Employers Pepsi, Starbucks and Cigna Are Dropping GLP-1 Coverage. At 65, Medicare May Cover Zepbound for Sleep Apnea or Wegovy for Heart Risk, With Part D Spending Capped at $2,400 in 2027

PepsiCo (NASDAQ:PEP | PEP Price Prediction) wrote to employees that prescription weight loss drugs “have become one of the fastest-growing costs in the PepsiCo Plans” and then dropped coverage, keeping it only for diabetes. Cigna (NYSE:CI) stopped covering GLP-1s for weight loss in its own employee plan on July 1. Starbucks (NASDAQ:SBUX) ended coverage for eligible employees in October.

Consider a hypothetical 65-year-old who lost employer coverage for Zepbound and is comparing Medicare drug plans during open enrollment, which runs October 15 through December 7. Her diagnosis now matters as much as her prescription. Medicare may cover the drug through Part D for certain medical conditions, while eligible patients seeking treatment for weight management have a separate $50 monthly option.

Your Diagnosis Could Determine Whether Medicare Pays

A 2003 federal law bars Part D from covering drugs prescribed for weight loss alone. Part D can cover GLP-1s for other approved medical uses. Wegovy qualifies for cardiovascular risk reduction in adults with established heart disease who are overweight or obese. Zepbound can be covered for moderate-to-severe obstructive sleep apnea in adults with obesity. Coverage still depends on the plan’s rules, and a prescription for weight loss alone generally isn’t covered through regular Part D.

Plan rules still apply. Each plan sets its own formulary tier and can require prior authorization to confirm the diagnosis. These claims count toward the Part D out-of-pocket threshold, which rises to $2,400 in 2027 from $2,100 in 2026. The maximum deductible climbs to $700 from $615. Once you reach the threshold, you pay nothing for covered Part D drugs for the rest of the year.

A $50 Bridge for Weight Loss, Ending December 2027

The Centers for Medicare & Medicaid Services (CMS) launched the Medicare GLP-1 Bridge in July 2026 and extended it through December 2027 after delaying its longer-term BALANCE program. The Bridge charges a flat $50 per prescription, or $600 a year, for Wegovy (injection or tablets), Foundayo or the Zepbound KwikPen. Zepbound vials and single-dose pens are excluded.

To qualify, you generally need Part D coverage, must meet one of the following medical criteria when treatment begins, and cannot already qualify for regular Part D coverage of a GLP-1:

• BMI of 35 or higher, with no other condition
• BMI of 30 or higher plus heart failure with preserved ejection fraction, uncontrolled hypertension or stage 3a or worse kidney disease
• BMI of 27 or higher plus prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease

People with type 2 diabetes, moderate-to-severe sleep apnea or certain forms of advanced fatty liver disease are excluded from the Bridge, even if their Part D plan doesn’t cover the prescribed GLP-1. Those conditions may qualify for coverage through regular Part D instead.

Bridge Payments Never Touch Your $2,400 Cap

Bridge copays do not count toward the Part D deductible or the annual out-of-pocket cap, and Extra Help cannot pay them.

The Bridge offers predictable costs of $50 a month, or $600 a year. Regular Part D works differently: what you pay depends on the drug, your plan and other prescriptions, with covered out-of-pocket spending capped at $2,400 in 2027. Because eligibility differs between the two programs, the $600 and $2,400 figures aren’t necessarily competing prices for the same patient. Once someone reaches the Part D spending cap, covered prescriptions cost nothing for the rest of the year. Bridge copays remain separate and don’t count toward that limit.

Higher earners also owe a Part D income surcharge on top of the plan premium. In 2026 it starts at $14.50 a month for those filing individually above $109,000, and only about 8% of Part D enrollees pay it. That IRMAA surcharge is one of several premium traps tied to income from two years ago, which we mapped out alongside the rest in a free guide to Medicare’s hidden bills.

The Bridge also has an end date. Coverage after December 31, 2027 is not guaranteed, and many people regain weight after they stop. Without coverage, these drugs can cost more than $1,000 per month out of pocket.

Three Checks to Make Before December 7

1. Match the prescription to your records. If you have moderate-to-severe sleep apnea or established cardiovascular disease, ask your doctor whether Zepbound or Wegovy is approved for your condition. Confirm that your Part D plan covers the drug and check whether prior authorization is required.
2. Compare 2027 formularies before you let your plan renew. For every plan you consider, check the Wegovy and Zepbound tier and prior authorization rules. Plans change formularies every year, and your choice takes effect January 1, 2027.
3. Check your Bridge eligibility. Confirm that your medication and formulation qualify, and ask your prescriber about prior authorization. Remember that the temporary program ends December 31, 2027, so coverage beyond that date remains uncertain.

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