Will your plan help pay?

Start with your plan’s answer.

Tell your plan the medicine’s exact name and why your care professional is considering it. Ask for its answer in writing.

• Is the medicine on the plan’s covered-drug list?
• Does coverage depend on the condition it treats?
• Is approval needed before the prescription is filled?
• What would my share cost, and which pharmacy may fill it?

A formulary is the plan’s covered-drug list; prior authorization means the plan must agree in advance.

A yes to possible coverage is not a promise that this prescription will be paid.

Medicare’s usual drug benefit has limits.

As of September 26, 2026, Medicare Part D—the prescription-drug benefit—excludes drugs used only for weight loss.

For diabetes or another accepted use besides weight loss, the plan may cover that same medicine. Its covered-drug list and approval rules still apply.

Ask whether the proposed prescription belongs under your regular drug benefit or the temporary program below.

A specific program

There is a separate, temporary Medicare route.

As of September 26, 2026, eligible patients pay $50 for a monthly supply through the Medicare GLP-1 Bridge.

This temporary payment program covers certain weight medicines. The program starts July 1, 2026; its final day is December 31, 2027.

Eligibility requires an age of at least 18, plus a qualifying Part D drug plan or a Medicare Advantage plan that includes drug coverage. A prescription and approval in advance are required.

The health rules use BMI, a measure that compares weight with height, when this treatment began. Your doctor must check which of these groups you meet:

• BMI of 35 or higher.
• A BMI at or above 30, along with one of these conditions. These are heart failure with “preserved ejection fraction” in the diagnosis, hard-to-control high blood pressure, or kidney disease of stage 3a or later.
• A BMI at or above 27, along with one of these conditions. The qualifying conditions are pre-diabetes, a past heart attack or stroke, or artery disease causing symptoms in your arms or legs.

For the blood-pressure rule, two blood-pressure medicines must still leave the upper reading above 140 or the lower reading above 90.

Ask your doctor to confirm the diagnosis recorded for you, especially the heart-failure type or the kidney-disease stage.

For 2026, you cannot use the Bridge if you already received a medicine in this group through your Part D plan that year.

Treatment must also include a continuing plan for physical activity and food. Ask your drug plan whether your type of plan qualifies.

The regular Part D yearly cap limits what you pay yourself for covered medicines. The $50 Bridge payments are extra spending and do not bring you closer to that cap; coupons cannot reduce them.

There is no extra help based on low income for that payment under the Bridge.

Type 2 diabetes sends the prescription through regular Part D instead of the Bridge. The Bridge also excludes moderate or severe sleep apnea, and MASH, a specific liver disease, when its scarring is moderate or advanced.

The liver exclusion concerns MASH without cirrhosis, not every fatty-liver diagnosis. A prescription to reduce major heart or stroke problems also goes through regular Part D.

Ask separately about Medicaid and health spending accounts.

Ask your Wisconsin Medicaid plan about this exact prescription. A national announcement is not an answer about your own coverage.

BALANCE is a program in which CMS, the agency that runs Medicare and Medicaid, negotiates prices and coverage terms for weight medicines.

States, drug plans and drug makers choose whether to join. As of September 26, 2026, CMS had named no participating state, so that announcement did not establish Wisconsin Medicaid coverage.

An HSA (health savings account) and an FSA (flexible spending account) each let you pay eligible medical costs.

IRS tax guidance checked September 26, 2026, allows weight-loss expenses for treating a doctor-diagnosed disease, such as obesity, high blood pressure or heart disease.

For example, a weight-loss program to treat diagnosed obesity can qualify. Losing weight only to improve general health does not qualify, and diet food is not a deductible expense.

Ask the account administrator what paperwork it needs and whether this expense qualifies.