As of July 1, 2026, eligible Medicare Part D Members may be able to access certain GLP-1 medications for weight management through the CMS Medicare GLP-1 Bridge Program. This is a temporary federal demonstration program administered by the Centers for Medicare & Medicaid Services (CMS), not by MVP. The program operates outside of MVP Medicare Advantage and DualAccess Part D benefits, and CMS, not MVP, determines eligibility, reviews prior authorization requests, processes claims, and makes coverage decisions.

What Providers Need to Do

1. Confirm the Member is enrolled in eligible Medicare Part D coverage or a Medicare Advantage plan that includes Part D drug coverage.
2. Determine whether the GLP-1 medication is prescribed only for weight management. If the medication is being prescribed for another Part D-covered indication-such as type 2 diabetes, moderate-to-severe sleep apnea, or MASH-the request should follow the Member’s standard Part D coverage process, not the Bridge Program.
3. Review CMS clinical criteria before submitting the request. CMS may consider Members who are age 18 or older, are making Provider-recommended lifestyle changes, and meet BMI and qualifying condition requirements.
4. Identify whether the requested medication is included in the Bridge Program. The program may include Foundayo tablets, Wegovy injection or tablets, and Zepbound KwikPen. Other formulations may not be eligible through the Bridge Program.
5. Submit the prior authorization request directly to CMS through the CMS-designated process. CMS strongly encourages electronic submission through CoverMyMeds. Providers may also use the CMS Medicare GLP-1 Bridge prior authorization fax form.
6. Send the prescription for the eligible GLP-1 medication to the Member’s pharmacy after submitting the prior authorization request.
7. Direct Members to CMS for program questions, including eligibility, approval status, cost, and coverage decisions. MVP cannot approve, deny, or modify Bridge Program requests.

Key Eligibility Points to Review Before Submitting

CMS determines final eligibility, but Providers can help avoid delays by reviewing the Member’s clinical and coverage information before submitting a request. In general, the Bridge Program is intended for Medicare Part D Members who are prescribed an eligible GLP-1 medication for weight management only and who are not eligible to receive the GLP-1 medication through their Part D plan for another covered indication.

Providers should be prepared to attest that the medication is being prescribed to reduce excess body weight and maintain weight reduction, that the Member is engaged in lifestyle changes, and that the Member meets CMS BMI and qualifying condition criteria. CMS criteria may include a BMI of 35 or higher, a BMI of 30 or higher with certain qualifying conditions, or a BMI of 27 or higher with certain qualifying conditions.

Important Reminders for Providers

1. The Bridge Program is not part of MVP’s Medicare Advantage or DualAccess Part D benefit.
2. MVP does not process Bridge Program prior authorization requests or claims.
3. Bridge Program approvals, denials, and appeals are handled through the CMS-designated process.
4. Members approved through the Bridge Program may have a fixed monthly cost determined by CMS.
5. If a Member is approved for one eligible GLP-1 medication and later needs to switch to another eligible medication, the Provider must submit a new prior authorization request through the CMS process.
6. Members may not use discounts, coupons, or the Medicare Prescription Payment Plan to pay for medications prescribed through the Bridge Program.