Ask the plan about the product and its purpose.

Ask for the plan's decision process

• Does the plan cover this medicine for my treatment purpose?
• Does the prescriber need permission before the plan pays?
• What would I pay if permission is denied?

Keep in mind Prior authorisation is the plan's agreement that must come before payment.

As of September 26, 2026, Medicare could cover semaglutide for some non-weight treatment purposes, but each plan's medicine list and permission rules still applied.

Ask whether the Medicare Bridge fits

• Do I meet the age, weight, health and plan rules listed below?
• Who would send the request for the programme to approve payment?

Keep in mind At the September 26, 2026 check, Medicare had a temporary programme for certain weight medicines called the GLP-1 Bridge. GLP-1 is a group of medicines that act like a gut messenger involved in fullness and blood sugar. Semaglutide is in that group.

The scheduled programme dates were July 1, 2026 through December 31, 2027.

Eligible people paid $50 for each monthly supply.

For semaglutide (Wegovy), the Bridge included injections and tablets. Semaglutide (Ozempic) for weight loss was excluded.

The rules checked on September 26, 2026 required people to be at least 18 years old. The weight and health rules used BMI, a number worked out from height and weight, at the time this kind of treatment began.

One route required BMI of 35 or above.

Another route required BMI of 30 or above plus one of three health conditions. These were a specific kind of heart failure, high blood pressure that stayed too high despite treatment, or long-term kidney disease. Ask if your record lists heart failure with preserved ejection fraction or kidney disease that has reached stage 3a or above. These are the exact diagnosis names and kidney-disease level in the rules.

For this route, blood pressure had to stay above 140 for the upper reading or above 90 mm Hg for the lower reading, despite taking two blood-pressure medicines. These blood-pressure readings use the unit mm Hg.

A third route required BMI of 27 or above plus one of four health conditions. The conditions were pre-diabetes, meaning raised blood sugar before diabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease. That last name means disease in blood vessels away from the heart that is causing symptoms. Have the person providing your care confirm the diagnosis recorded for you.

To qualify, people needed either a separate Medicare drug plan or drug coverage within a Medicare Advantage plan that satisfied the programme's rules. A prescription and permission before payment were also required.

Treatment had to include ongoing planned help with food and physical activity.

Have your prescriber confirm the BMI and precise diagnosis recorded for you. Ask the plan to check your plan type. Being old enough does not settle the other rules.

Ask how exclusions and payments work

• Does my treatment purpose go through ordinary drug coverage instead?
• How does the programme payment affect my yearly spending?

Keep in mind Under the rules checked on September 26, 2026, type 2 diabetes, a blood-sugar condition, was excluded from the Bridge because it could go through ordinary Medicare drug coverage.

For 2026, the Bridge was unavailable to you if Medicare drug coverage had already covered the cost of any GLP-1 medicine for you that year. Ask the plan to check the names of medicines it paid for. Semaglutide products include Ozempic, Wegovy and Rybelsus; these examples are not the whole group.

The $50 payment for each month's Bridge supply was excluded when calculating the drug plan's annual limit on your own spending. Reaching that limit through other medicines did not remove the Bridge payment. There was no extra Bridge help for people with low incomes.

The Bridge also excluded moderate or severe obstructive sleep apnea, a named breathing problem during sleep. The liver exclusion covered MASH, a fatty-liver disease, when scarring was moderate to advanced and cirrhosis, meaning severe liver scarring, was absent. These conditions could use ordinary Medicare drug coverage. Ask the plan to check your exact diagnosis against the linked rules. A fatty-liver diagnosis alone did not rule you out.