06/05/2026
Good info for our Medicare clients 🙂
https://www.facebook.com/share/p/18f59LdKhq/?mibextid=wwXIfr
🚨 Medicare GLP-1 Bridge Program 🚨
Beginning July 1, 2026, CMS will make certain GLP-1 medications available to eligible Medicare Part D beneficiaries for the treatment of obesity and weight loss. This is a temporary demonstration that will run through December 31, 2027.
CMS will manage this program; it is separate from the beneficiary’s Medicare Part D coverage.
What this means for Medicare beneficiaries:
Medicare GLP-1 Bridge:
•Beneficiaries seeking GLP-1 medications for weight loss may be eligible through the Medicare GLP-1 Bridge if they meet the program’s criteria related to age, BMI, prescribed usage indication for weight loss in combination with lifestyle modifications, and other qualifying conditions.
To determine eligibility, clients should work with their provider to submit the Medicare GLP-1 Bridge prior authorization request to CMS.
•Pharmacies will collect the $50 copay amount and send a claim to the Medicare GLP-1 Bridge processor. If the pharmacy attempts to bill the beneficiary’s Part D plan, they will receive a rejection.
•The Medicare GLP-1 Bridge program does not change the beneficiary’s Part D coverage.
Beneficiaries using GLP-1 medications for Part D covered indications, such as diabetes, diabetes and cardiovascular, or sleep apnea, may continue to have coverage through their plan. Please see the plan’s Formulary and Evidence of Coverage (EOC) for complete coverage details.
•Medicare GLP-1 Bridge program medication costs do not count toward Part D maximum out-of-pocket costs.
•The Medicare GLP-1 Bridge is a CMS demonstration and is subject to change or termination by CMS at any time. We will continue to keep you informed and share information as it becomes available.
