The Medicare GLP-1 Bridge, in plain steps.

The basics

• Dates: July 1, 2026 through December 31, 2027.
• What it is: a CMS demonstration that runs outside the Part D benefit, with one central processor for prior auth, claims and pharmacy payment.
• Covered drugs (weight management only): Foundayo (tablets), Wegovy (injection and tablets), and Zepbound KwikPen only. Zepbound single-dose vials and single-dose pens are not covered.
• Fills: 28- or 30-day fills only. Patient copay is $50.
• Prescribers: Medicare enrollment is not required, but you must not be on the Medicare Preclusion List.

Who qualifies

Age 18 or older, prescribed to reduce excess body weight and maintain weight reduction alongside lifestyle modification, and one of these, measured at the time the GLP-1 was started:

Use the BMI at the start of GLP-1 therapy, even if it was started before July 2026. CMS's own example: a patient who started at BMI 37 and is now at 34 still meets the BMI 35 pathway.

Who goes through Part D instead

• Patients with type 2 diabetes, moderate-to-severe obstructive sleep apnea, or MASH with moderate-to-advanced fibrosis.
• GLP-1s prescribed to reduce cardiovascular event risk, even if weight loss is also a goal.
• Patients who already received a GLP-1 through their Part D plan.
• Patients in private fee-for-service, cost, PACE, fallback or religious fraternal plans, unless they also have a standalone Part D plan.

How to prescribe and get the prior auth

1. Send the prescription to the pharmacy first. Don't submit the prior auth before the pharmacy claim exists; it will come back "patient not found."
2. Add the Bridge details. CMS recommends an obesity diagnosis code (E66 family) and the note SEND TO BRIDGE FOR WEIGHT MANAGEMENT, so the claim isn't sent to the patient's Part D plan by mistake.
3. Wait for the PA request. The pharmacy usually sends it by electronic PA or fax within 24–72 hours.
4. No request after 72 hours? Download the CMS fax form and submit it yourself. CMS prefers electronic submission.
5. Complete it carefully. You attest under penalty of perjury, and CMS may check answers such as diabetes status against Medicare data.
6. Decision within 72 hours, sent to you by ePA or fax and mailed to the patient.

After the decision

• Approved: later fills don't need a new prior auth. Switching to a different covered GLP-1 does.
• Denied: there is no appeals process. You can resubmit the form with corrected or additional information.
• Questions: the CMS Bridge call center is 855-273-0102, Monday–Friday, 8am–7pm ET.

Sources

• CMS: Medicare GLP-1 Bridge, Information for Providers
• CMS: Medicare GLP-1 Bridge, Information for Prescribers (fact sheet)
• CMS: Medicare GLP-1 Bridge Prior Authorization Request Form