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A New Option for Medicare Members: The GLP-1 Bridge Program

At Network Health, we understand that managing your health—and your weight—can be an important part of feeling your best. That’s why we want to help you stay informed about a new opportunity available to Medicare members starting July 1, 2026.


Key Details at a Glance

Works Outside Your Network Health Plan
Questions about prescriptions or authorizations should go to your provider or pharmacy, as CMS has not provided Bridge-related contact information for patients at this time.
Prior Authorization Required
Your provider coordinates with CMS. Network Health does not track status.
Flat Monthly Cost
$50 per month and your copayment does not apply toward deductibles or out-of-pocket limits. It will stay at $50 per month throughout the year.

What is the GLP-1 Bridge Program?

The GLP-1 Bridge Program provides access to certain weight-management medications for eligible Medicare members. While Medicare regulations exclude insurance coverage of medications used in the treatment of weight loss, this demonstration program works outside of your Medicare plan.

Includes medications like:

  • Wegovy® (injectable and oral)
  • Zepbound® (injectable)
  • Foundayo® (oral)

Who is Eligible?

To qualify, you must:

  • Be a Medicare member with Part D coverage (PDP or MA-PD)
  • Not be receiving a GLP-1 through your Part D plan
  • Not have a condition that would be covered by Part D GLP-1s (examples include Type 2 diabetes, moderate to severe obstructive sleep apnea or noncirrhotic metabolic dysfunction-associated steatohepatitis [MASH] with moderate to advanced liver scarring [fibrosis])
  • Receive a Prior Authorization through Original Medicare
  • Meet clinical criteria such as body mass index (BMI) and certain conditions:
    • High blood pressure
    • Heart disease
    • Kidney disease
    • Pre-diabetes
  • Have your provider send a prescription to your pharmacy
If your prior authorization has been approved, the prescriptions can be processed by the pharmacy through original Medicare. These guidelines help ensure the program supports those who may benefit most from treatment.
Important: Network Health will not have visibility into prior authorizations or claims in this program.

What is the Cost?

Your cost is:

$50 per month

With the Bridge Program, your out-of-pocket cost is $50 per month regardless of your income level or stage of Medicare drug coverage. It's important to note that these costs do not count toward your Medicare Part D spending.

The program is currently scheduled through December 31, 2027.

Have more questions?

CMS maintains a frequently asked questions (FAQ) page for the Bridge program. View the FAQ here. Members can call 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048)  for additional information related to the Bridge program.

 

 

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