The Centers for Medicare and Medicaid Services (CMS) is advancing an initiative that proposes to expand access to GLP-1s for the Medicare population: the Medicare GLP-1 Bridge short-term demonstration program.
Overview of the Medicare GLP-1 Bridge demonstration program
CMS introduced the Medicare GLP-1 Bridge demonstration program as a short-term initiative to expand access to GLP-1 anti-obesity medications for eligible Medicare Advantage (MA) and Fee-For-Service (FFS) beneficiaries with Part D coverage, while longer-term coverage approaches are established.1 The program started on July 1, 2026, and is intended to continue until December 31, 2027.2 The program covers access to Foundayo (orforglipron), Wegovy (semaglutide) injection and tablets, and Zepbound (tirzepatide) KwikPen.
Currently, Medicare beneficiaries can qualify for GLP-1 coverage under their Part D benefit if they meet specific clinical criteria, including a diagnosis of type 2 diabetes or moderate-to-severe obstructive sleep apnea (OSA) with BMI ≥ 30 or noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced liver fibrosis. However, many Medicare beneficiaries who are overweight or obese do not meet these criteria, and the cost of GLP-1 medications can be unaffordable if paying out of pocket. The Bridge program is intended to offer affordable coverage to Medicare beneficiaries who seek treatment for an obesity or weight-management indication, yet do not meet the Part D benefit coverage criteria.
The Bridge program will operate separately from Part D benefits, meaning that use of GLP-1 medications under this program will not accrue Part D costs for the patient or the patient’s health plan. Instead, the Bridge program is designed to process all covered claims centrally, with patients responsible for a $50-per-script unsubsidized cost-sharing. Since this coverage is outside of Part D, the Part D deductible will not apply, beneficiaries will not be eligible for a low-income subsidy, and the copay will also not count toward the beneficiaries’ true out-of-pocket cost maximum. Additionally, manufacturer coupons and savings cards cannot be applied to Bridge program claims.
The demonstration is designed to evaluate how broader access to these therapies may influence health outcomes, healthcare utilization, and Medicare spending while supporting a more comprehensive approach to chronic disease management. Notably, in the first two months since the Bridge program launched, 500,000 Medicare beneficiaries have accessed the program to receive GLP-1.3
What is the overweight and obesity prevalence in the elderly population?
In 2024, the Congressional Budget Office (CBO) estimated that approximately 12.5 million Medicare beneficiaries could become newly eligible for anti-obesity medications under an illustrative policy expanding Medicare coverage to include future FDA-approved indications.4 The CBO estimated that two-thirds of Medicare beneficiaries are obese or overweight, with 35% having a BMI of 25–30 and 34% having a BMI over 30. This estimate illustrates the potential size of the Medicare population that could gain access to anti-obesity medications if coverage were expanded beyond currently covered indications.
Despite the potential size of this population, utilization of GLP-1 medications among Medicare beneficiaries has remained limited, particularly for obesity and weight-management indications that have not traditionally been covered under Part D. According to a 2025 poll conducted by the Kaiser Family Foundation (KFF), only 13% of respondents over age 65 had ever used a GLP-1, and 9% were currently on GLP-1 therapy at the time of polling.5 The survey included GLP-1 use for multiple indications, including diabetes, weight loss, and other chronic conditions, and therefore does not directly measure utilization among Medicare beneficiaries who would be eligible for the Bridge program. However, these findings provide context for the gap between current GLP-1 utilization and the larger population that could potentially gain access through expanded weight-management coverage.
Expanded access through the Bridge program broadens coverage criteria and may also help address several factors that have previously limited GLP-1 uptake, including:
- Prior authorization requirements
- Variable Part D formulary coverage, especially for non-diabetic patients with cardiovascular disease
- Step therapy requirements
- Cost-share and/or specialty tier placement
- Limited primary care prescribing capacity
What are the Medicare GLP-1 Bridge program administrative details?
Eligibility for GLP-1s through the Bridge program is limited to adults aged 18 years and older meeting either of the three defined criteria:6
- Body mass index (BMI) ≥ 35
- BMI ≥ 30 AND one or more of the following: heart failure with preserved ejection fraction, uncontrolled hypertension (defined as systolic blood pressure above 140 mm Hg or diastolic blood pressure above 90 mm Hg, despite concurrent treatment with two antihypertensive medications), or chronic kidney disease stage 3a or above
- BMI ≥ 27 AND one or more of the following: pre-diabetes, previous myocardial infarction, previous stroke, or symptomatic peripheral artery disease
Importantly, the demonstration applies only to GLP-1 therapy prescribed for weight management. Patients receiving GLP-1 medications for other Medicare-covered indications, including diabetes, OSA, or noncirrhotic MASH, continue to receive coverage through the Medicare Part D benefit.
