CMS issues Bridge operating guidance for Part D plans

The Centers for Medicare & Medicaid Services has published operating guidance for Part D plans on the Medicare GLP-1 Bridge, a demonstration program that gives eligible beneficiaries access to certain GLP-1 drugs for weight management from July 1, 2026, through December 31, 2027 ^[1]. The guidance confirms that the Bridge sits entirely outside the Part D benefit's usual coverage and payment system, so Part D sponsors do not carry financial risk for these drugs and do not need to opt in for their members to use the program ^[1].

Under the Bridge, CMS is using Humana, which already runs the Limited Income Newly Eligible Transition program, as a single central processor to handle prior authorization, claims, and pharmacy payment nationwide ^[1]. Three products qualify when prescribed to reduce or maintain weight loss: Foundayo (orforglipron), all forms of Wegovy (semaglutide), and only the KwikPen version of Zepbound (tirzepatide); single-dose vials and pens of Zepbound do not qualify ^[1]. Manufacturers are supplying these drugs at a net price of $245 per month, and eligible beneficiaries pay a flat $50 copay that does not change based on where they are in the Part D benefit's coverage phases ^[1].

To qualify, a prescriber must attest that a beneficiary is at least 18 and meets one of three BMI-based thresholds: a BMI of 35 or higher on its own; a BMI of 30 or higher with heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease stage 3a or higher; or a BMI of 27 or higher with prediabetes, a prior heart attack, prior stroke, or symptomatic peripheral artery disease ^[1]. The Bridge is meant only for people seeking a GLP-1 solely for weight management. Anyone diagnosed with type 2 diabetes, moderate to severe obstructive sleep apnea, or MASH (a liver disease formerly called NASH) with moderate to advanced scarring is instead directed to seek coverage through their regular Part D plan, since those conditions are already covered under the standard benefit ^[1]. CMS said the Bridge was extended through the end of 2027 after a separate initiative, the BALANCE Model, did not launch that year, which will let the agency keep collecting usage data ahead of any future changes to how GLP-1s are covered under Part D ^[1].

Why it matters for patients

Because the Bridge runs as its own payment channel, the $245 net price and $50 copay do not count toward a beneficiary's total drug costs or true out-of-pocket spending under Part D, and low-income cost-sharing subsidies do not apply to the copay ^[1]. That means someone using the Bridge for weight loss is tracking a separate cost ledger from their regular Part D drug spending. Coupons and manufacturer discount programs cannot be layered on top of a Bridge claim, and pharmacies can only submit claims electronically — there is no paper claims process or way for a patient to pay and then seek reimbursement directly ^[1]. CMS also said it will watch Part D plans closely to make sure they don't push people who qualify for standard formulary coverage — such as those prescribed Wegovy for cardiovascular risk reduction or Zepbound for sleep apnea — over to the Bridge instead of processing a normal coverage request ^[1].

What happens next

The Bridge began accepting claims July 1, 2026, and is set to run through December 31, 2027 ^[1]. CMS said it has not yet decided what lookback period it will use in 2027 to determine whether someone already received a GLP-1 through Part D that year, a rule it is currently applying using 2026 utilization data ^[1].