07/22/2026
๐ฆ๐๐ฎ๐ฟ๐๐ถ๐ป๐ด ๐๐๐น๐ ๐ญ, ๐ฎ๐ฌ๐ฎ๐ฒ, ๐๐ต๐ฒ ๐๐ฒ๐ป๐๐ฒ๐ฟ๐ ๐ณ๐ผ๐ฟ ๐ ๐ฒ๐ฑ๐ถ๐ฐ๐ฎ๐ฟ๐ฒ & ๐ ๐ฒ๐ฑ๐ถ๐ฐ๐ฎ๐ถ๐ฑ ๐ฆ๐ฒ๐ฟ๐๐ถ๐ฐ๐ฒ๐ (๐๐ ๐ฆ) ๐น๐ฎ๐๐ป๐ฐ๐ต๐ฒ๐ฑ ๐ฎ ๐๐ต๐ผ๐ฟ๐-๐๐ฒ๐ฟ๐บ ๐ฑ๐ฒ๐บ๐ผ๐ป๐๐๐ฟ๐ฎ๐๐ถ๐ผ๐ป ๐ฝ๐ฟ๐ผ๐ด๐ฟ๐ฎ๐บ ๐ฐ๐ฎ๐น๐น๐ฒ๐ฑ ๐๐ต๐ฒ ๐ ๐ฒ๐ฑ๐ถ๐ฐ๐ฎ๐ฟ๐ฒ ๐๐๐ฃ-๐ญ ๐๐ฟ๐ถ๐ฑ๐ด๐ฒ. ๐๐ ๐ด๐ถ๐๐ฒ๐ ๐ฒ๐น๐ถ๐ด๐ถ๐ฏ๐น๐ฒ ๐ฃ๐ฎ๐ฟ๐ ๐ ๐ฏ๐ฒ๐ป๐ฒ๐ณ๐ถ๐ฐ๐ถ๐ฎ๐ฟ๐ถ๐ฒ๐ ๐ฎ๐ฐ๐ฐ๐ฒ๐๐ ๐๐ผ ๐ฐ๐ฒ๐ฟ๐๐ฎ๐ถ๐ป ๐๐๐ฃ-๐ญ ๐ฑ๐ฟ๐๐ด๐ ๐ณ๐ผ๐ฟ ๐๐ฒ๐ถ๐ด๐ต๐ ๐น๐ผ๐๐ ๐ฎ๐ ๐ฎ ๐ฝ๐ฟ๐ฒ๐ฑ๐ถ๐ฐ๐๐ฎ๐ฏ๐น๐ฒ ๐บ๐ผ๐ป๐๐ต๐น๐ ๐ฐ๐ผ๐๐. ๐ง๐ต๐ถ๐ ๐ฎ๐ฟ๐๐ถ๐ฐ๐น๐ฒ ๐ฒ๐
๐ฝ๐น๐ฎ๐ถ๐ป๐ ๐๐ต๐ฒ ๐ฏ๐ฎ๐๐ถ๐ฐ๐ ๐ผ๐ณ ๐๐ต๐ฒ ๐ฝ๐ฟ๐ผ๐ด๐ฟ๐ฎ๐บ, ๐๐ต๐ฎ๐ ๐ถ๐ ๐ฐ๐ผ๐๐ฒ๐ฟ๐, ๐๐ต๐ผ ๐พ๐๐ฎ๐น๐ถ๐ณ๐ถ๐ฒ๐, ๐ฎ๐ป๐ฑ ๐ต๐ผ๐ ๐ถ๐ ๐ฑ๐ถ๐ณ๐ณ๐ฒ๐ฟ๐ ๐ณ๐ฟ๐ผ๐บ ๐๐๐ฎ๐ป๐ฑ๐ฎ๐ฟ๐ฑ ๐ฃ๐ฎ๐ฟ๐ ๐ ๐ฐ๐ผ๐๐ฒ๐ฟ๐ฎ๐ด๐ฒ.
๐ช๐ต๐ฎ๐ ๐๐ ๐๐ต๐ฒ ๐ ๐ฒ๐ฑ๐ถ๐ฐ๐ฎ๐ฟ๐ฒ ๐๐๐ฃ-๐ญ ๐๐ฟ๐ถ๐ฑ๐ด๐ฒ ๐ฃ๐ฟ๐ผ๐ด๐ฟ๐ฎ๐บ?
The Medicare GLP-1 Bridge is a temporary demonstration program run by CMS. It runs from July 1, 2026, through December 31, 2027. The program operates outside the standard Medicare Part D benefit, using a central processor managed by CMS to handle prior authorization, claims, and payments. Part D sponsors do not need to opt in for their beneficiaries to access Bridge drugs. The program was created to fill a gap after the BALANCE Model, originally planned for 2027, was delayed indefinitely.
๐ช๐ต๐ถ๐ฐ๐ต ๐๐ฟ๐๐ด๐ ๐๐ฟ๐ฒ ๐๐ผ๐๐ฒ๐ฟ๐ฒ๐ฑ?
The Bridge covers a limited set of GLP-1 medications for weight loss. Covered drugs include Wegovy (injections and tablets), Zepbound (KwikPen only), and Foundayo (tablet). Other GLP-1 drugs or formulations, such as Zepbound single-dose pens or vials, are not included. The program does not cover GLP-1s for indications like type 2 diabetes or sleep apnea; those should be obtained through a beneficiaryโs regular Part D plan.
