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The Centers for Medicare and Medicaid Services (CMS) is advancing an initiative that proposes to expand access to GLP-1s for the Medicare population: the Medicare GLP-1 Bridge short-term demonstration program.
Overview of the Medicare GLP-1 Bridge demonstration program
CMS introduced the Medicare GLP-1 Bridge demonstration program as a short-term initiative to expand access to GLP-1 anti-obesity medications for eligible Medicare Advantage (MA) and Fee-For-Service (FFS) beneficiaries with Part D coverage, while longer-term coverage approaches are established.1 The program started on July 1, 2026, and is intended to continue until December 31, 2027.2 The program covers access to Foundayo (orforglipron), Wegovy (semaglutide) injection and tablets, and Zepbound (tirzepatide) KwikPen.
Currently, Medicare beneficiaries can qualify for GLP-1 coverage under their Part D benefit if they meet specific clinical criteria, including a diagnosis of type 2 diabetes or moderate-to-severe obstructive sleep apnea (OSA) with BMI ≥ 30 or noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced liver fibrosis. However, many Medicare beneficiaries who are overweight or obese do not meet these criteria, and the cost of GLP-1 medications can be unaffordable if paying out of pocket. The Bridge program is intended to offer affordable coverage to Medicare beneficiaries who seek treatment for an obesity or weight-management indication, yet do not meet the Part D benefit coverage criteria.
The Bridge program will operate separately from Part D benefits, meaning that use of GLP-1 medications under this program will not accrue Part D costs for the patient or the patient’s health plan. Instead, the Bridge program is designed to process all covered claims centrally, with patients responsible for a $50-per-script unsubsidized cost-sharing. Since this coverage is outside of Part D, the Part D deductible will not apply, beneficiaries will not be eligible for a low-income subsidy, and the copay will also not count toward the beneficiaries’ true out-of-pocket cost maximum. Additionally, manufacturer coupons and savings cards cannot be applied to Bridge program claims.