The Medicare GLP-1 Bridge is a temporary CMS demonstration that does not require a separate enrollment application. It runs from July 1, 2026, through December 31, 2027, and approved patients pay $50 for a 28- or 30-day supply.

If you qualify, enrollment takes place through your healthcare provider and pharmacy:

  1. Confirm that you have eligible Medicare Part D drug coverage.
  2. Ask your provider whether you meet the program's medical criteria.
  3. Have your provider prescribe an eligible GLP-1 medication for weight management.
  4. Give the pharmacy your Medicare information so it can process the prescription through the Bridge.
  5. Complete the prior authorization request sent to your provider.
  6. Pick up the medication after approval and pay the $50 copayment.

Medicare GLP-1 Bridge at a Glance

Requirement Details
Medicare coverage Eligible Medicare Part D drug coverage is required
Age At least 18
Purpose Reducing excess body weight and maintaining weight reduction
Covered medications Foundayo, Wegovy, and Zepbound KwikPen
Patient cost $50 per 28- or 30-day supply
Enrollment method Provider prescription, pharmacy claim, and prior authorization
Program dates July 1, 2026, through December 31, 2027
Separate application No

Step 1: Confirm That You Have Eligible Medicare Part D Coverage

The Medicare GLP-1 Bridge is available to people with qualifying Medicare drug coverage, including:

  • A standalone Medicare Part D prescription drug plan
  • A Medicare Advantage plan with prescription drug coverage, known as an MA-PD plan
  • Certain Special Needs Plans
  • Employer or union group waiver plans
  • The Limited Income Newly Eligible Transition, or LI NET, program

Original Medicare by itself does not qualify. If you have Original Medicare without Part D, you must first find out whether you can join a Medicare drug plan. Medicare permits Part D enrollment during certain periods, including an Initial Enrollment Period or a qualifying Special Enrollment Period.

Do not cancel an existing Medicare Advantage or prescription drug plan to seek Bridge coverage. The Medicare GLP-1 Bridge operates separately from the Part D benefit. Your current plan may need to cover a GLP-1 medication when it is prescribed for another Medicare-covered condition.

Step 2: Check Whether You Meet the Medical Criteria

You must be at least 18 and meet one of these BMI and health-condition combinations when you start GLP-1 therapy:

  • BMI of 35 or higher, with no additional condition required
  • BMI of 30 or higher plus at least one of these conditions:
    • Heart failure with preserved ejection fraction
    • Uncontrolled hypertension
    • Stage 3a or more advanced chronic kidney disease
  • BMI of 27 or higher plus at least one of these conditions:
    • Prediabetes
    • Previous heart attack
    • Previous stroke
    • Symptomatic peripheral artery disease

Your provider must calculate your BMI and verify the applicable diagnosis. The provider must also certify that you will use the medication with a lifestyle program focused on diet and exercise.

Step 3: Ask Your Provider to Prescribe an Eligible Medication

For weight management, the Medicare GLP-1 Bridge covers:

  • Foundayo, tablets
  • Wegovy, injection or tablets
  • Zepbound KwikPen

The program does not cover single-dose Zepbound pens or Zepbound vials.

Tell your provider that you want the prescription evaluated under the Medicare GLP-1 Bridge for weight management. CMS instructs prescribers to send the prescription to the pharmacy with an obesity diagnosis code from the E66 code family and the note "SEND TO BRIDGE FOR WEIGHT MANAGEMENT."

Step 4: Give the Pharmacy Your Medicare Information

The pharmacy may ask for your Medicare Number, which appears on your Medicare card. If you do not have the card, the pharmacy may be able to verify your identity with the last four digits of your Social Security number.

The pharmacy sends the prescription claim to the Medicare GLP-1 Bridge central processor. The Bridge program, rather than your Medicare Part D insurer, checks eligibility, processes prior authorization, adjudicates the claim, and pays the pharmacy.

Step 5: Have Your Provider Complete the Prior Authorization

If the first claim indicates that you may qualify, the pharmacy generally sends a prior authorization request to your provider within 24 to 72 hours. Your provider must complete the form and confirm that the eligibility information is accurate.

CMS generally sends the approval or denial to the provider within 72 hours after the prior authorization is submitted. Medicare also mails you a decision letter.

If the pharmacy has not sent a request after 72 hours, your provider can use the CMS Bridge prior authorization form. If the request is denied because information is incorrect or incomplete, the provider may resubmit it for review. CMS states that the Bridge program does not have a separate beneficiary appeals process.

Step 6: Pick Up the Medication and Pay the Copayment

After approval, you pay $50 for a one-month supply at the pharmacy. The Medicare Part D deductible does not apply to Bridge medications.

The $50 copayment does not count toward your Part D true out-of-pocket costs, deductible, or out-of-pocket maximum. Medicare's low-income subsidy does not reduce this copayment.

The Bridge covers only 28-day or 30-day fills. After the first prescription is approved, you generally do not need a new prior authorization for refills or dose changes if you stay on the same medication. You need a new prior authorization if you switch to another covered GLP-1 drug.

Who Cannot Use the Medicare GLP-1 Bridge?

You generally cannot use the Bridge if:

  • Your Medicare Part D plan already covers or has covered your GLP-1 medication
  • You received a GLP-1 through Part D during calendar year 2026
  • You have type 2 diabetes
  • You have moderate-to-severe obstructive sleep apnea
  • You have fatty liver disease or qualifying MASH that should be handled through Part D
  • You are younger than 18
  • You do not meet the BMI and health-condition criteria

If your GLP-1 is prescribed for a Medicare-covered condition such as type 2 diabetes, moderate-to-severe sleep apnea, or cardiovascular risk reduction, your provider should send the request to your existing Part D plan instead of the Bridge program.

What to Do If You Think You Qualify

Call your doctor's office and say:

"I may qualify for the Medicare GLP-1 Bridge. Can you check my BMI and medical conditions, prescribe an eligible medication if appropriate, and submit the Bridge prior authorization if the pharmacy requests it?"

You can also check the Medicare GLP-1 Bridge information page or call 1-800-MEDICARE, 1-800-633-4227. TTY users can call 1-877-486-2048.