part D plan (CMS). Whether your particular plan covers a particular drug still depends on its formulary.
Medicare: the GLP-1 Bridge
The Medicare GLP-1 Bridge is a temporary CMS program that runs from July 1, 2026 to December 31, 2027. It covers three FDA-approved products for weight management: Foundayo (a tablet), Wegovy (injection or tablet) and Zepbound (the KwikPen only) (Medicare.gov).
What it costs. A $50 copay for a one-month supply. That copay does not count toward your Part D deductible or yearly out-of-pocket limit, and it cannot be lowered by Extra Help (CMS).
Who qualifies. You need Medicare drug coverage, you must be 18 or older, and you must meet one of three body mass index (BMI) thresholds (CMS):
- a BMI of 35 or more;
- a BMI of 30 or more with heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease (stage 3a or worse); or
- a BMI of 27 or more with prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease.
Who goes through regular Part D instead. If you have type 2 diabetes, moderate to severe sleep apnea or fatty liver disease, or your Part D plan already covers your GLP-1, the Bridge is not your route: those prescriptions go through your Part D plan.
How you get it. Your prescriber sends the prescription to a pharmacy, and the medication must be approved through prior authorization before it is covered. Which plan types take part is set out on Medicare.gov; check there, or call your plan, before assuming yours does.
Medicaid: it depends on your state
Medicaid programs must cover GLP-1s for medically accepted uses such as type 2 diabetes, but covering them for obesity is optional, and states decide for themselves. According to KFF, 13 state Medicaid programs covered GLP-1s for obesity under fee-for-service as of January 2026, and California, New Hampshire, Pennsylvania and South Carolina had eliminated that coverage since October 2025 (KFF, January 2026). Coverage has been changing quickly as states weigh the cost, so ask your state Medicaid program or your managed-care plan directly; each of our state pages also carries what we found for that state.
Compounded GLP-1s are not covered
Neither program covers compounded semaglutide or tirzepatide for weight loss. The Medicare exclusion applies to weight loss as the use, however the drug is made, and the Bridge covers only the three FDA-approved products named above. Compounded medications are not FDA-approved, and a compounded preparation is not a generic or an equivalent version of any branded product.
Where we fit
Gentle Health does not bill Medicare, Medicaid or private insurance. For compounded medication, everyone pays the same published monthly price, with the medication, physician care, visits, messaging and overnight refrigerated shipping included: semaglutide injections start at $135 a month and tirzepatide injections at $169. What that price covers, and what it commits you to, is set out in what a GLP-1 program’s monthly price includes. Our doctor also prescribes brand-name Zepbound, Wegovy and Foundayo for $28/month of doctor’s care, with the medicine bought separately through LillyDirect or NovoCare at a self-pay price; that route does not go through Medicare either.
If you are on Medicare and meet the Bridge criteria, a $50 copay for an FDA-approved product costs less than our monthly price, and it is worth asking your own doctor about first. If you do not qualify, or your state’s Medicaid program does not cover obesity treatment, the options when coverage says no are in what to do when insurance will not cover weight-loss medication.
Frequently asked questions
Does Medicare cover Wegovy or Zepbound for weight loss? Through the Medicare GLP-1 Bridge, yes, for eligible people: Wegovy (injection or tablet), Zepbound KwikPen and Foundayo, for a $50 monthly copay with prior authorization, from July 1, 2026 through December 31, 2027. Outside the Bridge, Part D still excludes drugs used for weight loss.
Who qualifies for the $50 Medicare GLP-1 copay? People 18 or older with Medicare drug coverage and a BMI of 35 or more, or 30 or more with certain heart, blood-pressure or kidney conditions, or 27 or more with prediabetes or certain cardiovascular history. People with type 2 diabetes, sleep apnea or fatty liver disease go through their regular Part D plan instead.
Does Medicaid cover GLP-1s for weight loss? Only in some states. Covering them for obesity is optional, and KFF counted 13 state programs doing so under fee-for-service as of January 2026. Ask your state program directly, because coverage has been changing.
Does Medicare or Medicaid cover compounded semaglutide or tirzepatide? No. Compounded GLP-1s are not FDA-approved, and the Medicare GLP-1 Bridge covers only specific FDA-approved products.
Can I use Gentle Health if I have Medicare? We do not bill Medicare, so you would pay our published monthly price yourself, the same as anyone else. If you qualify for the Bridge, compare that $50 copay first.
Dr. James Simmons, MD