Medicare GLP-1 Bridge

Section 402(a)(1)(A) of the Social Security Amendments of 1967, as amended and expressly made applicable to Part D by section 1860D-42(b) of the Social Security Act (“the Act”), authorizes the Secretary to carry out demonstration projects to determine whether “changes in methods of payment or reimbursement” under Medicare “would have the effect of increasing the efficiency and economy of health services” covered under Medicare through the “creation of additional incentives to these ends.” Pursuant to such authority, the Medicare GLP-1 Bridge will operate between July 1, 2026, and December 31, 2027.

The Medicare GLP-1 Bridge will be extended through December 31, 2027, providing eligible Medicare Part D beneficiaries with access to certain GLP-1 drugs and allowing CMS to collect additional data on GLP-1 utilization to share with Part D plan sponsors ahead of potential implementation of BALANCE in Part D.  

Eligible beneficiaries will have a $50 copay. Eligible GLP-1 drugs furnished under the Medicare GLP-1 Bridge are provided outside of the Part D benefit payment flow and coverage. This means that the Part D deductible will not apply, no part of the $50 copay counts towards the beneficiary’s TrOOP costs, and there is no low-income subsidy (LIS) provided for LIS beneficiaries.