Medicare GLP-1 Bridge program: What you need to know

As of July 1, 2026, the Centers for Medicare & Medicaid Services (CMS) launched the Medicare GLP-1 Bridge program. This short-term demonstration program: 

• Expands access to select GLP-1 medications when used specifically for weight management
• Operates outside of your patients’ Medicare Part D coverage offered by UnitedHealthcare
• Uses a CMS central processor for prior authorization and eligibility determinations, instead of Medicare Part D plans

If you prescribe GLP-1 medications for weight management to Medicare patients, you may begin to see prescriptions processed through the Medicare GLP-1 Bridge program.

What medications are included

The Bridge program currently includes:

• Foundayo™ (tablets)
• Wegovy® (injection and tablets)
• Zepbound® KwikPen® (The single-dose Zepbound pen and Zepbound vials are not covered.)

The program does not include other GLP-1 medications — including Ozempic®, Rybelsus®, Mounjaro®, and Trulicity®. 

How the process works

The Medicare GLP-1 Bridge program is administered by CMS in coordination with your patient’s pharmacy. In most cases, you won’t need to initiate connect with CMS or UnitedHealthcare. However, you may be asked to complete a prior authorization form as part of the Bridge program review process.

If you are prescribing a GLP-1 for weight loss through the Bridge program, the process includes the following steps:

1. Submit the prescription to the pharmacy using your standard process. Include the obesity diagnosis code (E66 family) if appropriate and add a note that states, “Send to bridge for weight management” on the prescription. If this direction is not included, the pharmacy may send the claim to the health plan instead and standard Medicare Part D coverage does not typically include GLP-1 medications for weight management.
   
   
2. The pharmacy submits the claim to Bridge. The initial claim will be returned, which is expected and part of the process. This denial triggers the prior authorization request.
   
   
3. Look for a prior authorization request form from the pharmacy. You can expect to receive this within 24–72 hours after submission, either electronically via CoverMyMeds or by fax. You must wait to receive this request from the pharmacy before submitting — do not submit a PA directly to CMS without it. If you have not received an authorization request from the pharmacy within 72 hours, download and submit the fax form.
   
   
4. Complete and submit the prior authorization form. Approval or denial is communicated back to you and your patient within 72 hours of submission. Once the first fill is approved, subsequent fills do not require a new prior authorization — unless your patient switches to a different covered GLP-1 medication.

Eligibility

CMS determines patient eligibility for the program. In general, the program applies to patients who:

• Are enrolled in an eligible Medicare Part D plan
• Are age 18 or older
• Meet one of the following:
  • BMI ≥ 35
  • BMI ≥ 30 and a diagnosis of 1 or more of the following: (A) heart failure with preserved ejection fraction, (B) uncontrolled hypertension (defined as SBP > 140 mm Hg or DBP > 90 mm Hg, despite concurrent treatment with 2 antihypertensive medications) or (C) chronic kidney disease stage 3a or above
  • BMI ≥ 27 with qualifying clinical criteria (e.g., pre-diabetes, chronic kidney disease stage 3a or higher, uncontrolled hypertension, heart failure with preserved ejection fraction)

The program does not apply to patients:

• Who already receive GLP-1 medications through their Part D plan
• With certain diagnoses that are covered under Part D, including:
  • Type 2 diabetes
  • Moderate-to-severe obstructive sleep apnea
  • Metabolic dysfunction-associated steatohepatitis (MASH)
  • Established cardiovascular disease at risk for major adverse events

In these cases, standard Part D coverage pathways continue to apply.

Resources

For the most current information, visit CMS. For technical questions, email CMS at glp1demo@cms.hhs.gov.