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Information for Providers | CMS

Guidance for healthcare providers on the Medicare GLP-1 Bridge program, a short-term demonstration starting July 1, 2026, to expand access to specific weight-loss medications.

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Information for Providers | CMS

Summary: The Medicare GLP-1 Bridge program, launching July 1, 2026, provides a pathway for Medicare Part D beneficiaries to access specific GLP-1 medications for weight management when they are not eligible through their standard plan and do not have specific comorbidities like type 2 diabetes.

Starting July 1, 2026, the Centers for Medicare & Medicaid Services (CMS) will implement the Medicare GLP-1 Bridge, a short-term demonstration program designed to increase access to GLP-1 medications (Foundayo, Wegovy, and Zepbound KwikPen) for weight management. The program operates outside of standard Part D coverage, utilizing a central processor for claims and prior authorizations. Eligibility is restricted to patients who lack coverage through their Part D plan and do not have type 2 diabetes, moderate-to-severe sleep apnea, or metabolic dysfunction-associated steatohepatitis (MASH). Providers must follow specific clinical criteria regarding BMI and associated health conditions, and must coordinate with pharmacies to ensure claims are routed correctly to the Bridge program.

Document outline

1. What is the Medicare GLP-1 Bridge program? 2. Patient Eligibility Criteria 3. Covered GLP-1 Medications 4. Prescriber Process for Coverage 5. Prior Authorization Requirements 6. Prescriber Eligibility 7. Contact and Technical Support
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