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, 2026.

The Medicare GLP-1 Bridge will be nationwide and available in all states and territories.

To qualify for coverage of eligible GLP-1 drugs via the Medicare GLP-1 Bridge, Medicare beneficiaries must meet certain prior authorization criteria and be enrolled in a standalone prescription drug plan (PDP) or Medicare Advantage (MA) coordinated care plan (i.e., HMO, HMOPOS, and Local and Regional PPO plans) that offers prescription drug coverage (MA-PD plans) in CY 2026.

Part D beneficiaries in Special Needs Plans (SNPs), employer/union group waiver plans (EGWPs), and the Limited Income Newly Eligible Transition (LI NET) program are eligible to participate. Beneficiaries enrolled in private fee-for-service plans, section 1876 cost contract plans, section 1833 health care prepayment plans, PACE organizations, fallback plans, and religious fraternal benefit plans are not eligible to participate, unless also enrolled in a standalone PDP, as applicable.

Additionally, dually-eligible beneficiaries who are enrolled in eligible Part D plan types and meet the prior authorization criteria will have access to GLP-1 drugs via the Medicare GLP-1 Bridge.

At this time, for the purposes of the Medicare GLP-1 Bridge, an eligible GLP-1 drug is any of the following products when used to reduce excess body weight and maintain weight reduction: Foundayo®, Wegovy® (injection and tablets), and Zepbound® (KwikPen®). 

Note: This was updated on April 6, 2026, to include Foundayo® following FDA approval and to clarify that only the KwikPen®  formulation of Zepbound® is included.

Beginning July 1, 2026, all formulations of Foundayo®, all formulations of Wegovy®, and the KwikPen ®  formulation of Zepbound® will be available to eligible beneficiaries through the Medicare GLP-1 Bridge. The single-dose vial and single-dose pen formulations of Zepbound® will not be available through the Medicare GLP-1 Bridge. The specific National Drug Code (NDCs) are listed below:  

• Foundayo® NDCs: 0002-4178-31, 0002-4503-31, 0002-4794-31, 0002-4803-31, 0002-4839-31, 0002-4953-31
• Wegovy® NDCs: 0169-4525-14, 0169-4505-14, 0169-4501-14, 0169-4517-14, 0169-4524-14, 0169-4415-31, 0169-4404-31, 0169-4409-31, 0169-4425-31, 0169-4572-14.
• Zepbound® NDCs: 0002-3566-11, 0002-3555-11, 0002-3544-11, 0002-3533-11, 0002-3522-11, and 0002-3511-11.   

This list of products and NDCs may be updated over the course of the Medicare GLP-1 Bridge.  

To access GLP-1 medications via the Medicare GLP-1 Bridge, an eligible beneficiary must have a medical provider submit a prior authorization request and a prescription for an eligible GLP-1 drug for a use covered under the demonstration. CMS will provide additional information on prior authorization processes in Spring 2026.

For the Medicare GLP-1 Bridge, as in the Part D program, a provider does not need to be enrolled in Medicare in order to write a prescription or submit a prior authorization request for products provided under the Medicare GLP-1 Bridge to an eligible beneficiary. However, the provider must not be on the Preclusion List in order for the drug to be coverable under the Medicare GLP-1 Bridge for an eligible beneficiary.

For a beneficiary to qualify for the Medicare GLP-1 Bridge, a provider must submit a prior authorization request that attests the beneficiary meets the following criteria:

• The beneficiary is prescribed the requested drug to reduce excess body weight and maintain weight reduction in combination with current and ongoing lifestyle modification including structured nutrition and physical activity consistent with the applicable FDA approved label, AND
  • The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to thirty-five (≥35) at the time of initiation of GLP-1 therapy, or
  • The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to thirty (≥30) at the time of initiating GLP-1 therapy with a diagnosis of one or more of the following: (A) heart failure with preserved ejection fraction, (B) uncontrolled hypertension (defined as systolic blood pressure above 140 mm Hg or diastolic blood pressure above 90 mm Hg, despite concurrent treatment with two antihypertensive medications), or (C) chronic kidney disease stage 3a or above, or
  • The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to twenty-seven (≥27) at the time of initiating GLP-1 therapy with a diagnosis of one or more of the following: (A) pre-diabetes (as defined by American Diabetes Association guidelines), (B) previous myocardial infarction, (C) previous stroke, or (D) symptomatic peripheral artery disease.

Eligible beneficiaries must meet the clinical criteria at the time of GLP-1 therapy initiation. This includes beneficiaries who initiated therapy prior to enrolling in Medicare Part D and/or prior to the July 1, 2026 launch of the Medicare GLP-1 Bridge. 

For example, if a beneficiary initiated GLP-1 therapy in September 2024 with a body mass index (BMI) of 37 and has a BMI of 34 at the time of a July 2026 prior authorization request, the prescribing provider should attest that the beneficiary met the BMI ≥35 criterion at the time therapy was initiated. 

CMS will be using a single central processor to manage prior authorization, claims adjudication, and payment to pharmacies for the Medicare GLP-1 Bridge. When a provider prescribes an eligible GLP-1 drug to an eligible beneficiary for a use covered under the Medicare GLP-1 Bridge, the provider will submit a prior authorization request to the central processor rather than to the eligible beneficiary’s Part D plan. CMS will conduct outreach and education to help providers understand when to submit a prior authorization request for an eligible GLP-1 drug to the beneficiary’s Part D plan versus the central processor.

When a provider prescribes a GLP-1 drug to a beneficiary for a use covered under the basic Part D benefit (e.g., Zepbound® for the treatment of moderate to severe obstructive sleep apnea (OSA) in adults with obesity; Wegovy® to reduce the risk of major adverse cardiovascular (CV) events in adults with established CV disease and either obesity or overweight), the provider will need to complete the applicable utilization management requirements through the beneficiary’s Part D plan.

CMS will be utilizing Humana, the current administrator of the Limited Income Newly Eligible Transition (LI NET) program, as the central processor for the Medicare GLP-1 Bridge.   The LI NET infrastructure provides the end-to-end operational capabilities and national scale that are critical to provide broad access to GLP-1 drugs to Medicare beneficiaries via the GLP-1 BRIDGE starting July 1, 2026.

The Medicare GLP-1 Bridge will be the primary payer for products covered under the Medicare GLP-1 Bridge and will not coordinate benefits with other payers. Coupons and discount programs may not be applied to Medicare GLP-1 Bridge claims. 

The central processor will process claims submitted electronically using the NCPDP Telecommunication Standard. Paper claims and direct member reimbursements will not be accepted by the central processor. 

CMS expects to release additional operational guidance on pharmacy claims processing in Spring 2026.

The Medicare GLP-1 Bridge is a short-term demonstration to provide eligible Medicare Part D beneficiaries with early access to certain GLP-1 drugs ahead of the launch of the BALANCE Model on January 1, 2027. To maintain access in 2027, beneficiaries who participate in the Medicare GLP-1 Bridge will need to enroll in a Part D plan for 2027 that has opted to participate in BALANCE for continued access to GLP-1 drugs for weight loss. CMS will provide additional information on the transition from the Medicare GLP-1 Bridge to the BALANCE Model in coming months, including planned beneficiary outreach and education.