Medicare GLP-1 Bridge Runs Through 2027: Open Enrollment Checklist
Medicare's GLP-1 Bridge, which covers Wegovy, Foundayo and the Zepbound KwikPen for weight loss at a $50 monthly copay, now runs through December 31, 2027. To use it you need Part D drug coverage, through either a standalone drug plan or a Medicare Advantage plan with drugs, so the October 15 to December 7 open enrollment window is when to make sure you have it. If your prescriber is a telehealth clinician, the bigger question is whether they will send your prescription to a pharmacy that bills the Bridge and complete the prior authorization.
Key takeaways
- CMS extended the Bridge through December 31, 2027. CMS also said in April 2026 that it will not launch the BALANCE model in Medicare for 2027.
- Eligibility runs through Part D: a standalone prescription drug plan or a Medicare Advantage plan with drug coverage. Some plan types are excluded.
- The $50 copay does not count toward your Part D deductible or out-of-pocket cap, and Extra Help does not lower it.
- Your prescriber does not need to be enrolled in Medicare to submit the Bridge prior authorization, but must not be on Medicare's Preclusion List.
- Bridge approvals are valid through December 31, 2027 unless you change to a different GLP-1.
What changed for 2027
The Bridge launched July 1, 2026. It was first set to end December 31, 2026. CMS's Bridge page now says it provides access "between July 1, 2026, and December 31, 2027."
The extension replaces what was supposed to come next. According to a KFF analysis updated May 11, 2026, CMS announced on April 21, 2026 that it would not implement the BALANCE model in Medicare Part D in 2027, citing a need for more GLP-1 utilization data. KFF also reports that major Part D sponsors had been reluctant to join the model as designed. The Medicaid side of BALANCE is proceeding separately. KFF notes that how coverage continues after 2027 is unclear unless CMS acts again.
For you, that means the Bridge is the Medicare route for weight-loss GLP-1 coverage through all of 2027, and the plan you pick this fall needs to keep you eligible for it.
Who qualifies
CMS's provider information page and prescriber fact sheet set the clinical criteria. You must be 18 or older, and at the time you start GLP-1 therapy, one of these must be true:
| BMI at start of therapy | Plus at least one of |
|---|---|
| 35 or higher | Nothing else required |
| 30 or higher | Heart failure with preserved ejection fraction; uncontrolled high blood pressure despite two blood pressure medicines; or chronic kidney disease stage 3a or higher |
| 27 or higher | Prediabetes; a previous heart attack or stroke; or symptomatic peripheral artery disease |
Source: CMS Medicare GLP-1 Bridge Prescriber Fact Sheet (June 2026).
Some people are excluded because their Part D plan is the right route instead. CMS says people with type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH are not eligible for the Bridge and should go through their Part D plan, as should prescriptions meant to reduce cardiovascular event risk. People already getting a GLP-1 through their Part D plan are also excluded.
The covered products are Foundayo tablets, Wegovy injection and tablets, and the Zepbound KwikPen. Zepbound single-dose pens and vials are not covered, and neither are pen needles.
Your open enrollment checklist
Medicare's Open Enrollment Period runs October 15 to December 7, and changes take effect January 1. Here is what to confirm for Bridge purposes.
- You will have Part D drug coverage on January 1. Medicare.gov lists standalone drug plans, Medicare Advantage plans with drug coverage, Special Needs Plans, employer group plans (EGWPs) and LI NET as qualifying.
- Your plan type is not on the excluded list. CMS says enrollees in private fee-for-service, cost, PACE, fallback and religious fraternal plans are ineligible unless they also have a standalone drug plan.
- You know your total cost. The Bridge copay is $50 for a 28- or 30-day supply. It does not count toward your Part D deductible or out-of-pocket limit, cannot be reduced by Extra Help, and cannot be spread out through the Medicare Prescription Payment Plan. KFF puts the Part D out-of-pocket cap at $2,100 in 2026 and $2,400 in 2027; Bridge copays sit outside it.
- Your other drugs are still covered. Pick a plan for everything else you take. The Bridge runs outside your plan's formulary, so plan choice does not change the $50 copay.
- Your pharmacy can bill the Bridge. Ask whether your pharmacy, including any mail-order pharmacy, processes Bridge claims. CMS has set up a dedicated billing identifier for pharmacies (BIN/PCN 028918 / MEDDGLP1BR, per its pharmacy page).
If you are switching plans and already have a Bridge approval, CMS's pages say approvals last through December 31, 2027 unless you change GLP-1s. They do not address a plan switch specifically, so confirm with 1-800-MEDICARE before you assume nothing changes.
Comparing ways to get a GLP-1?
See how current telehealth options handle Medicare patients, then confirm each provider's licensing, pharmacy and terms directly.
Paid links. We may earn a commission; it never changes what we write. See all options. Compounded medications are not FDA-approved.
How the Bridge prior authorization works
The Bridge uses one central processor instead of your plan. CMS's pharmacy information page names Humana, the current administrator of Medicare's LI NET program, as that processor. The steps, per CMS:
- Your prescriber sends the prescription to a pharmacy with an obesity diagnosis code (E66 family) and the note "SEND TO BRIDGE FOR WEIGHT MANAGEMENT."
- The pharmacy submits the claim, which triggers a prior authorization request to the prescriber, usually within 24 to 72 hours, by electronic PA or fax.
- If no request arrives within 72 hours, the prescriber can download the fax form and submit it directly. Submitting before a pharmacy claim exists returns a "patient not found" error.
