WEight Loss ONly program
Begins 7/1/2026
Speak with your Doctor, you must meet program criteria
See Next Steps Below
Medicare GLP-1 Bridge Program update for weight loss medication
We now have more information about the new Medicare GLP-1 Bridge Program that begins July 1, 2026.
One of the biggest updates is that CMS has released the Prior Authorization (PA) form that providers will need to complete for eligible patients. This is a separate and distinct Program! Not part of Part D nor MedAdvantage (MAPD) while in the bridge phase. However, you must be enrolled in a PDP or MAPD
WHAT DOES THIS MEAN?
If you’re interested in a GLP-1 weight loss medication through this program, your next step is talking with your doctor.
Your doctor will determine whether you meet the medical requirements and complete the required Prior Authorization documentation.
The medication cannot simply be prescribed and filled—you must meet the program criteria and have an approved prior authorization.
There are 3 Covered Medications at this point: Wegovy (Semaglutide -injection or oral tablet), Zepbound (Tirzepatide – KwikPen only), and Foundayo (oral GLP-1)
Because the GLP-1 Bridge is exclusively a Medicare Part D demonstration program, participants must be enrolled in a Medicare prescription drug plan to take advantage of the $50 monthly copay. Unless you are receiving Social Security Disability Insurance (SSDI) and have passed the 24-month waiting period, you cannot access Medicare at 62.
Other things we know:
To QUALIFY for the Medicare GLP-1 Bridge Program, you must be 18 or older, have a standalone Medicare Part D or Medicare Advantage prescription drug plan, and require the medication strictly for weight loss. You must also meet specific Body Mass Index (BMI) and pre-existing health conditions.
Eligible beneficiaries may be able to receive certain GLP-1 weight loss medications for a flat $50 copay through December 31, 2027.
The program is separate from normal Medicare prescription drug coverage. Does NOT count toward your Part D deductible, not your TrOOP (True Out-of-pocket), Everyone, regardless of LIS (Low Income Status) will have a $50 copay. No manufacturer coupons are permitted to be used in conjunction with this program.
The $50 copay does NOT count toward your Medicare drug deductible or annual out-of-pocket drug spending limit.
Some of the eligibility criteria released by CMS include:
• BMI of 35 or higher, OR
• BMI of 30 or higher with certain qualifying health conditions
IMPORTANT INFO:
If you’re already receiving a GLP-1 through Medicare for another covered condition—such as Type 2 diabetes, certain cardiovascular conditions, obstructive sleep apnea, or MASH—your medication would generally continue through your regular Medicare drug coverage rather than the Bridge Program. If you’ve been waiting to see how this program will actually work, we’re finally starting to get some answers.
As always, your doctor is the best place to start if you’re interested in whether you may qualify. LINKs to the government site:
https://www.medicare.gov/publications/12234-medicare-glp-1-bridge-glp-1-drugs-for-50-a-month.pdf
https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge
Lynne & Sue
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https://lynneclausen.annuity.com/
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