On July 1, the Centers for Medicare and Medicaid Services launched its Medicare GLP-1 Bridge initiative, which is designed to expand access to GLP-1 medications and to evaluate the impacts of increased access on the Medicare program.
Through the program, eligible individuals enrolled in Medicare Part D prescription drug coverage can obtain certain GLP-1 medications to lose weight or maintain weight reduction at $50 per month. The initiative will remain available through December 31, 2027.
To be deemed eligible for coverage under the Bridge Model, Medicare beneficiaries must have one of the following:
- A Body Mass Index (BMI) of 35 or higher
- A BMI of 30 or higher, and certain types of heart failure OR high blood pressure that’s hard to control OR chronic kidney disease (stage 3a or above)
- A BMI of 27 or higher, and prediabetes OR history of a heart attack, stroke or blocked arteries in legs or arms
Beneficiaries with type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease may already be eligible for coverage through their Medicare drug plan.
Patients are directed to speak with their physicians about whether a GLP-1 is right for them and whether they meet eligibility criteria. Prescribing clinicians are required to submit a prior authorization request attesting the GLP-1 prescription is for weight reduction and weight management and that a beneficiary meets the clinical criteria and does not have any conditions that would make them already eligible for GLP-1 coverage under Part D.
CMS Medicare GLP-1 Bridge Fact Sheet
GLP-1 Bridge Program Information and Resources