Medicare BRIDGE Program – Updated 5/12/2026

What It Is

  • A short-term demonstration run by CMS that provides eligible Medicare Part D beneficiaries with access to certain GLP-1 drugs between July 1, 2026 and December 31, 2027
  • Designed as a two-step approach — the Bridge is the temporary phase, with the more permanent BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model intended to follow
  • The program operates outside the standard Medicare Part D benefit and uses a central processor to handle prior authorizations, claims, and payments — Part D sponsors are not involved in its operations or financial risk

Covered Drugs

  • The pilot covers: the pill and injectable formulations of Wegovy, the KwikPen formulation of Zepbound, and the Foundayo pill
  • If you are taking Ozempic or Mounjaro for Type 2 Diabetes, you will continue to use your standard Part D coverage — not the Bridge program

Cost

  • Eligible beneficiaries pay a flat $50 per month copay for their GLP-1 medication
  • GLP-1 drugs under the Bridge cost $245 per month total, with CMS covering the balance beyond the $50 copay
  • The $50 copay does not count toward the Part D deductible, nor does it count toward the $2,100 annual out-of-pocket cap on prescription drug costs
  • The Bridge program is unique in that it offers a predictable $50 copayment that does not go up as dosages increase
  • If you receive the low-income subsidy (Medicare Extra Help), you cannot use that assistance for drugs covered by the GLP-1 Bridge program

Who Is Eligible

  • Must be enrolled in a standalone prescription drug plan (PDP) or Medicare Advantage coordinated care plan that offers prescription drug coverage (MA-PD) in CY 2026
  • Part D beneficiaries in Special Needs Plans (SNPs), employer/union group waiver plans (EGWPs), and the Limited Income Newly Eligible Transition (LI NET) program are eligible
  • Beneficiaries enrolled in private fee-for-service plans, section 1876 cost contract plans, PACE organizations, and religious fraternal benefit plans are not eligible, unless also enrolled in a standalone PDP

Clinical Eligibility Criteria (Prior Authorization)

  • Age 18 or older
  • The drug must be prescribed for weight loss/maintenance alongside lifestyle changes
  • BMI of 35 or higher automatically qualifies
  • BMI ≥ 27 with a history of heart attack or a diagnosis of pre-diabetes also qualifies
  • This includes beneficiaries who initiated therapy prior to enrolling in Medicare Part D and/or prior to the July 1, 2026 launch — providers should attest the beneficiary met BMI criteria at the time therapy was initiated

How It Works Operationally

  • You do not need to separately enroll in the Bridge program — your doctor submits a prior authorization to the central system run by CMS contractor Humana
  • Your doctor does not need to be listed as a Medicare provider to write a prescription or submit prior authorization
  • CMS is utilizing Humana, the current administrator of the LI NET program, as the central processor — it will process claims submitted electronically using the NCPDP Telecommunication Standard. Paper claims and direct member reimbursements will not be accepted
  • Pharmacies do not need to opt in to participate
  • CMS has established a specific Bank Identification Number (BIN) and Processor Control Number (PCN) for the Bridge: BIN 028918, PCN MEDDGLP1BR
  • The Medicare GLP-1 Bridge will be the primary payer and will not coordinate benefits with other payers. Coupons and discount programs may not be applied to Bridge claims

Important Caveats

  • Most studies have shown that many people who stop using GLP-1 drugs regain the weight they lost — and the program ends in December 2027
  • If you use the Bridge program in 2026, you may need to switch Part D plans during open enrollment for 2027 to ensure you move into a plan that supports the BALANCE model
  • A key component of the follow-on BALANCE model is lifestyle support — beneficiaries will likely be required to participate in weight-management programs to maintain coverage
  • The Bridge does not impact beneficiary appeal rights under Part D
  • Details of the GLP-1 Bridge and BALANCE Model are subject to change