Many people are trying to enroll in the Medicare GLP-1 Bridge program through CMS and running into trouble. This guide walks through who qualifies, what the program covers, what it costs, and the eight-step enrollment process so you or your prescriber can get set up without the usual confusion.
Start with basic eligibility
Before anything else, confirm the patient meets the CMS baseline criteria. All three must be true:
- Enrolled in Medicare Part D
- Diagnosed with obesity or cardiovascular risk
- Meets one of the three BMI thresholds below
BMI criteria (one must apply)
Patient qualifies based on obesity diagnosis alone.
Patient qualifies with at least one weight-related comorbidity (hypertension, type 2 diabetes, dyslipidemia).
Patient qualifies with established cardiovascular disease and elevated risk.
When Part D is the right route
The Bridge program runs through the patient's existing Medicare Part D plan. If the patient is already enrolled in Part D and meets the eligibility above, the Bridge program is the lower-cost route for the three covered medications. Patients without Part D will need to enroll before accessing the program.
The 8-step enrollment process
Confirm Medicare Part D enrollment
Verify the patient has an active Medicare Part D plan. If not, enrollment is required before the Bridge program can be accessed.
Confirm clinical eligibility
Document the obesity or cardiovascular risk diagnosis and confirm the patient meets one of the BMI thresholds above.
Select the covered medication
Choose Foundayo (tablet), Wegovy (injection or tablet), or Zepbound (KwikPen only). Single-dose Zepbound pens and vials are not covered.
Prescriber submits prescription
The prescribing provider sends the prescription to the pharmacy processor at 844-673-0910. Prescribers do not need to be enrolled in Medicare to prescribe through the Bridge program.
Pharmacy verifies Bridge eligibility
The processing pharmacy checks the patient's Part D enrollment and Bridge program eligibility before dispensing.
Patient confirms $50 copay
The patient pays the flat $50 per month program copay. This is separate from their Part D deductible and does not count against it.
Medication is shipped or picked up
The pharmacy fulfills the prescription according to the patient's preference and plan terms.
Set up monthly refills
Confirm the refill schedule with the pharmacy to keep the patient on continuous therapy without gaps.
Download this guide
Prescribers and patients can download the full one-pager to print, share, or keep on hand for reference.