Medicare GLP-1 Bridge Program

No. Completing our interest form does not enroll you, guarantee approval or begin the prior authorization by itself.

The form helps Skippack Pharmacy collect the information needed to process your prescription through the Medicare GLP-1 Bridge.

Your healthcare provider must also:

Decide whether a GLP-1 medication is medically appropriate for you.
Send a prescription for a covered medication to Skippack Pharmacy.
Complete the Medicare GLP-1 Bridge prior authorization.

Please do not submit multiple interest forms. We will contact you if additional information is needed.

Yes. All medications offered through the Medicare GLP-1 Bridge require a valid prescription.

Your provider must select the medication and dose, send the prescription to Skippack Pharmacy with an indication “SEND TO
BRIDGE FOR WEIGHT MANAGEMENT”  and complete the prior authorization when requested.

Skippack Pharmacy cannot prescribe the medication or determine whether it is medically appropriate for you.

You may qualify if:

• You are at least 18 years old.
• You have an eligible Medicare prescription drug plan.
• The medication is being prescribed to reduce excess body weight or maintain weight reduction.
• You are participating in ongoing lifestyle changes that include nutrition and physical activity.
• You met one of Medicare’s clinical criteria when you first started GLP-1 therapy.

You may meet the clinical criteria if one of the following applies:

Your starting BMI was 35 or higher.

OR

Your starting BMI was 30 or higher and you had at least one of the following:

• Heart failure with preserved ejection fraction
• Uncontrolled high blood pressure despite treatment with two blood pressure medications
• Chronic kidney disease stage 3a or higher

OR

Your starting BMI was 27 or higher and you had at least one of the following:

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

Skippack Pharmacy does not make the final eligibility decision. Your provider must document your information, and eligibility is determined through the Medicare prior authorization process.

You may not qualify if:

• You are younger than 18.
• You do not have eligible Medicare prescription drug coverage.
• You do not meet Medicare’s clinical criteria.
• The medication is not being prescribed for weight reduction or weight maintenance.
• Your Medicare Part D plan is already paying for your GLP-1 medication.
• The medication is being prescribed for type 2 diabetes, moderate-to-severe obstructive sleep apnea or certain forms of MASH because those uses may need to be processed through your regular Medicare Part D plan.

Not every Medicare plan type qualifies. Call 1-800-MEDICARE if you are unsure whether your drug plan is eligible.

The Medicare GLP-1 Bridge currently includes:

• Foundayo tablets ( NDCs: 0002-4178-31, 0002-4503-31, 0002-4794-31, 0002-4803-31, 0002-4839-31, 0002-4953-31)
• Wegovy injections (NDCs: 0169-4525-14, 0169-4505-14, 0169-4501-14, 0169-4517-14, 0169-4524-14, 0169-4572-14)
• Wegovy tablets (NDCs: 0169-4415-31, 0169-4404-31, 0169-4409-31, 0169-4425-31)
• Zepbound KwikPen (NDCs: 0002-3566-11, 0002-3555-11, 0002-3544-11, 0002-3533-11, 0002-3522-11, and 0002-3511-11)

The following products are not included:

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

Some of these medications may still be covered through regular Medicare Part D when prescribed for certain medical conditions. That is separate from the Medicare GLP-1 Bridge.

The list of covered medications may change during the program.

No. The Zepbound KwikPen does not come with pen needles, and pen needles are not covered by the Medicare GLP-1 Bridge.

Compatible pen needles may be purchased separately from Skippack Pharmacy for $5 for four needle tips, which is a one-month supply.

A new needle must be used for each weekly injection.

The general process is:

Step 1: Skippack Pharmacy receives your prescription.

Your provider sends a prescription for a covered medication to Skippack Pharmacy.

Step 2: We process the prescription.

We submit the prescription through the Medicare GLP-1 Bridge system. We may need your Medicare Number or Medicare card before we can process it.

Step 3: A prior authorization request is sent to your provider.

The request is generally sent electronically or by fax within 24–72 hours after the pharmacy processes the claim.

Step 4: Your provider completes the prior authorization.

Your provider must submit your BMI, medical history and other required information.

Step 5: Medicare reviews the request.

Medicare’s program processor reviews the completed prior authorization and issues an approval or denial.

Step 6: Skippack Pharmacy processes the approved prescription.

If approved, we will process the prescription and contact you regarding medication availability, payment, or pickups.

After Skippack Pharmacy processes your prescription, the prior authorization request is generally sent to your provider within 24–72 hours.

Once your provider submits the completed prior authorization, a decision is generally sent within 72 hours.

The 72-hour review period does not begin when you complete Skippack Pharmacy’s interest form. It begins after your provider submits the completed prior authorization.

The process may take longer if:

• We have not received the prescription.
• Your Medicare information is missing.
• Your provider has not completed the authorization.
• The authorization contains missing or incorrect information.
• Additional medical records are needed.

First, contact your provider and confirm that the completed Medicare GLP-1 Bridge prior authorization was submitted.

Submitting a prescription does not mean the prior authorization has been completed.

Approval or denial notices are generally:

• Mailed to the patient
• Sent electronically or by fax to the prescriber

Skippack Pharmacy may not immediately receive the approval or denial notice. We will contact you when we can successfully process the prescription or when additional information is needed.

Please do not submit another interest form while your authorization is being reviewed.

If approved, the copay is $50 for one 28- or 30-day supply of a covered medication.

The $50 payment:

• Does not count toward your Medicare Part D deductible.
• Does not count toward your Part D out-of-pocket maximum.
• Is not reduced by Medicare Extra Help.
• Cannot be spread across monthly payments through the Medicare Prescription Payment Plan.
• Cannot be combined with manufacturer coupons or discount cards.

Additional supplies that are not covered by the Bridge, such as Zepbound KwikPen needles, are purchased separately.

No. The Medicare GLP-1 Bridge allows only one 28- or 30-day supply per fill.

Sixty-day and 90-day supplies are not available through this program, even when the prescription includes multiple refills.

Generally, no.

Once approved, the Medicare GLP-1 Bridge prior authorization is valid through December 31, 2027.

A new prior authorization is generally not needed for:

• Regular monthly refills
• An increase in dose
• A decrease in dose

Your provider must still send a new prescription when your dose changes.

A new prescription and a new prior authorization are required when you switch from one covered GLP-1 medication to another.

For example, an approval for Wegovy does not automatically cover Zepbound KwikPen.

Contact your provider if you want to discuss switching medications.

You and your provider should receive a notice explaining the decision.

There is not a traditional appeal process through the Medicare GLP-1 Bridge. However, your provider may submit the prior authorization again if:

• Incorrect information was entered.
• Information was missing.
• Updated medical information is available.
• Additional documentation may show that you qualify.

Skippack Pharmacy cannot change or overturn Medicare’s eligibility decision.

Contact your healthcare provider if:

• You need a prescription.
• You want to know whether a GLP-1 is medically appropriate.
• Your prior authorization has not been completed.
• Your BMI or medical information is missing.
• You need a dose change.
• You want to switch medications.

Call 1-800-MEDICARE if:

• You have questions about Medicare eligibility.
• You are unsure whether your plan qualifies.
• You received an approval or denial notice you do not understand.
• You need general information about the Medicare GLP-1 Bridge.

Contact Skippack Pharmacy if:

• Your provider has already sent your prescription.
• You need to provide your Medicare information.
• Your authorization has been approved.
• You have questions about medication availability.
• You need information about pickup,  payment or pen needles.