Medicare, GLP-1 Bridge Program

Understanding the Medicare GLP-1 Bridge Program for Weight Management

If you are on Medicare and have struggled with weight for many years, you may be hearing about new medicines called GLP-1s.

What Is the Medicare GLP-1 Bridge Program?

The Medicare GLP-1 Bridge is a short-term demonstration program from the Centers for Medicare & Medicaid Services (CMS). It runs from July 1, 2026, through December 31, 2027, and operates outside the usual Medicare Part D rules (cms.gov). Its goal is to give eligible beneficiaries access to certain GLP-1 medicines for weight loss at a predictable cost while CMS studies how these drugs affect health and spending.

Under the Bridge, three medications are included when they are prescribed for weight management:

1- Foundayo® tablet

2- Wegovy® injection or tablet

3- Zepbound® KwikPen® but not its single-dose pens or vials (medicare.gov).

If you qualify, you pay a flat $50 per month for each covered GLP-1 prescription (medicare.gov). This is separate from your Part D plan:

• The $50 does not count toward your Part D deductible or out-of-pocket maximum.

• Extra Help, low-income subsidies, coupons, and the Medicare Prescription Payment Plan cannot reduce this amount.

Your provider will confirm BMI and medical history before requesting Bridge coverage.

Elegibility: You must be 18 or older and have Medicare Part D drug coverage. (medicare.gov). And have body mass index (BMI) of 35 or higher. or:

• Your BMI is 30 or higher and you have certain conditions such as heart failure, uncontrolled high blood pressure, or chronic kidney disease, or

• Your BMI is 27 or higher and you have prediabetes, a past heart attack or stroke, or symptomatic peripheral artery disease (medicare.gov).

You aren't eligible if you:

• Already get GLP-1 drugs covered through your Medicare Part D plan

• Have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (but your Part D plan might cover your GLP-1s).

How to Get Started

If you think you may qualify, schedule a visit with your primary care clinician or specialist. They will review your BMI. If appropriate, they can write a prescription and submit it to the Medicare GLP-1 Bridge.

For more information on plans or to review your options, please contact us for a FREE, confidential and personalized consultation.

Covered Arizona
Phone: (623) 396-5645
Email: [email protected] Web: www.coveredaz.com