By Kathryn Reynolds, MD
One of the hottest topics in endocrinology is the use of GLP1/GLP1-GIP medications. These medications were initially approved for the treatment of type 2 diabetes, and over the past few years the list of approved conditions has expanded to include overweight and obesity, obstructive sleep apnea, and fatty liver disease. A problem I have frequently encountered as a physician is the large number of patients who were unable to access these medications due to cost and/or insurance coverage. There has recently been a great deal of excitement generated regarding the new Medicare Bridge Program; we have been receiving a significant number of questions and requests since the program began at the beginning of the month. I wanted to write this short article to briefly review the Bridge program, including eligibility criteria.
The Medicare GLP-1 Bridge program is a temporary pilot program which began on July 1, 2026 and is scheduled to run through December 31, 2027. It gives eligible Medicare beneficiaries access to specific weight loss medications for a flat copy of $50 per month. The program is managed by the Centers for Medicare and Medicaid Services (CMS) outside of regular Part D drug plans. It is important to realize that this bridge program is only for weight management. It does not include discounted GLP1 coverage for other approved conditions such as type 2 diabetes. The covered medications are Wegovy (tablet or injection), Zepbound (injection by Kwik Pen only), and Foundayo (tablet).
Patients must be 18 years or older and have eligible Part D drug plan coverage. You must be taking the medication solely for weight loss or weight maintenance; you do not qualify under the bridge program if your plan already covers the drug for other conditions (diabetes, moderate-to-severe sleep apnea, or fatty liver disease). Eligible patients are sorted into three tiers according to BMI and co-morbid conditions. They are as follows:
- Tier 1: BMI 35 or greater, no additional conditions needed
- Tier 2: BMI 30 or greater plus congestive heart failure, difficult-to-control hypertension, or
Stage 3a+ chronic kidney disease - Tier 3: BMI 27 or greater plus prediabetes, history of prior heart attack or stroke, or PAD
(blocked blood vessels in extremities)
One question that I am frequently asked is regarding eligibility for coverage under the bridge program for patients who are already taking a GLP1 medication and have already lost significant weight; thus their current BMI may not qualify under the program. Many patients have been paying a significant amount of money out of pocket for a GLP1 and now wish to enroll in the bridge program. Under the “look back” principle, you just need documentation of the baseline BMI prior to the start of GLP1 therapy to determine eligibility. Another question I have already been asked quite often is “what happens to the availability/price of the medications after the end of the program (end of 2027)?" We don’t have an answer for that yet but I hope that patients will be able to continue to have affordable access to needed medications.