CMS releases physician guidance on new Medicare GLP-1 Bridge Program ahead of July 1 launch
The Centers for Medicare & Medicaid Services (CMS) has released physician guidance on the Medicare GLP-1 Bridge Program, a temporary demonstration program scheduled to begin July 1, 2026.
The program marks a significant change from longstanding Medicare Part D policy. Since the creation of Part D, federal law has excluded coverage of drugs used solely for weight loss. Under the Bridge Program, certain Medicare beneficiaries may now have a pathway to coverage for GLP-1 medications used for weight management, provided they meet CMS clinical criteria and prior authorization requirements.
Which patients may qualify
Eligible Medicare beneficiaries prescribed a covered GLP-1 medication for weight management may qualify if they meet one of the following criteria:
- BMI of 35 or greater
- BMI of 30 or greater with heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or higher
- BMI of 27 or greater with prediabetes, previous myocardial infarction, previous stroke, or symptomatic peripheral artery disease
Beneficiaries who have Medicare Part D coverage for a GLP-1 medication based on another covered indication—such as Type 2 diabetes or obstructive sleep apnea—are not eligible for the program and should continue to obtain coverage through their Part D plan.
What physicians need to know
Beginning July 1, physicians may receive prior authorization requests as part of the Bridge Program. Physicians should be aware that all prior authorizations for GLP-1 medications covered under the Bridge Program will be processed retrospectively (i.e., after the time of prescribing), and physicians should be prepared to document the patient’s diagnosis, clinical indication, BMI, and relevant comorbidities for use later when completing the prior authorization request. CMS will use this information to determine whether the medication should be covered through the Bridge Program or through the beneficiary’s Medicare Part D plan.
Additional information for prescribers, including eligibility criteria and prior authorization requirements, is available on CMS’ provider webpage.
