Medicare & GLP-1: A New Short Term Program
The Centers for Medicare & Medicaid Services (CMS) is running a new short-term program that provides GLP-1 weight-loss drugs to people who have Medicare Part D from July 1, 2026, to December 31, 2027. This program is called Medicare GLP-1 Bridge and is available in all US states and territories.
Who qualifies:
Must have traditional Medicare with a Part D plan or a Medicare Advantage Plan with prescription drug coverage
Must use GLP-1 drugs to lose weight and keep the weight off
Must meet the Medicare GLP-1 Bridge medical requirements (see below)
Which GLP-1s are covered?
Wegovy- injection and tablets
Foundayo- injection and tablets
Zepbound- KwikPen only
Medicare GLP-1 Bridge covers these drugs only when they are used to help people lose weight and keep it off. Patients must also follow healthy habits, such as eating well and exercising.
Additionally, the following two medical requirements must be met:
At the time of GLP-1 weight-loss drugs being started (even if it was in the past), the patient must be, or have been, at least 18 years old, and must have, or have had, a BMI (body mass index) of:
35+ or
30+ with a diagnosed condition of heart failure, uncontrolled hypertension, or moderate to severe kidney disease or
27+ with a diagnosed condition of prediabetes, past heart attack, past stroke, or symptomatic peripheral artery disease
AND
2. The patient must not already qualify for GLP-1 weight-loss medication through their Medicare Part D.
Part D commonly covers GLP-1s for patients with Type 2 diabetes, sleep apnea, MASH liver disease, and cardiovascular disease
How to apply for the Medicare GLP-1 Bridge program if eligible:
A doctor or healthcare provider must submit an approval request to Humana- the organization that handles applications for the Medicare GLP-1 Bridge program- either electronically or via fax using the Medicare GLP-1 Bridge prior authorization form, which can be found here. The form must confirm the above medical requirements as well as explain that the GLP-1 is being taken for the purpose of losing weight and keeping it off. After this form is approved, the patient can fill the prescription at a pharmacy for a $50 copay.
It is important to note that since the Medicare GLP-1 Bridge program is different from Medicare Part D, copayments will not count towards a Part D deductible phase or standard benefit.
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