Medicare GLP-1 Bridge
Who qualifies for Medicare's $50 GLP-1 copay?
You qualify for the $50 GLP-1 copay if you have Medicare Part D and meet one of three BMI-and-condition profiles under the Bridge program — and you do not already have a condition Medicare covers a GLP-1 for.
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About 3.8 million Medicare Part D members are expected to be eligible. The three qualifying profiles are: a BMI of 35 or higher; a BMI of 30 or higher with chronic kidney disease (stage 3a+), HFpEF, or uncontrolled blood pressure on two or more medications; or a BMI of 27 or higher with prediabetes, a past heart attack or stroke, or symptomatic peripheral artery disease.
One step trips people up: the pharmacy has to submit the claim and get a denial first, and only then can your doctor file the prior authorization that unlocks the $50 copay. It feels like a rejection, but the denial is a required part of the process.
Related questions
Does the $50 count toward my deductible?
No. The $50 monthly copay does not count toward your Part D deductible or your out-of-pocket limit.
Why did my pharmacy deny the claim?
The denial is required under the Bridge. Bring it to your doctor, who then files the prior authorization referencing it.
Not sure if you qualify?
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