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The Medicare GLP-1 Bridge is a temporary CMS demonstration program running from July 1, 2026, to December 31, 2027. It allows eligible Medicare Part D beneficiaries to access select FDA-approved weight-loss medications—Wegovy (injections and tablets), Zepbound (KwikPen), and Foundayo—for a fixed monthly copayment of about $50.
Key Program DetailsHow It Works: The program operates entirely outside the standard Medicare Part D payment flow using a central CMS processor. Your Part D plan does not need to opt in for you to use it.Medications Covered: Wegovy (injection/tablets), Zepbound (KwikPen), and Foundayo.
Important Limitation: The Bridge covers GLP-1 drugs only when prescribed for weight loss or weight maintenance. If you require a GLP-1 for Type 2 diabetes or cardiovascular risk reduction, it must be covered through standard Part D.
Who is Eligible?To qualify, you must meet the following baseline and clinical criteria:Enrollment: You must be enrolled in a standalone Medicare Prescription Drug Plan (PDP) or a Medicare Advantage plan that includes prescription drug coverage.Clinical Criteria: Your doctor must submit a Prior Authorization Form confirming you have a diagnosis of obesity or are overweight, and you meet one of the following weight and health condition profiles:BMI ≥ 35BMI ≥ 30 + diagnosed heart failure, uncontrolled hypertension, or chronic kidney diseaseBMI ≥ 27 + diagnosed pre-diabetes, previous heart attack, previous stroke, or symptomatic peripheral artery disease
Lifestyle Changes: You must be prescribed the medication as part of a comprehensive weight management plan that includes structured nutrition and physical activity.
Costs and ProcessCopay: Eligible patients pay exactly $50 per 28- or 30-day supply. This is a flat rate and does not count toward your Part D deductibles or out-of-pocket maximums.
Doctor Action Required: Your doctor or prescriber must submit both your prescription and the required prior authorization directly to the CMS centralized processor (managed by Humana).
Pharmacy Pickup: Once the central processor approves the claim, the pharmacy will be notified to fill the medication and collect your $50 copay.
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