What are GLP-1 Medications?

Semaglutide (e.g., Ozempic®, Wegovy®)
Liraglutide (e.g., Victoza®, Saxenda®)
Tirzepatide (e.g., Zepbound®, Mounjaro®)
Orforglipron (Foundayo®)

These medicines may be used to treat Type 2 diabetes, help with weight loss, or lower the risk of some heart problems. Your provider will decide if one of these medicines is right for you.

What is the Medicare GLP-1 Bridge Program? (click here) ➜

The Medicare GLP-1 Bridge program is a temporary program that provides access for beneficiaries to certain weight loss medications that are not normally covered under the Part D plan.

What is the Timeline for the Program? (click here)➜

The GLP-1 Bridge Program will be in effect for 18 months, beginning July 1, 2026 and ending December 31, 2027.

What are the Costs for the Program? (click here)➜

If you qualify, your cost will be $50 for each month’s supply, and the low-income subsidy is not applicable. This program is separate from your regular Part D drug coverage and does not apply to your deductible, donut hole, or TrOOP costs.

What are the Overall Eligibility Criteria? (click here)➜

Meet health criteria and have never filled a past prescription for a GLP-1 under Medicare Part D.
Have a prescription for a covered GLP-1 medication for weight loss and maintain weight reduction; and
Are enrolled in an eligible plan type.

What are the Health Criteria?

Eligibility for the GLP-1 Bridge Program requires that patients have not have a history of filling a GLP-1 prescription under Medicare Part D. Patients must also meet defined BMI and clinical health criteria, including:

1. BMI of 35 or higher; or
2. BMI of 30 or higher with a diagnosis of: (1) heart failure, (2) uncontrolled high blood pressure, &/or (3) chronic kidney disease (stage 3a or higher); or
3. BMI of 27 with a diagnosis of: (1) pre-diabetes, (2) previous heart attack, (3) previous stroke, &/or (4) symptomatic Peripheral Artery Disease (PAD).

What are the Covered GLP-1 Medications?

The program covers these medicines when they are prescribed for weight loss: Foundayo® tablets, Wegovy® injection, Wegovy® tablets, and Zepbound® KwikPen®.

What are the Eligible Plan Types?

For 2026, you may qualify if you are in one of these Medicare drug plan types:

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); or
Part D Special Needs Plan (SNP); or
Employer/Union Group Waiver Plan (EGWP); or the
Limited Income Newly Eligible Transition (LI NET) program.

If you have both Medicare and Medicaid, you may still qualify if you are in an eligible Medicare drug plan and meet the approval rules. If you have TRICARE For Life, you may qualify only if you are also in an eligible Medicare drug plan. (Please note: 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.)

Not sure what plan you have? View How do I Determine my Medicare Part D Plan Type section below or ask your Kinney Pharmacist!

How do I Determine my Medicare Part D Plan Type? (click here)➜

You can identify your plan type and details by checking your plan ID card and/or enrollment materials (such as Annual Notice of Change or Evidence of Coverage) which should show both the plan name and plan type (e.g., “Medicare Prescription Drug Plan (PDP)” or “Medicare Advantage Prescription Drug Plan (MA-PD). If it says PDP, it’s a standalone drug plan. If it’s bundled with medical coverage (HMO/PPO), it’s a Medicare Advantage plan with drug coverage (MA-PD). You can also log into your MyMedicare account on www.Medicare.gov, call your plan provider at the number listed on the back of your ID card, or call 1-800-MEDICARE (1-800-633-4227).

What are the Steps to Participate? (click here)➜

To participate in the Medicare GLP-1 Bridge Program, follow these steps:

YOU should see your healthcare provider to ensure that you meet clinical health criteria.
YOUR PROVIDER will electronically send a prescription for a covered medication to Kinney Drugs.
YOU must provide Kinney with your Medicare ID number on your red, white and blue card to bill the Bridge Program.
KINNEY DRUGS will first try to fill the medication under your Part D plan. If a prior authorization is required, Kinney Drugs will request a prior authorization from your healthcare provider.
YOUR PROVIDER will submit the PA through CMS’s GLP-1 Bridge Program portal if not covered under Part D.
THE BRIDGE PROGRAM will authorize Kinney Drugs to fill the prescription, once the PA is approved.

PLEASE NOTE: This process can take 3-14 days to complete for the first fill. Subsequent refills (including dosage changes) would follow the normal refill process. (If your prescriber were to change your prescribed medication, the process would begin again.)