The Centers for Medicare & Medicaid Services has shared updates on its website on the Medicare GLP-1 Bridge, where CMS will provide eligible Medicare beneficiaries access to certain GLP-1 medications for $50 per month beginning July 1, 2026, and running through Dec. 31, 2027. Details are below.
Patient eligibility. To qualify for coverage of eligible GLP-1 drugs via the Medicare GLP-1 Bridge, Medicare beneficiaries must meet certain prior authorization criteria and be enrolled in a standalone prescription drug plan (PDP) or Medicare Advantage (MA) coordinated care plan (i.e., HMO, HMOPOS, and Local and Regional PPO plans) that offers prescription drug coverage (MA-PD plans) in CY 2026. Part D beneficiaries in Special Needs Plans (SNPs), employer/union group waiver plans (EGWPs), and the Limited Income Newly Eligible Transition (LI NET) program are eligible to participate. Beneficiaries enrolled in private fee-for-service plans, section 1876 cost contract plans, section 1833 health care prepayment plans, PACE organizations, fallback plans, and religious fraternal benefit plans are not eligible to participate unless also enrolled in a standalone PDP, as applicable. Additionally, dually eligible beneficiaries who are enrolled in eligible Part D plan types and meet the prior authorization criteria will have access to GLP-1 drugs via the Medicare GLP-1 Bridge.
Eligible GLP-1s. At this time, for the purposes of the Medicare GLP-1 Bridge, an eligible GLP-1 drug is any of the following products when used to reduce excess body weight and maintain weight reduction: Foundayo, Wegovy (injection and tablets), and Zepbound (KwikPen).
Beginning July 1, 2026, all formulations of Foundayo, all formulations of Wegovy, and the KwikPen formulation of Zepbound will be available to eligible beneficiaries through the Medicare GLP-1 Bridge. The single-dose vial and single-dose pen formulations of Zepbound will not be available through the Medicare GLP-1 Bridge. The specific National Drug Codes (NDCs) as of 5/8/2026 are listed below:
- Foundayo NDCs: 0002-4178-31, 0002-4503-31, 0002-4794-31, 0002-4803-31, 0002-4839-31, 0002-4953-31
- Wegovy NDCs: 0169-4525-14, 0169-4505-14, 0169-4501-14, 0169-4517-14, 0169-4524-14, 0169-4415-31, 0169-4404-31, 0169-4409-31, 0169-4425-31, 0169-4572-14
- Zepbound NDCs: 0002-3566-11, 0002-3555-11, 0002-3544-11, 0002-3533-11, 0002-3522-11, and 0002-3511-11
This list of products and NDCs may be updated over the course of the Medicare GLP-1 Bridge.
Payment to pharmacies. Pharmacies do not need to opt in to participate in the Medicare GLP-1 Bridge. CMS and the central processor will provide additional technical instructions on pharmacy claims processes for the Medicare GLP-1 Bridge in the coming months. CMS has established a Bank Identification Number (BIN) and a Processor Control Number (PCN) specific to the Medicare GLP-1 Bridge (028918 MEDDGLP1BR). CMS will conduct outreach and education to help pharmacists understand when to submit a claim request for an eligible GLP-1 drug to the beneficiary’s plan versus the central processor. Pharmacies will collect a $50 copay amount from the eligible beneficiary, and the central processor will process payment to the pharmacy. Pharmacies will be reimbursed by the central processor at the wholesale acquisition cost of a drug, less the beneficiary copay, plus a dispensing fee and, as applicable, sales tax.
NCPA will be hosting a webinar on the GLP-1 Bridge soon to educate members. CMS will share additional information for beneficiaries as the program begins. In addition, CMS continues to work with stakeholders — including providers, pharmacies, and manufacturers — to support implementation and ensure all partners have the information they need ahead of launch. For more information, including an FAQ and payer sheet, see CMS’ webpage here.