- The prescriber attests, under penalty of perjury, that you meet the criteria. Medicare.gov adds that the prescriber certifies you are using the drug as part of a lifestyle program focused on diet and exercise.
- Decisions go to the prescriber within 72 hours of submission and are mailed to you.
Two features are worth knowing. There is no formal appeals process; if a denial looks wrong, the prescriber can resubmit a corrected form. And after the first approved fill, refills and dose changes do not need a new authorization unless you switch to a different GLP-1.
The telehealth questions
Many cash-pay GLP-1 programs are built around their own pharmacies and their own pricing, not around Medicare billing. Before you count on the Bridge, put these questions to the program in writing:
| Question | Why it matters | What a good answer looks like |
|---|---|---|
| Will your clinician complete the Medicare GLP-1 Bridge prior authorization? | The Bridge only works if your prescriber answers the PA request from the pharmacy. | A yes, with how they handle ePA or fax requests and who watches for them. |
| Will you send my prescription to a pharmacy I choose, with the E66 code and Bridge note? | The pharmacy claim starts the process. A program that only ships through its own pharmacy may not bill the Bridge. | Willingness to e-prescribe to your retail or mail-order pharmacy. |
| Is the clinician on Medicare's Preclusion List? | CMS says the prescriber must not be on it for the drug to be coverable. | A direct no. |
| Is the clinician opted out of Medicare? | Opting out does not block the Bridge PA, but Medicare will not pay for that clinician's visits. | A clear statement of what you will pay for visits. |
| What will you charge me for visits and messages? | The Bridge covers the drug, not the program's membership or consult fees. | A written fee schedule. |
Sources: CMS Prescriber Fact Sheet; Medicare.gov, Does your provider accept Medicare?
The opt-out point, clarified
CMS states that "a provider does not need to be enrolled in Medicare in order to write a prescription or submit a prior authorization request" for the Bridge. What disqualifies a prescriber is being on the Preclusion List. So a cash-pay telehealth clinician who never enrolled in Medicare can still get your Bridge drug approved.
Opt-out status matters for a different bill. Medicare.gov says that if a provider has opted out, "Medicare won't pay for any service you get from this doctor, even if it's a Medicare-covered service," and you may pay under a private contract. Medicare.gov links to a lookup of opted-out providers. Know that before you sign up for paid visits.
Hypothetical scenario (illustrative only)
A 68-year-old with original Medicare and a standalone drug plan had a BMI of 31 when starting treatment, has stage 3a chronic kidney disease and no diabetes, and has been paying cash for a GLP-1 through an online program. On paper, that profile matches one of the Bridge criteria. The obstacle is logistical: if the program will only fill through its own pharmacy and will not answer a Bridge PA request, the person would need either a program that will, or their regular doctor, to use the Bridge. Keeping the drug plan through open enrollment keeps that option open.
Reviewing your GLP-1 plan for 2027?
Compare participating providers' current terms, and verify Medicare handling, licensing and pharmacy details with each one.
Paid links. We may earn a commission; it never changes what we write. See all options. Compounded medications are not FDA-approved.
Where this guide stops
This summarizes CMS and Medicare.gov guidance as of October 2026. It is not enrollment or medical advice, and CMS updates Bridge pages and FAQs periodically. For plan choices, use Medicare's plan finder or call 1-800-MEDICARE; your State Health Insurance Assistance Program offers free counseling. Whether a GLP-1 is right for you, and which one, is a decision for you and a prescriber who knows your full history, especially if you have diabetes, kidney disease or heart failure.
Frequently asked questions
How long does the Medicare GLP-1 Bridge last?
CMS says the Bridge provides access between July 1, 2026 and December 31, 2027. CMS announced in April 2026 that it would not launch the BALANCE model in Medicare for 2027.
Do I need a Part D plan to use the Bridge?
Yes. You need Part D drug coverage, such as a standalone drug plan or a Medicare Advantage plan with drug coverage. Private fee-for-service, cost, PACE, fallback and religious fraternal plan enrollees are ineligible unless they also have a standalone drug plan.
Does the $50 Bridge copay count toward my out-of-pocket cap?
No. Medicare.gov says the copay does not count toward your Part D deductible or out-of-pocket limit, and Extra Help cannot lower it.
Can a telehealth clinician who isn't enrolled in Medicare submit the Bridge prior authorization?
Yes. CMS says a provider does not need to be enrolled in Medicare to prescribe or submit the Bridge prior authorization, but must not be on Medicare's Preclusion List. If the clinician has opted out of Medicare, Medicare will not pay for their visits.
Do I need a new prior authorization in 2027?
CMS says Bridge approvals are valid through December 31, 2027, including refills and dose changes, unless you switch to a different GLP-1.
Sources
- CMS, Medicare GLP-1 Bridge (last modified 07/13/2026)
- CMS, Medicare GLP-1 Bridge: Information for Providers (last modified 08/06/2026)
- CMS, Medicare GLP-1 Bridge Prescriber Fact Sheet (June 2026)
- CMS, Medicare GLP-1 Bridge: Information for Pharmacies (last modified 08/17/2026)
- Medicare.gov, Weight loss drugs
- Medicare.gov, Joining a plan (enrollment periods)
- Medicare.gov, Does your provider accept Medicare as full payment?
- KFF, What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge (updated May 11, 2026)
Medical disclaimer: This article is general information, not medical advice, and does not replace a licensed clinician who knows your history. Approvals, labels, coverage and prices change; check the linked sources and talk with your prescriber or pharmacist before making decisions about any medication.