๐ช๐ต๐ผ ๐ถ๐ ๐๐น๐ถ๐ด๐ถ๐ฏ๐น๐ฒ?
To qualify, you must be 18 or older and enrolled in Medicare Part D, either through a stand-alone plan or a Medicare Advantage Prescription Drug (MA-PD) plan. You must also meet specific body mass index (BMI) and health criteria. For example, you may qualify if you have a BMI of 35 or higher, a BMI of 30 or higher with heart failure, uncontrolled hypertension, or chronic kidney disease, or a BMI of 27 or higher with prediabetes, a history of heart attack, or peripheral artery disease. Beneficiaries with type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease are not eligible through the Bridge, those conditions are treated through standard Part D coverage. According to the Kaiser Family Foundation, nearly four million Medicare beneficiaries met the eligibility criteria in 2023.
๐๐ผ๐ ๐ ๐๐ฐ๐ต ๐๐ผ๐ฒ๐ ๐๐ ๐๐ผ๐๐?
Eligible beneficiaries pay a fixed $50 copay per month for covered drugs. The total monthly cost of these drugs is $245, with the beneficiaryโs share held at $50. This $50 copay does not count toward the Part D deductible or out-of-pocket limit. Low-income subsidy (Extra Help) cannot be applied to Bridge costs. Standard Part D cost-sharing (deductible, coinsurance, coverage gap) does not apply to drugs obtained through the Bridge.
๐๐ผ๐ ๐๐ผ ๐ฌ๐ผ๐ ๐๐ป๐ฟ๐ผ๐น๐น?
Enrollment requires prior authorization from the Bridge program. Your doctor must submit a prior authorization form to Medicare for approval. Once approved, the central processor manages the claim and payment. The program does not require re-authorization for dose changes as long as the same drug is used. Beneficiaries currently receiving GLP-1s through Part D for non-weight-loss indications should continue using their Part D plan and cannot switch to the Bridge for those drugs.
๐๐ผ๐ ๐๐ผ๐ฒ๐ ๐๐ ๐๐ถ๐ณ๐ณ๐ฒ๐ฟ ๐ณ๐ฟ๐ผ๐บ ๐ฃ๐ฎ๐ฟ๐ ๐ ๐๐ผ๐๐ฒ๐ฟ๐ฎ๐ด๐ฒ?
The Bridge operates entirely outside the Part D benefit. Drugs covered under the Bridge are not subject to Part D deductibles or the coverage gap, and they do not count toward your true out-of-pocket (TrOOP) costs. The fixed $50 copay is the same regardless of income. Prior authorization is handled directly by Medicare through a central processor, not by the Part D plan. This streamlined approach ensures predictable pricing and removes plan-level variability.
๐ง๐ต๐ฒ ๐๐ฟ๐ถ๐ฑ๐ด๐ฒ ๐๐. ๐๐ต๐ฒ ๐๐๐๐๐ก๐๐ ๐ ๐ผ๐ฑ๐ฒ๐น
The BALANCE Model was a proposed CMS program that would have allowed Part D plans to voluntarily opt in to cover GLP-1 drugs for weight loss. It was originally scheduled to start in 2027 but has been delayed indefinitely. The Bridge demonstration was extended through December 31, 2027, to fill this gap. Unlike the planned BALANCE Model, the Bridge is mandatory for all eligible beneficiaries, there is no plan opt-in required.
Can I use Extra Help to pay the $50 copay?
No. Low-income subsidy (Extra Help) cannot be applied to the GLP-1 Bridge copay. The $50 monthly amount is fixed for all eligible beneficiaries, and it does not count toward your Part D out-of-pocket limit or deductible.
๐ช๐ต๐ฎ๐ ๐ต๐ฎ๐ฝ๐ฝ๐ฒ๐ป๐ ๐ฎ๐ณ๐๐ฒ๐ฟ ๐๐ฒ๐ฐ๐ฒ๐บ๐ฏ๐ฒ๐ฟ ๐ฏ๐ญ, ๐ฎ๐ฌ๐ฎ๐ณ?
The Bridge demonstration ends on that date. CMS has not announced a permanent replacement beyond the delayed BALANCE Model. Beneficiaries should watch for updates from Medicare about future coverage options for weight loss drugs.
Will my Part D plan cover GLP-1s for weight loss if I donโt use the Bridge?
Standard Part D plans cannot cover drugs used solely for weight loss unless they are approved for another medical condition. The Bridge demonstration is currently the only way for eligible beneficiaries to get Wegovy, Zepbound, or Foundayo for weight loss under Medicare.
๐๐ผ ๐ ๐ป๐ฒ๐ฒ๐ฑ ๐๐ผ ๐ป๐ผ๐๐ถ๐ณ๐ ๐บ๐ ๐ฃ๐ฎ๐ฟ๐ ๐ ๐ฝ๐น๐ฎ๐ป ๐ฏ๐ฒ๐ณ๐ผ๐ฟ๐ฒ ๐๐๐ถ๐ป๐ด ๐๐ต๐ฒ ๐๐ฟ๐ถ๐ฑ๐ด๐ฒ?
No. Part D sponsors do not need to opt in for beneficiaries to access Bridge drugs. You simply work with your doctor to submit the prior authorization to Medicare. Your Part D plan remains unchanged for your other medications.
The Medicare GLP-1 Bridge Program offers a straightforward path to affordable weight loss medication for eligible beneficiaries through December 2027. If you think you may qualify, talk to your doctor about the prior authorization process. For official details, visit CMS.gov or Medicare.gov.
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