The Centers for Medicare & Medicaid Services (CMS) has launched the GLP-1 Bridge Program, a temporary initiative to provide coverage for effective weight-loss medications. This program marks a significant shift in Medicare policy, as traditional Part D plans have not covered drugs primarily for weight management. Medicare aims to address the rising prevalence of obesity and its chronic complications through this bridge.

Eligibility requirements for the GLP-1 Bridge Program include:

• Age 18 or older
• Enrollment in a Medicare Part D or Medicare Advantage Prescription Drug (MA-PD) plan
• One of the following BMI and health condition combinations:
  • BMI ≥ 35 (regardless of other health conditions)
  • BMI ≥ 30 with at least one of the following: heart failure with preserved ejection fraction (HFpEF), hypertension, or chronic kidney disease (CKD)
  • BMI ≥ 27 with a history of pre-diabetes, myocardial infarction, stroke, or peripheral artery disease (PAD)

The program covers the following GLP-1 receptor agonists:

• Foundayo (orforglipron) tablet, all dose strengths and formulations
• Wegovy (semaglutide) injections and tablets, all dose strengths and formulations
• Zepbound (tirzepatide) injections, only when prescribed as the KwikPen (single-dose vials and other single-dose pen formats are excluded)

All prescriptions require prior authorization through Humana, which oversees clinical review to ensure adherence to the program's strict medical-necessity guidelines.

A key feature of the program is the cost-sharing structure. Eligible participants pay a flat $50 monthly copay for their medication. However, these payments do not count toward the True Out-of-Pocket (TrOOP) threshold. This means the $50 monthly spend will not help beneficiaries reach the "catastrophic coverage" phase of their Medicare Part D plan.

The GLP-1 Bridge Program is scheduled to begin on July 1, 2026, and is currently authorized to run through December 31, 2027. This 18-month window provides a significant opportunity for patients to address obesity-related health risks using advanced pharmacological tools previously unavailable under Medicare. Patients interested in the program should consult their healthcare provider to begin the screening and prior authorization process well in advance of the July launch date.

• Medicare GLP-1 Bridge Program (CMS)