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Medicare's GLP-1 Bridge Program: What to Know
A new pilot program helps some beneficiaries access GLP-1 medications outside standard Part D rules.
Talk to a Licensed Agent: (302) 407-0876What the Bridge Program Does
Medicare's GLP-1 Bridge Program is a pilot that runs separately from standard Part D rules, waiving the usual Part D deductible for a specific set of GLP-1 medications used for chronic weight management.
Rather than paying standard cost-sharing, eligible beneficiaries pay a flat monthly copay for a 28–30 day supply. That flat amount doesn't count toward the Part D deductible or out-of-pocket maximum, and it generally can't be reduced further by Extra Help or the Medicare Prescription Payment Plan — check current program terms for the exact copay amount, since pilot program details can be updated.
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Call (302) 407-0876Who Qualifies
Eligibility is based on BMI combined with certain health conditions. Generally, a BMI of 35 or higher qualifies on its own. A BMI between 30 and 34.99 can qualify alongside a condition such as heart failure, uncontrolled hypertension, chronic kidney disease, a prior heart attack or stroke, peripheral artery disease, or prediabetes. A BMI between 27 and 29.99 can qualify alongside a prior heart attack, stroke, peripheral artery disease, or prediabetes diagnosis.
The program generally excludes people already receiving a GLP-1 through standard Part D coverage, people with a type 2 diabetes diagnosis, and people with moderate-to-severe sleep apnea or fatty liver disease. It's available through standalone Part D plans, Medicare Advantage plans, Special Needs Plans, and a few other plan types — your doctor submits the prescription and prior authorization on your behalf.
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