Medicare GLP

The Medicare GLP-1 Bridge is a temporary Medicare program that may help certain Medicare Part D patients access specific GLP-1 medications for weight management.

The program begins July 1, 2026 and is currently scheduled to run through December 31, 2027.

This is not regular Medicare Part D coverage. It is a separate Medicare program with its own rules, covered medications, and approval process.

If approved, eligible patients may pay a $50 copay for a one-month supply of certain covered GLP-1 medications.

Approval is not automatic. Your healthcare provider must send a prescription and complete the required prior authorization.

You may qualify if:

You have Medicare drug coverage, also called Medicare Part D, and your provider is prescribing the medication for weight reduction or ongoing weight maintenance.

Your provider must also confirm that you meet Medicare’s clinical criteria.

In general, you may qualify if one of these applies:

You have a BMI of 35 or higher.

OR

You have a BMI between 30 and 34.99 and at least one qualifying health condition, such as:

• Heart failure with preserved ejection fraction
• Uncontrolled high blood pressure
• Chronic kidney disease stage 3a or higher
• Prediabetes
• Previous heart attack
• Previous stroke
• Symptomatic peripheral artery disease

OR

You have a BMI between 27 and 29.99 and at least one qualifying health condition, such as:

• Prediabetes
• Previous heart attack
• Previous stroke
• Symptomatic peripheral artery disease

Important: Skippack Pharmacy does not decide who qualifies. Your healthcare provider and the Medicare prior authorization process determine eligibility.

At this time, the Medicare GLP-1 Bridge includes:

• Foundayo tablet
• Wegovy injection
• Wegovy tablet
• Zepbound KwikPen only

The list of covered products may change during the program. We recommend checking with Medicare, your provider, or our pharmacy team before assuming a medication is covered.

The following medications are not included under the Medicare GLP-1 Bridge for weight management:

• Ozempic
• Mounjaro
• Compounded semaglutide
• Compounded tirzepatide
• Zepbound single-dose vials
• Zepbound single-dose pens

Some GLP-1 medications may still be covered by regular Medicare Part D for certain medical conditions, such as type 2 diabetes. That is separate from the Medicare GLP-1 Bridge.

*60-day and 90-day fills are NOT available through this program*

Step 1: Talk to your healthcare provider.

Ask your provider if a GLP-1 medication is medically appropriate for you and whether you may meet Medicare’s criteria.

Step 2: Your provider sends the prescription.

Starting July 1, 2026, your provider can send a prescription for a covered GLP-1 medication to the pharmacy.

Step 3: The pharmacy processes the prescription.

The pharmacy will process the prescription through the Medicare GLP-1 Bridge system. We may need your Medicare Number or your Medicare card to help process the claim.

Step 4: Your provider completes the prior authorization.

Your provider must complete the required prior authorization. This is where Medicare reviews whether you meet the program criteria.

Step 5: You wait for approval.

Approval is not instant and is not guaranteed. Medicare or the program processor will review the information submitted.

Step 6: If approved, you pay $50.

If approved, you may pay $50 for a one-month supply of the covered GLP-1 medication.

To help avoid delays, please have the following ready:

• Your Medicare card or Medicare Number
• Your Medicare Part D or Medicare Advantage drug plan card
• Your current height and weight
• Your starting weight or BMI if you already started GLP-1 therapy before this program
• The name of the medication your provider is prescribing
• Your provider’s name, phone number, and fax number
• A list of your major health conditions
• Any letter or prior authorization notice you receive from Medicare or the program processor

If you do not have your Medicare card, the pharmacy may ask for the last 4 digits of your Social Security number to help locate your Medicare Number.

For more information about the Medicare GLP-1 Bridge, visit Medicare’s official page at:

Medicare.gov/coverage/weight-loss-drugs

You can also call 1-800-MEDICARE with questions about eligibility, coverage, or prior authorization.