CMS posts beneficiary guidance for the Medicare GLP-1 Bridge and its $50 copay

Medicare has posted beneficiary-facing guidance for the Medicare GLP-1 Bridge, a short-term demonstration that gives eligible Part D enrollees access to certain GLP-1 drugs for a flat $50 copay. The CMS page carries a last-modified date of July 13, 2026 ^[1].

The Bridge began July 1, 2026, and runs through December 31, 2027 ^[1]. CMS says it extended the program to that end date after the BALANCE model did not launch in 2027, so the agency can gather more data on GLP-1 use to share with Part D plan sponsors ahead of a possible BALANCE rollout in Part D ^[1].

Copay, and how the program sits outside Part D

Eligible beneficiaries pay $50 ^[1]. The drugs are furnished outside the Part D benefit's coverage and payment flow. That means the Part D deductible does not apply, no part of the $50 counts toward a beneficiary's true out-of-pocket (TrOOP) costs, and no low-income subsidy is provided for people who normally receive Extra Help ^[1]. The $50 therefore does not count toward the annual Part D out-of-pocket maximum, and it is the same flat amount for everyone who qualifies ^[2].

CMS is using a single central processor in 2026 to manage prior authorization, claims adjudication, and payment to pharmacies ^[1]. Because the program sits outside normal Part D payment, Part D sponsors do not carry risk for the drugs and do not have to opt in for beneficiaries to use the Bridge ^[1]. A Medicare advisory firm's overview identifies Humana as the central claims processor; the CMS beneficiary page does not name the processor ^[1][2].

Which drugs, and who qualifies

CMS describes the program as covering "certain GLP-1 drugs" but does not name them on the beneficiary page ^[1]. A United Medicare Advisors overview lists Wegovy (all formulations), Zepbound (KwikPen formulation only) and Foundayo, which that overview describes as an oral formulation, as covered under the Bridge. It says Ozempic and Mounjaro stay under regular Part D rules for type 2 diabetes and are not part of the Bridge ^[2].

The same overview describes clinical criteria a doctor would verify through prior authorization: a BMI of 35 or higher with no other conditions; a BMI of 30 or higher plus a condition such as heart failure, uncontrolled high blood pressure or chronic kidney disease; or a BMI of 27 or higher plus pre-diabetes, a prior heart attack or stroke, or peripheral artery disease. Enrollees must have Part D or a Medicare Advantage plan with drug coverage ^[2]. These tier details do not appear on the CMS beneficiary page ^[1].

Medicare directs people to Medicare.gov/glp1bridge to check whether they might qualify, or to 1-800-MEDICARE (1-800-633-4227), with TTY users calling 1-877-486-2048 ^[1].

Why it matters for patients

Because the Bridge runs outside normal Part D rules, the $50 does not reduce what a beneficiary owes elsewhere in the Part D benefit, and Extra Help does not lower it ^[1][2]. For people who qualify, $50 a month is far below what these drugs can cost through standard coverage. The advisory overview lists Wegovy at about $1,300 a month and estimates coinsurance of 25% to 33%, or roughly $325 to $430 a month, for beneficiaries paying a share of the list price ^[2].

Beneficiaries who do not meet the Bridge criteria remain under ordinary Part D rules. In that setting, the overview says Wegovy is covered only for reducing cardiovascular risk, while Ozempic and Mounjaro are covered for type 2 diabetes ^[2]. Eligibility for the Bridge depends on medical criteria and an approved prior authorization, not on income ^[2].

What happens next

The Bridge is scheduled to run through December 31, 2027 ^[1]. CMS has not said whether the program will continue after that date, or what happens to participants when it ends; that has not been disclosed ^[1][2]. CMS also has not published the specific list of covered drugs on its beneficiary page, so the drug names above come from the advisory overview rather than from Medicare ^[1][2].