Medicare’s $50 GLP-1s skip TFL
You need Part D to get it.
Open Enrollment ends December 7. TRICARE says TFL users can also join Part D through a special enrollment period.
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1. What the Bridge is
The Medicare GLP-1 Bridge is a CMS demonstration that runs from July 1, 2026 to December 31, 2027. If you qualify, you pay a flat $50 copay for certain GLP-1 drugs prescribed for weight loss.
| Rule | What it means |
|---|---|
| Covered drugs | Wegovy (injection and tablets), Zepbound KwikPen, Foundayo |
| Your cost | $50 copay; no Part D deductible |
| Out-of-pocket cap | The $50 does not count toward it |
| Extra Help | Does not lower the $50 |
| Approval | Prior authorization through one CMS processor |
| Who can use it | Part D enrollees only |
Zepbound vials and the single-dose pen are not part of it, only the KwikPen. What happens after 2027 is not settled.
2. Why TRICARE For Life users are left out
The Bridge runs through Part D. Most TRICARE For Life users don’t have Part D; they get drugs through the TRICARE pharmacy program, which TRICARE says is creditable coverage. So they don’t qualify.
TRICARE won’t fill the gap either. Since August 31, 2025, TRICARE doesn’t cover weight-loss drugs for TRICARE For Life beneficiaries. TRICARE Prime and Select users can still get them with prior authorization. GLP-1s prescribed for type 2 diabetes are a separate question and depend on the diagnosis.
MOAA is pressing Congress and the Defense Health Agency to restore TFL coverage, and a retired Air Force colonel has sued over the 2025 change. Neither has changed the rule yet.
3. Who medically qualifies
You must be 18 or older and meet one of these, measured when you started the drug:
- BMI 35 or higher.
- BMI 30 or higher plus heart failure with preserved ejection fraction, uncontrolled high blood pressure, or stage 3a or worse kidney disease.
- BMI 27 or higher plus prediabetes, a prior heart attack, a prior stroke, or symptomatic peripheral artery disease.
Prescribed for type 2 diabetes, sleep apnea, liver disease (MASH) or to cut heart-attack risk? That goes through your regular Part D plan at the plan’s price, not the Bridge.
4. The Part D decision for TFL users
You can add a Part D plan during Medicare Open Enrollment, October 15 to December 7, 2026. It starts January 1, 2027, which leaves 12 months of the Bridge. TRICARE says its pharmacy coverage also makes you eligible for a special enrollment period, so you can join Part D at other times. Ask Medicare (1-800-MEDICARE) how early your coverage can start.
- No late penalty. TRICARE pharmacy coverage is creditable, so joining Part D now or later carries no penalty.
- You keep TRICARE. With both, Part D pays first and TRICARE pays last.
- You pay a premium. Part D premiums vary by plan. Higher incomes add IRMAA on top.
- Do the math. Twelve months of Part D premium plus $600 in copays, compared with what you pay for the drug now.
Medicare Advantage plans with drug coverage also qualify, but they change how your care works. Read Medicare vs. Medicare Advantage first. TRICARE says joining a Medicare Advantage plan does not end TFL.
5. Federal retirees in FEHB
Many FEHB plans offer Medicare drug coverage through an employer group Part D plan (EGWP) and enroll eligible annuitants automatically. CMS lists EGWPs as eligible for the Bridge. If you have Medicare and your FEHB plan’s Part D, you may already qualify.
Check your plan’s brochure or call the carrier. How FEHB handles weight-loss drugs on its own is covered in GLP-1 coverage in FEHB. Retirees with both TRICARE For Life and FEHB should read TRICARE For Life and FEHB.
6. What to do now
- Ask your doctor whether you meet the BMI and health criteria above.
- Compare Part D plans on Medicare.gov using your current drug list. See Part D prescription drug coverage.
- Count the total: premium plus copays for 2027, against your cost today.
- Enroll by December 7 for a January 1 start, or ask about the special enrollment period. Then your doctor requests prior authorization.
More on the fall deadlines in Medicare Open Season decisions. For other TRICARE choices, see TRICARE Prime, Select and For Life.
Comparing health plans this fall? Warrior Insure on TRICARE and FEHB and its 2027 Open Season guide walk through the plans. Still working for the government? Federal Warrior’s FEHB comparison tool helps you pick. On a tight budget? Warrior Disability explains Extra Help, which lowers other drug costs but not the $50 Bridge copay.
7. Frequently asked questions
What is the Medicare GLP-1 Bridge?
A CMS demonstration that runs from July 1, 2026 to December 31, 2027. Eligible Medicare Part D enrollees pay a flat $50 copay for certain weight-loss GLP-1 drugs: Wegovy (injection and tablets), the Zepbound KwikPen and Foundayo. The Part D deductible does not apply, the copay does not count toward the Part D out-of-pocket cap, and Extra Help does not lower it.
Why are TRICARE For Life users excluded?
The Bridge runs through Part D plans, and most TRICARE For Life users get their drugs through the TRICARE pharmacy program instead of a Part D plan. TRICARE itself stopped covering weight-loss drugs for TRICARE For Life beneficiaries in 2025, so they are left with neither.
Can a TRICARE For Life user join Part D to get the Bridge?
Yes. Medicare Open Enrollment runs October 15 to December 7, 2026, and a Part D plan chosen then starts January 1, 2027. TRICARE says its pharmacy coverage also makes you eligible for a special enrollment period to join Part D at other times. TRICARE pharmacy coverage counts as creditable coverage, so there is no late-enrollment penalty for joining now. With both, Part D pays first and TRICARE pays last. You pay the Part D premium, plus IRMAA if your income is high.
Do federal retirees in FEHB qualify?
Often, yes. FEHB plans that offer Medicare drug benefits enroll eligible annuitants automatically, and CMS lists these employer group Part D plans (EGWPs) as eligible for the Bridge. You still need to meet the medical criteria and get prior authorization.
Who medically qualifies?
Adults whose BMI was 35 or higher when they started the drug; or 30 or higher with heart failure with preserved ejection fraction, uncontrolled high blood pressure or stage 3a or worse kidney disease; or 27 or higher with prediabetes, a prior heart attack, a prior stroke or symptomatic peripheral artery disease. GLP-1s for type 2 diabetes or sleep apnea stay under your regular Part D plan.
- CMS, Medicare GLP-1 Bridge
- CMS, GLP-1 Bridge information for providers (criteria and drugs)
- TRICARE, prescription weight loss drugs (updated Oct 1, 2026)
- TRICARE, Medicare Part D and TRICARE pharmacy coverage
- TRICARE, Medicare Advantage and TRICARE For Life
- OPM, Medicare and FEHB drug benefits
- Military.com, Pentagon drops GLP-1 weight-loss coverage for Medicare-eligible retirees (Aug 2025)
- MOAA, Legal case seeking GLP-1 TRICARE For Life reversal
- MOAA, New Medicare GLP-1 program excludes TRICARE For Life beneficiaries
This page explains coverage rules and costs. It is not medical advice. Decisions about treatment belong with you and your doctor; confirm coverage with your plan.