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Medicare GLP-1 Bridge Program
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New pathway for weight loss
medications (Effective July 1, 2026)
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The Centers for Medicare & Medicaid Services (CMS)
is introducing the Medicare GLP-1 Bridge Program. This temporary
demonstration model expands access for eligible Medicare Part D
beneficiaries to GLP-1 medications prescribed solely for weight loss.
The Medicare GLP-1 Bridge will operate outside of the
Medicare Part D program and payment flow. CMS will use a single
central processor to manage prior authorization, claims adjudication,
and payment to pharmacies for the Medicare GLP-1 Bridge.
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- Effective: July 1,
2026, through December 31, 2027
- Covered therapies: Wegovy®,
Foundayo®, Zepbound® (KwikPen)
- Patient cost: Flat
$50/month
- Administration: CMS central processor (not Part
D plans)
- Purpose: Provide
Medicare beneficiaries access to GLP-1 medications for weight
loss who do not have type 2 diabetes, moderate-to-severe
obstructive sleep apnea, or fatty liver disease (NASH).
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Provider responsibilities
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- Identify
appropriate candidates based on BMI and comorbid criteria
- Prescribe covered therapies and send the
prescription to the pharmacy (prior authorization process can
only be initiated after a rejected claim is processed at the
pharmacy)
- Wait for a prior authorization request from
the pharmacy
- Complete and submit the GLP-1 Bridge prior
authorization form to the CMS Bridge central processor (not the
plan)
- Encourage patients to fill prescriptions at
participating pharmacies
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You
are receiving this email because you are a provider contracted with
an Aspire Health Medicare Advantage or managed care commercial plan.
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Previous e-Newsletters
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Our mailing address is:
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