Medicare GLP-1 Bridge Coverage

IMPORTANT INFORMATION ABOUT MEDICARE PART D AND GLP-1 DRUGS

Medicare GLP-1 Bridge Coverage (2026-27) has very specific requirements for all patients, including an appointment with your primary care provider. Your first step is to make an appointment.

Our front desk team cannot answer questions about your eligibility as clinical criteria is not their area of expertise. Request an appointment with your primary care physician via MyChart to get the discussion underway.

Next, please be aware that only specific drugs are covered: Foundayo® (tablet), Wegovy® (injection or tablet) and Zepbound® (KwikPen® only; single-dose vials/pens are not covered).

Medicare pre-authorization is required. Your physician will need to submit a form to receive approval from Medicare for coverage.

The following information is available on the Medicare Fact Sheet in greater detail.

Eligibility Requirements

You must meet all of the following:

1. Plan enrollment
   • Enrolled in a standalone Medicare Part D Prescription Drug Plan (PDP) or a Medicare Advantage plan with drug coverage (MA PD), including HMO, HMOPOS, and Local/Regional PPO plans. See Medicare+1.
   • Enrolled in a Special Needs Plan (SNP) or dually eligible (Medicare + Medicaid) in an eligible plan type (Visit medicare.tools for more.)
   • Not eligible if your only coverage is a private fee for service plan, cost contract plan, PACE, fallback plan, or religious fraternal benefit plan (unless also enrolled in a PDP) See Centers for Medicare & Medicaid Services for more.
2. Clinical criteria
   • You must be 18 years of age or older and meet at least one of the following:
     • BMI >= 35
     • BMI >= 30 and one of:
     • Diastolic heart failure (HFrEF)
     • Uncontrolled hypertension (>=140/90 mm Hg despite two antihypertensives)
     • Chronic kidney disease stage 3a or higher
   • BMI >= 27 and one of:
     • Prediabetes
     • Previous heart attack or stroke
     • Symptomatic peripheral artery disease

Important Exclusions

• Already receiving GLP 1 coverage through your Part D plan (must continue via that plan). See Medicare Fact Sheet.
• Have type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease (MASH). See Medicare Fact Sheet.

Cost

• $50 per month for all covered drugs, regardless of income. See Medicare Fact Sheet.
• This amount does not count toward your Medicare Part D deductible or out of pocket limit. Learn more at Medicare Fact Sheet.
• Not eligible for the Medicare Prescription Payment Plan. Learn more at Medicare Fact Sheet.

How to Access

• Make an appointment to speak to your doctor about starting GLP 1 therapy and eligibility.
• If eligible, your prescription will be processed through the Medicare GLP 1 Bridge system, not your Part D plan.
• Pharmacies will need your Medicare ID number to process the prescription. Learn more at Medicare Fact Sheet.

You can also answer a few questions on the Medicare site to learn whether the temporary Medicare GLP-1 Bridge might be right for you.