As of July 1,2026, Medicare instituted the Medicare GLP-1 Bridge Program that will discount the cost to Medicare beneficiaries over 18 for GLP-1 drugs for weight loss. This is an 18-month trial running through December 31, 2027, to determine the interest and efficacy of GLP-1 drugs for weight management. To take advantage of the program, you need to meet all of the Medicare GLP-1 Clinical criteria: 

  1. Patient must be at least 18 years old and have Medicare Part D coverage. 
  2. GLP-1 is prescribed for weight loss and maintaining weight reduction alongside lifestyle modification. 
  3. At the initiation of therapy (prior to or under this program), the patient has one of the following:
    • BMI of 35 or higher with no additional diagnosis required. 
    • BMI of 30 or higher AND a diagnosis of one or more of the following: heart failure with preserved ejection fraction; uncontrolled hypertension or chronic kidney disease stage 3a or  above. 
    • BMI or 27 or higher AND a diagnosis of one or more of the following: pre-diabetes; previous  myocardial infarction; previous stroke: or symptomatic peripheral artery disease. 

How the prescription process works: 

  1. On or after July 1st, your doctor should submit a prescription for the GLP-1 drug to your pharmacy of choice. Be sure that the prescription references the disease code E66 for obesity, and clearly marks the prescription in large capital letters: ”SEND TO MEDICARE GLP-1 BRIDGE FOR WEIGHT MANAGEMENT”. Otherwise, the prescription may be sent to your Part D provider and delay the process. 
  2. The pharmacy will send the prescription to the Medicare GLP-1 Bridge Central Processor. This prescription will need your Medicare MBI # or the last 4 digits of your SSN for verification. 
  3. The processor will deny the claim (thus verifying that you are not covered by insurance, an eligibility requirement) and requesting a Prior Authorization. The pharmacy then initiates Prior Authorization and routes the request to your physician’s office via ePA (covermymeds) or fax. 
  4. Your physician’s office completes the PA according to instructions and submits electronically (preferred) or Fax (accepted). 
  5. Most PA are adjudicated, and the decisions faxed within 72 hours.  
  6. Once approved, the pharmacy will fill your prescription; you will pay $50 for the month’s supply. Subsequent refills do not need a new Prior Authorization unless you switch to a different covered GLP-1 drug. 
  7. If you believe you have been wrongfully denied, claims can be resubmitted for re-review. 

Begin by discussing this program with your primary physician, and it is recommended that you make yourself aware of potential side effects and follow up with your doctor who should monitor the drug use.