It is a short-term, specialized federal demonstration program running from July 1, 2026, through December 31, 2027. Created by the Centers for Medicare & Medicaid Services (CMS), it operates completely outside of standard Medicare Part D plan coverage to provide dedicated weight-loss medication access to individuals who don’t have coverage options under their current regular plans.

The Bridge Program explicitly covers three specific medications when they are being prescribed strictly to reduce excess body weight:

• Foundayo® (Tablets)
• Wegovy® (Injections and Tablets)
• Zepbound® (KwikPen® formulation only)

Critical Formulation Warning: The Bridge Program explicitly states that standard, single-dose Zepbound pens and Zepbound vials are NOT covered. If your prescription is not written specifically for the KwikPen format, your pharmacy claim will automatically fail.

If your medical paperwork is approved, you will pay a flat $50 copayment for a 28-day or 30-day supply of your medication.

• This $50 cost is fixed, meaning you pay this exact amount even if you normally qualify for Medicare Extra Help.
• Because the Bridge operates outside your normal insurance network, this $50 copay will not count toward your standard Part D annual deductible or your yearly out-of-pocket maximum.
• You cannot use the Medicare Prescription Payment Program to split up or finance this specific monthly copay.

No! This is the single most confusing part of the entire program. The Bridge Program features a strict, mandatory “intentional denial” rule.

Before your medical provider is legally permitted to submit your Prior Authorization paperwork, your pharmacy must first electronically transmit a prescription claim to the Bridge network and receive a formal system rejection. This initial pharmacy denial is actually a required green light that opens the system up so your doctor can submit your medical files.

To qualify for coverage, you must be at least 18 years of age, be using the medication for chronic weight management alongside structured nutrition and lifestyle adjustments, and fit into one of three strict health categories when you start your treatment:

• Category 1 (BMI of 35 or higher): You qualify based entirely on your body mass index alone. No secondary health conditions are required.
• Category 2 (BMI between 30 and 34.9): You must also have a documented medical history of at least one of the following conditions: Heart failure with preserved ejection fraction (HFpEF), uncontrolled high blood pressure (meaning it stays high despite taking two different blood pressure medications), or Chronic Kidney Disease (Stage 3a or above).
• Category 3 (BMI between 27 and 29.9): You must also have a documented medical history of at least one of the following conditions: Pre-diabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease (poor circulation).

Eligible beneficiaries must meet the clinical criteria at the time of GLP-1 therapy initiation — including beneficiaries who initiated therapy prior to July 1, 2026. For example, if a beneficiary initiated GLP-1 therapy in September 2024 with a BMI of 37 and has a BMI of 34 at the time of the July 2026 prior authorization request, the prescribing provider should attest that the beneficiary met the BMI ≥35 criterion at the time therapy was initiated. This is huge for patients already on GLP-1s who have lost weight — you won’t be denied just because your current BMI dropped below the threshold.

If you have Type 2 Diabetes, moderate-to-severe Obstructive Sleep Apnea (OSA), or metabolic dysfunction-associated steatohepatitis (MASH/fatty liver disease), you are explicitly excluded from using the Bridge Program.

However, this is a major advantage for you. Standard Medicare Part D plans are already federally required to cover GLP-1 medications for these specific medical diagnoses. If you have any of these conditions, your care provider must bypass the Bridge entirely and submit your prior authorization directly to your standard Part D insurance provider.

No. The paperwork must be entirely completed and submitted by a prescribing medical professional. Your clinician must attest that all your BMI records and medical history criteria are completely true and accurate under penalty of perjury. The federal government explicitly cross-checks these forms against existing Medicare data registries to independently verify your health history.

No. Once your initial medical prior authorization is officially accepted by the central processor, your subsequent monthly refills will process smoothly without needing new paperwork. The only exception is if your doctor decides to switch your medication (for example, moving you from Wegovy to Foundayo) – switching to a different drug requires your provider to submit an entirely new prior authorization form.

CoreLife simplifies the process from start to finish. Our providers prescribe and manage Bridge Program medications directly, handle the required authorization process for eligible patients, and provide ongoing clinical oversight throughout treatment. Patients pay a simple $50 monthly copay through the Bridge Program, separate from their Medicare Part D coverage, and can fill their prescription at any participating pharmacy. If needed, our care coordinators can also help identify participating pharmacies and answer questions along the way -making it easier to access the care and medication support you need.