Regulatory NewsBREAK: CMS Releases Frequently Asked Questions on the Medicare GLP-1 Bridge

On March 3, 2026, the Centers for Medicare & Medicaid Services (CMS) issued Frequently Asked Questions (FAQs) about the Medicare GLP-1 Bridge (the Bridge).

The Bridge will offer early access to GLP-1 drugs for weight loss to eligible Medicare Part D beneficiaries.

• The Bridge will be a short-term demonstration that will run from July 1 to December 31, 2026.
• It will act as a transition to the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model, which starts in 2027. 
• Part D sponsors are not involved in the Bridge's operations or risks. The program will operate outside the Medicare Part D benefit and will utilize a central processor to handle prior authorizations, claims, and payments.

The Bridge will be available nationwide and will be accessible to Medicare beneficiaries enrolled in standalone Prescription Drug Plan (PDP) or Medicare Advantage plans with drug coverage in 2026, including certain Special Needs Plans and dually eligible beneficiaries.

Eligible drugs include Wegovy (both injectable and tablets) and Zepbound when used for weight loss and maintenance.

Providers must submit prior authorization requests and prescriptions for eligible GLP-1 drugs to a central processor instead of the beneficiary’s Part D plan. CMS will offer more details on this process in Spring 2026.

Providers must verify that beneficiaries meet specific BMI thresholds and have certain health conditions, such as heart failure, hypertension, chronic kidney disease, pre-diabetes, or a history of cardiovascular issues.

Pharmacies must use a specific BIN and PCN for claims to the central processor, collect a $50 copay from beneficiaries, and will be reimbursed at no less than the wholesale acquisition cost, minus the copay, plus a dispensing fee.

Part D plans are not responsible for Bridge drugs and should direct providers to the central processor if they submit prior authorization requests for Bridge drugs. The Bridge does not impact beneficiary appeal rights under Part D.

GLP-1 drugs under the Bridge cost $245 per month with a $50 copay that does not count toward Part D out-of-pocket costs or subsidies. Drugs covered under standard Part D remain under Part D coverage and management. 

More on This Topic:

• FAQs
• BALANCE Model News Release 

For questions, please reach out to Vicky Jucelin.