A different prior authorization process
Although the standardized eligibility and centralized administration process is intended to reduce barriers, the Bridge program uses a different prior authorization workflow than traditional Part D benefits. Rather than initiating prior authorization through an integrated electronic prior authorization (ePA) workflow, providers first submit the prescription to the pharmacy with instructions to route the claim through the Medicare GLP-1 Bridge program. Following an intentional initial claim denial, the pharmacy generates the required prior authorization request and sends it back to the prescriber, who must wait for the request before submitting supporting documentation. This reliance on pharmacy-generated prior authorization requests may require additional coordination between prescribers and pharmacies compared with more integrated ePA workflows.
Why ACOs should care about the Medicare GLP-1 Bridge Program
By expanding access to anti-obesity medications, the Bridge program has the potential to improve weight management, glycemic control, cardiovascular outcomes, and chronic kidney disease progression among Medicare populations attributed to Medicare ACOs (MSSP, REACH, and LEAD). For overweight and obese Medicare ACO attributed beneficiaries who do not qualify for GLP-1s under their Part D benefit, the Bridge program can increase access to GLP-1s and potentially lead to reductions in obesity-related adverse events and associated Part A and B spending.
Although Bridge is intended as a short-term program, if it is extended or incorporated into the BALANCE Model, as originally intended, these potential downstream benefits could be evaluated over a longer period of sustained GLP-1 use.7
However, the financial implications of a reduction in Part A and B spending for ACO beneficiaries who benefit from GLP-1 use may be more nuanced. If increased uptake of GLP-1 use results in a reduction in Medicare Parts A and B spending across the Medicare population, those changes could also affect expenditure trends used in developing or updating ACO benchmarks. Depending on how these trends are incorporated into benchmark calculations, the Bridge program could accelerate the rate of improvement against which ACOs are measured, requiring ACOs to reduce spending at least as quickly as the broader market to maintain or improve value-based care performance.
These considerations suggest that the potential implications of the Bridge program for ACOs extend beyond GLP-1 access to the processes needed to support sustained treatment. For ACOs, this may include integrating obesity treatment into population health programs and chronic care management strategies that support weight management and address related cardiometabolic conditions before they result in costly complications. These needs could be fulfilled in various ways, including expanding existing in-house capabilities or engaging technology-enabled partners that can support these efforts through patient identification, eligibility verification, prescription coordination, digital care management, medication adherence, lifestyle coaching, and longitudinal clinical support. Organizations that integrate these capabilities into their infrastructure may be better positioned to improve outcomes, reduce avoidable utilization, and strengthen performance under value-based care arrangements, although the appropriate level of investment will depend on whether these efforts generate sufficient incremental clinical and financial value to justify additional operational costs.
Conclusion
As access to GLP-1 therapies expands, ACOs will increasingly need to integrate medication management with scalable clinical workflows. Organizations that support medication adherence while strengthening chronic disease management may be better-positioned to evaluate and potentially realize improvements in clinical outcomes and total cost of care for at-risk populations.
1 Freed, M., Cubanski, J., & Williams, E. (2026, May 11). What to know about the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge. KFF. Retrieved October 2, 2026, from https://www.kff.org/medicare/what-to-know-about-the-balance-model-for-glp-1s-in-medicare-and-medicaid/.
2 Medicare GLP-1 Bridge. (2026, July 13). Centers for Medicare and Medicaid Services. Retrieved October 2, 2026, from https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge.
3 President Donald J. Trump announces deal with nine additional pharmaceutical manufacturers to lower drug prices for Americans [Fact sheet]. (2026, August 31). The White House. Retrieved October 2, 2026, from https://www.whitehouse.gov/fact-sheets/2026/08/fact-sheet-president-donald-j-trump-announces-deal-with-nine-additional-pharmaceutical-manufacturers-to-lower-drug-prices-for-americans/.
4 Barselau, A., Duchovny, N., Maeda, J., & Zwiefel, N. (2024, October). How would authorizing Medicare to cover anti-obesity medications affect the federal budget?. Congressional Budget Office. Retrieved October 2, 2026, from https://www.cbo.gov/system/files/2024-10/60441-medicare-coverage-obesity.pdf.
5 Palosky, C. (2025, November 14). Poll: 1 in 8 adults say they are currently taking a GLP-1 drug for weight loss, diabetes or another condition, even as half say the drugs are difficult to afford. KFF. Retrieved October 2, 2026, from https://www.kff.org/public-opinion/poll-1-in-8-adults-say-they-are-currently-taking-a-glp-1-drug-for-weight-loss-diabetes-or-another-condition-even-as-half-say-the-drugs-are-difficult-to-afford/.
6 Medicare GLP-1 Bridge. (2026, July 13). Centers for Medicare and Medicaid Services. Retrieved October 2, 2026, from https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge.
7 BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model. (2026, September 29). Centers for Medicare and Medicaid Services. Retrieved October 2, 2026, from https://www.cms.gov/priorities/innovation/innovation-models/balance.