Could You Qualify for the Medicare GLP-1 Bridge Program?
Learn about the Medicare GLP-1 Bridge Program for weight loss, including who may qualify for certain GLP-1 medications with a $50 monthly copay. Explore Medicare coverage requirements, BMI and health criteria, covered medications, and the steps to take with your health care provider to get started.
GLP-1 medications can help with weight loss, but figuring out whether Medicare can help cover them isn't always straightforward. The Medicare GLP-1 Bridge Program is a temporary federal program that gives eligible Medicare beneficiaries access to certain GLP-1 medications for weight loss with a $50 monthly medication copay.
At a glance: About the Bridge Program
- The Bridge Program runs through December 31, 2027.
- You must be at least 18 and have eligible Medicare Part D drug coverage.
- Eligibility depends on your BMI, certain health conditions, the medication prescribed, and other program requirements.
- A health care provider must prescribe a covered medication and submit the required prior authorization.
Could you qualify? Use this checklist
| 🔘 Do you have eligible Medicare drug coverage? | This generally means a standalone Part D plan or a Medicare Advantage plan with prescription drug coverage. Some plan types are excluded. |
| 🔘 Were you at least 18 when you started GLP-1 treatment? | The program's age and clinical criteria apply when treatment begins. |
| 🔘 Did your BMI meet the program's criteria when you started treatment? | The criteria include a BMI of 35 or higher; a BMI of 30 or higher with certain conditions, such as heart failure with preserved ejection fraction, uncontrolled high blood pressure, or stage 3a or higher chronic kidney disease; or a BMI of 27 or higher with prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease. |
| 🔘 Are you seeking treatment for weight management? | The program is intended for weight loss and maintaining weight reduction, alongside ongoing nutrition and physical activity support. |
| 🔘 Are you already receiving a GLP-1 through your Medicare drug plan? | If your plan covers your GLP-1 medication, you generally aren't eligible to receive it through the Bridge. |
| 🔘 Do you have a condition that may be covered through Part D instead? | People with type 2 diabetes, moderate-to-severe sleep apnea, or certain forms of fatty liver disease generally aren't eligible for the Bridge and should ask their drug plan about coverage. |
| 🔘 Have you talked with your health care provider? | Ask whether you may meet the criteria, whether your prescription is for a covered medication, and what is needed for prior authorization. |
What should you do next?
- Check your Medicare coverage and gather your health and medication history. These details can help you and your health care provider determine whether you may qualify.
- Complete the required steps with your provider. If you're eligible for Bridge, your provider must prescribe a covered GLP-1 medication and, when required, submit a prior authorization. They must also confirm that you're using the medication as part of a lifestyle program focused on diet and exercise.
- Watch for a coverage letter in the mail. You'll receive a letter letting you know whether your medication is covered through the Medicare GLP-1 Bridge Program. Your prior authorization generally remains valid through December 31, 2027, including for refills and dose changes, unless you switch GLP-1 medications.
- Fill your prescription at the pharmacy. Your pharmacy will process your prescription through the Bridge Program, and you may need to provide your Medicare Number of the last four digits of your Social Security number.
Figuring out whether you qualify for the Medicare GLP-1 Bridge Program can feel overwhelming, but you don't have to navigate it alone. Visit Medicare.gov to check whether you might qualify using their eligibility checker.
Could You Qualify? Stay in the Know
Get helpful updates from NCOA about the Medicare GLP-1 Bridge Program, including eligibility requirements, who may qualify, and what steps to take next.
