Medicare GLP-1 Bridge Program
The Medicare GLP-1 Bridge Program is a limited-time CMS program that provides eligible Medicare Part D beneficiaries access to certain GLP-1 drugs at a $50 copayment for a monthly supply between July 1, 2026, and December 31, 2027.
What is the purpose of this program?
The purpose of the GLP-1 Bridge Program is to provide eligible beneficiaries with access to GLP-1drugs intended for weight loss, and help improve overall health along with lifestyle interventions. Outside of this program, GLP-1 drugs are not covered for weight loss indication.
I currently receive GLP-1 drugs through my Medicare Advantage plan. Should I change anything?
If you are currently receiving GLP-1 drugs through your Medicare Advantage plan, nothing changes for you. Continue receiving your drugs as usual.
How do I know if I am eligible to receive GLP-1 drugs furnished via the Bridge program?
Medicare beneficiaries will need to meet certain clinical criteria and be enrolled in a standalone prescription drug plan (PDP) or Medicare Advantage (MA) plan that offers prescription drug coverage in 2026. UCLA Health Medicare Advantage Plans are Medicare Advantage plans with prescription drug coverage. Therefore, if your doctor determines that you meet the clinical criteria, you may qualify.
What clinical criteria must I meet to qualify?
The clinical criteria are based on Body Mass Index (BMI) and certain diagnoses. Your doctor will determine if you meet the clinical criteria.
I receive low income subsidy to help pay for my prescriptions will this apply to Bridge Program?
No, low income cost sharing subsidies do not apply to any portion of the copay
Can I use a manufacturer copay card or drug discount program with the Bridge Program?
No, the Bridge program does not allow manufacturer copay cards or other discount programs
How do I access a Bridge GLP-1 drug?
This is a multi-step process.
Step 1: Your doctor submits a prescription to your pharmacy
- This prescription needs to include your diagnosis indicating that weight management is needed, and must include directions to the pharmacy that state “Send To Bridge For Weight Management”.
- We also recommend including your Medicare beneficiary ID on these prescriptions as it is that number that must be submitted by your pharmacy to Medicare.
Step 2: Your pharmacy submits the prescription to Medicare’s chosen central processor
- Your pharmacy must submit this prescription with your Medicare Beneficiary number (NOT YOUR INSURER’S MEDICARE ID) to Medicare’s chosen central processor.
- This will generate a claim rejection stating a Prior Authorization is required from your doctor. This is a required step and part of the process.
Step 3: Your pharmacy sends the Prior Authorization request to your doctor
Step 4: Your doctor submits the Prior Authorization request to Medicare’s central processor
- Your doctor should then submit the completed prior authorization form to Medicare’s central processor.
- The prior authorization processor will take up to 72 hours to make their decision. These authorizations are not eligible for an expedited or urgent timeframe.
Step 5: Your pharmacy reprocesses the claim and fills your prescription
- Once the authorization is approved, both you and your doctor will be notified.
- If your case was denied, your doctor can resubmit a new case for another review if you believe the denial was in error.
- If your case is approved, we recommend you and your doctor coordinate who calls your pharmacy to let them know that your drug was approved, so they can reprocess the claim and fill your prescription. Otherwise, your pharmacy will not know that your drug was approved and may not have it ready for you when you show up.