As of July 1, eligible Medicare beneficiaries have a new way to access certain GLP-1 medications at reduced costs through the Medicare GLP-1 program. This temporary program was launched by the Centers for Medicare & Medicaid Services (CMS) to expand access to certain weight-loss medications for qualifying Medicare members.
For agents, understanding how the program works is key. Many clients have questions about GLP-1 medications, eligibility requirements, and potential out-of-pocket costs. The Medicare GLP-1 Bridge Program creates an opportunity to help beneficiaries navigate these conversations with greater confidence.
What is the Medicare GLP-1 Bridge Program?
The Medicare GLP-1 Bridge is a short-term CMS demonstration program running from July 1, 2026, through December 31, 2027. It provides eligible Medicare Part D beneficiaries access to certain GLP-1 medications for a flat rate of $50 per month. The program operates outside of the traditional Medicare Part D benefit structure and uses a centralized process to determine beneficiary eligibility, review prior authorization requests, process claims, and reimburse pharmacies.
Currently, the program only includes select GLP-1 medications:
- Wegovy
- Zepbound
- Foundayo
Refer to the Medicare GLP-1 fact sheet for more information on the program.
Why The Program Matters to Your Clients
For many Medicare beneficiaries, the cost of GLP-1 medications has been a significant barrier to access. The Bridge Program offers a more affordable option for eligible individuals who meet specific clinical requirements, helping reduce monthly medication costs while improving access to weight-loss drugs.
As an agent, you are usually the first person beneficiaries turn to when they hear about new Medicare-related programs. While agents should not provide medical advice, understanding the basics of the program can help you guide clients toward the right resources and conversations with healthcare providers.
Understanding Eligibility
Eligibility is based on both Medicare coverage status and specific clinical criteria. To qualify, beneficiaries must generally have Medicare Part D coverage and meet certain health requirements related to body mass index (BMI) and qualifying conditions. Additionally, CMS requires a provider-submitted prior authorization before coverage can begin.
With that in mind, beneficiaries should work directly with their healthcare provider to determine if they qualify, as eligibility rules can be complex and depend on an individual’s medical history.
Consumer Guide Available to TMG Partners
To help support your client conversations, we’ve created a downloadable Consumer Guide to the Medicare GLP-1 Bridge Program.
This guide is designed to help consumers better understand:
- Which GLP-1 medications are covered
- Monthly costs and what beneficiaries can expect to pay
- Eligibility requirements
- How beneficiaries can get started
- Important compliance-approved program details
- Questions to discuss with their healthcare provider
This educational resource can help simplify the program and provide your clients with a clear overview of their options.
Tidewater partners can download the GLP-1 Consumer Guide here.
Stay Informed & Educate
The GLP-1 Bridge Program is an exciting development for eligible beneficiaries interested in weight-management treatment options. By staying informed and providing access to educational resources, agents can help clients better understand the program and take the next steps needed with their healthcare providers.
Be sure to share the Consumer Guide with clients who want to better understand their available options and how to get started with the program. And remember, the Tidewater team is always here to provide additional resources, guidance, and support. You’re there for your clients, and we’re here for you.
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