CMS recently launched the Medicare GLP-1 Bridge, a short-term demonstration that provides eligible Part D beneficiaries with access to certain glucagon‐like peptide‐1 (GLP-1) drugs. Between July 1, 2026, and December 31, 2027, eligible patients can get these medications for $50 per month through the bridge program.
Announced in December 2025, the demonstration serves as a bridge to the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model. Under BALANCE, CMS plans to expand beneficiaries’ access to GLP-1s and lower drug costs through negotiations with manufacturers on behalf of Medicaid and Part D plans. While the Medicaid portion of the model launched in May, the agency delayed implementation of the Part D initiative until 2027. In the meantime, the Medicare GLP-1 Bridge will cap eligible beneficiaries’ monthly out-of-pocket costs at $50 for these drugs and allow CMS to gather additional utilization data.
Part D beneficiaries who are enrolled in eligible plan types, use GLP-1 drugs for weight loss and management, and meet certain clinical criteria are eligible for the Medicare GLP-1 Bridge program. Eligible beneficiaries must have met the clinical criteria when GLP-1 therapy was initiated. This includes patients who initiated therapy before enrolling in Part D and/or prior to the launch of the bridge program, according to CMS.
Individuals who already receive these medications through Part D or are otherwise eligible for Part D coverage of GLP-1s do not qualify for the payment cap. Patients who have type 2 diabetes, moderate-to-severe obstructive sleep apnea, or fatty liver disease do not qualify, as they can receive GLP-1 coverage through their Part D plan.
Foundayo (tablets), Wegovy (injection and tablets), and Zepbound (KwikPen) qualify for coverage under the initiative when used for weight loss and management. Pen needles are not covered under the Medicare GLP-1 Bridge and should not be billed to the demonstration or the patient’s Part D plan.
Although providers are not required to include diagnosis code information and/or a pharmacy annotation on the claim, CMS recommends it. A Part D denial is not required to submit a claim to the bridge program.
CMS released a fact sheet to instruct prescribers on clinical criteria, prior authorization processes, and more. The agency also released a series of FAQs to provide additional information for providers, pharmacies, and Part D plans. The provider FAQs list the National Drug Codes (NDC) for the formulations available to beneficiaries through the Medicare GLP-1 Bridge, but CMS noted that the list of products and NDCs may be updated over the course of the demonstration.