Table of Contents
- What Is the Medicare GLP-1 Bridge?
- Which GLP-1 Medications Does the Program Cover?
- Who Is Eligible for the Medicare GLP-1 Bridge?
- How Much Does It Cost Beneficiaries?
- How Does the Prior Authorization Process Work?
- What Does This Mean for Providers and Pharmacies?
- What Comes Next After the Bridge?
What Is the Medicare GLP-1 Bridge?
The Centers for Medicare & Medicaid Services (CMS) launched the Medicare GLP-1 Bridge on July 1, 2026. This short-term demonstration program gives eligible Medicare Part D beneficiaries access to certain GLP-1 drugs between July 1, 2026, and December 31, 2027.
Notably, the program runs outside standard Medicare Part D. Part D sponsors carry no financial risk for eligible GLP-1 drugs furnished under the Bridge, and they do not need to opt in for their beneficiaries to access these medications. This design removes a major barrier that previously prevented seniors from obtaining these treatments through their existing plans.
CMS Administrator Dr. Mehmet Oz noted that these treatments represent a major medical advancement, yet too many seniors remain unable to access them due to high cost. The Medicare GLP-1 Bridge aims to change that by making these medications more affordable and accessible.
Background: Why the Bridge Was Created
For years, Medicare and Medicaid largely excluded GLP-1 medications for weight loss purposes. A statutory exclusion barred coverage of drugs used for weight loss or weight gain. The BALANCE Model — the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth program — was designed to close that gap, but it does not launch for Part D plan sponsors until January 2027. Therefore, CMS created the Bridge to give beneficiaries early access during the transition period.
Which GLP-1 Medications Does the Program Cover?
Covered Drugs Under the Bridge
At this time, eligible GLP-1 drugs under the Medicare GLP-1 Bridge include Foundayo®, Wegovy® (both injection and tablet formulations), and Zepbound® in the KwikPen® formulation only, when prescribed to reduce excess body weight and maintain weight reduction.
Providers and beneficiaries should be aware of one important limitation: the Zepbound single-dose vial and single-dose pen formulations are not eligible. Ozempic, Mounjaro, and other GLP-1s prescribed for type 2 diabetes, cardiovascular risk reduction, or sleep apnea remain under standard Part D coverage and are not part of the Bridge.
What the Bridge Does Not Cover
Type 2 diabetes, obstructive sleep apnea, and noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) indications remain eligible for Part D coverage. Beneficiaries with these diagnoses receive GLP-1s through their Part D plan and therefore cannot receive them through the Medicare GLP-1 Bridge, even if they otherwise meet the Bridge’s clinical criteria.
Who Is Eligible for the Medicare GLP-1 Bridge?
Plan Enrollment Requirements
To qualify, Medicare beneficiaries must be enrolled in a standalone prescription drug plan (PDP) or a Medicare Advantage coordinated care plan that offers prescription drug coverage in CY 2026. Part D beneficiaries in Special Needs Plans (SNPs), employer/union group waiver plans (EGWPs), and the Limited Income Newly Eligible Transition (LI NET) program are also eligible to participate.
Clinical Eligibility Criteria
Eligibility requires Part D enrollment plus a BMI of 35 or higher, or a BMI of 30 or higher with qualifying comorbidities, using baseline BMI at the time of GLP-1 therapy initiation as documented by prescriber attestation.
This matters for patients already on GLP-1 therapy. Eligible beneficiaries must meet the clinical criteria at the time of GLP-1 therapy initiation — including beneficiaries who began therapy prior to July 1, 2026. For example, if a beneficiary started GLP-1 therapy in September 2024 with a BMI of 37 and now has a BMI of 34, the prescribing provider should attest that the beneficiary met the BMI threshold at the time therapy began.
How Much Does It Cost Beneficiaries?
The $50 Monthly Copay
Eligible individuals enrolled in Medicare Part D prescription drug plans can access these medications at a predictable, affordable cost of $50 for a monthly supply.
However, that $50 works differently than standard Part D cost-sharing. The copay does not count toward the patient’s Part D out-of-pocket maximum. Because the Bridge sits outside standard Part D, it falls outside the patient’s $2,100 annual out-of-pocket cap in 2026.
A Note for Low-Income Subsidy Patients
For patients enrolled in the Low-Income Subsidy (LIS) program, LIS cost-sharing subsidies do not apply to Bridge claims. A patient who normally pays a few dollars or nothing for their medications under LIS will pay the full $50 Bridge copay. Providers should communicate this clearly to vulnerable patients before initiating Bridge prescriptions.
How Does the Prior Authorization Process Work?
Submitting Through the Central Processor
To access GLP-1 medications via the Medicare GLP-1 Bridge, an eligible beneficiary’s medical provider must submit a prior authorization request and a prescription for an eligible GLP-1 drug. Prior authorization requests are accepted electronically or by fax using the Medicare GLP-1 Bridge prior authorization form, and CMS strongly encourages electronic submission.
Who Handles Claims
CMS is using Humana — the current administrator of the Limited Income Newly Eligible Transition (LI NET) program — as the central processor for the Medicare GLP-1 Bridge. The LI NET infrastructure provides end-to-end operational capabilities and national scale to support broad access to GLP-1 drugs starting July 1, 2026.
What Does This Mean for Providers and Pharmacies?
Provider Responsibilities
Providers do not need to be enrolled in Medicare to write a prescription or submit a prior authorization. However, they must not appear on Medicare’s Preclusion List.
CMS adjudicates Bridge prescriptions outside pharmacy benefit managers and Part D plans via the central processor. Submitting claims through standard Part D pathways will generate rejections. Providers must route all Bridge-related prior authorizations directly to the central processor.
Pharmacy Participation
Pharmacies do not need to opt in — all pharmacies automatically participate. Pharmacies must use BIN 028918 and PCN MEDDGLP1BR. The $50 copay is collected at the counter, and the central processor reimburses the pharmacy at no less than wholesale acquisition cost, minus the copay, plus a dispensing fee and applicable sales tax.
What Comes Next After the Bridge?
The Road to the BALANCE Model
The Bridge acts as a transition to the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model, which starts in 2027. Part D sponsors are not involved in the Bridge’s operations or risks.
Furthermore, the Medicare GLP-1 Bridge allows CMS to collect additional data on GLP-1 utilization to share with Part D plan sponsors ahead of potential implementation of BALANCE in Part D. In this way, the Bridge is not just a coverage solution — it is also a data-gathering effort that will shape future Medicare drug policy for obesity treatment.
The Medicare GLP-1 Bridge builds on CMS’s broader efforts to improve access to innovative therapies and support healthier outcomes for Medicare beneficiaries. For millions of seniors who have waited years for affordable access to weight management medications, the Bridge represents a meaningful step forward.
