For years, the rule has been absolute: Medicare does not pay for weight loss. If you wanted Wegovy or Zepbound to shed pounds rather than treat diabetes, you were on your own, facing a monthly bill of $1,000 or more.

That rule technically still exists, but a massive exception is about to punch a hole right through it.

Starting this summer, a new federal initiative—often branded as “TrumpRx” but officially known as the GLP-1 Payment Demonstration—will allow specific Medicare Part D plans to cover these drugs with a strict copay cap. If you play your cards right, the medication that used to cost a fortune could drop to just $50 a month by July.

But there is a catch. This isn’t an automatic rollout for everyone. It is a “voluntary model,” which means you need to verify your eligibility and potentially pre-register with your doctor now to access the pricing when the window opens.

The ‘TrumpRx’ timeline explained

The government’s plan is actually split into two phases, and knowing the difference prevents you from showing up at the pharmacy too early.

1. The Bridge (Starts July 2026): Because the full program takes time to set up, CMS is launching a temporary “bridge” demonstration in July. This is the “loophole” that matters right now. It allows Medicare beneficiaries in participating plans to get GLP-1 drugs for a capped $50 copay, even before the official model fully kicks in.

2. The BALANCE Model (Starts January 2027): The comprehensive program, known as the BALANCE Model, officially integrates into Medicare Part D plans starting Jan. 1, 2027. This is when the coverage becomes a standard part of plan offerings rather than a special demonstration.

Why you might miss out

The “voluntary” part of this model is where people will get burned. Because this is a pilot program, not every insurance carrier is required to participate in the July bridge phase.

According to details released by CMS, participation is optional for Part D sponsors. If your specific plan decides the administrative burden isn’t worth it, they might not offer the $50 rates until the mandatory changes or broader adoption in 2027.

How to lock in your eligibility

You cannot simply walk into CVS in July and demand the $50 rate. You need to lay the groundwork now.

1. Check your plan’s participation status: Call the customer service number on the back of your Medicare Part D or Medicare Advantage card. Do not ask “do you cover Ozempic?”—the answer will likely be “no” based on the old rules. Ask specifically: “Is this plan participating in the CMS GLP-1 Payment Demonstration starting in July?” If your current provider isn’t participating, you may need to look into how Medicare drug plans are changing to find one that is for the next open enrollment.

2. Get the specific diagnosis code: The coverage under TrumpRx/BALANCE is often tied to “obesity with comorbidities.” Your doctor needs to document not just your BMI, but the related conditions—like hypertension, pre-diabetes, or high cholesterol—that justify the prescription under the “comprehensive health” label of the model.

3. Watch for the portal: As part of the initiative, a new pricing portal (“TrumpRx”) is expected to launch for direct purchasing. Keep an eye on Medicare.gov updates this spring, as the portal may offer cash-pay discounts (~$350/month) even before your insurance copay kicks in.

The bottom line

We have spent years telling you that Medicare won’t save you from the high cost of weight loss drugs. Come July, that advice changes.

The drugs are the same, but the mechanism for paying for them is shifting. If you can navigate the paperwork of this new model, you could save over $11,000 a year. If you ignore it, you will keep paying full price.