What organizations need to know about the Medicare GLP-1 Bridge program

CMS recently launched the Medicare GLP-1 Bridge, a short-term demonstration that provides eligible Part D beneficiaries with access to certain glucagon‐like peptide‐1 (GLP-1) drugs. Between July 1, 2026, and December 31, 2027, eligible patients can get these medications for $50 per month through the bridge program.

Announced in December 2025, the demonstration serves as a bridge to the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model. Under BALANCE, CMS plans to expand beneficiaries’ access to GLP-1s and lower drug costs through negotiations with manufacturers on behalf of Medicaid and Part D plans. While the Medicaid portion of the model launched in May, the agency delayed implementation of the Part D initiative until 2027. In the meantime, the Medicare GLP-1 Bridge will cap eligible beneficiaries’ monthly out-of-pocket costs at $50 for these drugs and allow CMS to gather additional utilization data.

Part D beneficiaries who are enrolled in eligible plan types, use GLP-1 drugs for weight loss and management, and meet certain clinical criteria are eligible for the Medicare GLP-1 Bridge program. Eligible beneficiaries must have met the clinical criteria when GLP-1 therapy was initiated. This includes patients who initiated therapy before enrolling in Part D and/or prior to the launch of the bridge program, according to CMS.

Individuals who already receive these medications through Part D or are otherwise eligible for Part D coverage of GLP-1s do not qualify for the payment cap. Patients who have type 2 diabetes, moderate-to-severe obstructive sleep apnea, or fatty liver disease do not qualify, as they can receive GLP-1 coverage through their Part D plan.

Foundayo® (tablets), Wegovy® (injection and tablets), and Zepbound® (KwikPen®) qualify for coverage under the initiative when used for weight loss and management. Pen needles are not covered under the Medicare GLP-1 Bridge and should not be billed to the demonstration or the patient’s Part D plan.

Although providers are not required to include diagnosis code information and/or a pharmacy annotation on the claim, CMS recommends it. A Part D denial is not required to submit a claim to the bridge program.

CMS released a fact sheet to instruct prescribers on clinical criteria, prior authorization processes, and more. The agency also released a series of FAQs to provide additional information for providers, pharmacies, and Part D plans. The provider FAQs list the National Drug Codes (NDC) for the formulations available to beneficiaries through the Medicare GLP-1 Bridge, but CMS noted that the list of products and NDCs may be updated over the course of the demonstration.