On July 1, 2026, CMS launched Medicare GLP-1 Bridge, which gives, for the first time ever, eligible Part D beneficiaries access to GLP-1s for weight loss. Use Healthie? Here’s how to participate and best practices setting up Healthie configurations. 

Last updated: July 7, 2026 | We'll update this guide as CMS releases new guidance.

Overview

• CMS launched the Medicare GLP-1 Bridge, a Section 402 demonstration that gives eligible Medicare Part D beneficiaries access to Wegovy, Zepbound KwikPen, and Foundayo for a flat $50/month copay through December 31, 2027 (CMS press release).
• This is effectively the first time Medicare has covered GLP-1s for weight loss and a net new population of Medicare patients (KFF estimates roughly 3.8 million Americans) may be eligible to benefit from GLP-1s.
• Medical providers must attest that the drug is being used "in combination with current and ongoing lifestyle modification including structured nutrition and physical activity" (CMS, Information for Providers).

Medicare is covering GLP-1s for the first time

Historically, Medicare Part D was statutorily prohibited from covering drugs used solely for weight loss. A patient with obesity but no diabetes could be an ideal GLP-1 candidate and still face full retail pricing well above the Bridge's negotiated rate. This made the medicines unaffordable. 

Here’s what changed on July 1, 2026:

• Dates: July 1, 2026 through December 31, 2027 (an 18-month window). It was originally slated to run through the end of 2026 as a bridge to the BALANCE Model, but CMS extended it a year after the BALANCE Model's Part D launch was shelved when major insurers declined to participate.
• Cost: A flat $50 monthly copay. Manufacturers provide the drugs at a net price of ~$245/month; CMS covers the remaining $195 (CMS, Information for Pharmacies).
• Covered drugs: all formulations of Wegovy (injection and tablets), all formulations of Foundayo (orforglipron), and Zepbound KwikPen only. Single-dose vials and pens are excluded (CMS, Information for Providers).
• It runs outside Part D. Part D plans don't process claims. CMS uses Humana as the central processor. The $50 copay doesn't count toward the Part D deductible or out-of-pocket cap, and low-income subsidies don't apply.
• Nationwide, all states and territories.

Who's eligible (per CMS's clinical criteria, assessed at the time GLP-1 therapy was initiated): enrolled in an eligible Part D plan; age 18+; and one of three tiers — BMI ≥35 alone; BMI ≥30 with HFpEF, uncontrolled hypertension, or CKD stage 3a+; or BMI ≥27 with prediabetes, prior MI, prior stroke, or symptomatic peripheral artery disease. Excluded: anyone who can already get a GLP-1 through Part D for type 2 diabetes, moderate-to-severe OSA, or MASH.

To qualify a patient, the prescriber has to submit a prior authorization attesting that the drug is prescribed "to reduce excess body weight and maintain weight reduction in combination with current and ongoing lifestyle modification including structured nutrition and physical activity consistent with the applicable FDA approved label" (CMS, Information for Providers). Structured nutrition and physical activity are written into eligibility attestation. 

Prospective gaps, depending on care team composition 

• Prescribing providers must be a part of the Care Team
• Overall, Medicare’s Medical Nutrition Therapy (MNT) benefit, covered at 100% with no cost-sharing, is limited to diabetes, non-dialysis chronic kidney disease, and the 36 months following a kidney transplant. A diagnosis of obesity alone may not qualify for MNT
• There's a Intensive Behavioral Therapy (IBT) for obesity benefit (BMI ≥30, up to 22 visits per 12-month period), but it has to be furnished in a primary care setting and billed by, or "incident to," a primary care provider.

Bridge is temporary for now

Bridge is currently slated for 18 months, and currently slated to end December 31, 2027. Medicare is still barred by law from covering weight-loss drugs. CMS can't make this permanent on its own; it's testing it under temporary "demonstration" authority. Congress could elect to turn this demonstration into a program. Its intended successor, the BALANCE Model for Medicare Part D, didn't launch as planned after major insurers declined to commit. There's currently no guaranteed path for these patients to keep affordable GLP-1 access after 2027 — as KFF's Juliette Cubanski told CBS News, "we have this temporary program, and then no clear path forward yet as to what will happen at the end of 2027." 

The Medicare GLP-1 Bridge Workflow in Healthie

Use Healthie? Here’s how we recommend setting up your account

Step 1:  Identify Prospective Patients

• Create a Patient Tag: "Bridge-Eligible"
• Build a filtered view in your Client List: BMI ≥27, no diabetes/OSA/MASH diagnosis code, Medicare Part D as payer (Need help with this? Reach out).
• Run a baseline report off of this view

Step 2: Build a Bridge / GLP-1 Charting Template: Create a dedicated charting template for Bridge and GLP-1 visits. 

Include:

• BMI and weight, set as Metric fields so they populate the patient's Metrics graph automatically
• Structured nutrition plan and physical activity guidance, matched to the attestation language
• Protein intake and body-composition tracking
• GI symptom and tolerance notes
• Lifestyle-modification attestation language for the prescriber's PA file

Use Smart Fields to pull BMI and relevant history from your intake form into this template automatically, and Smart Phrases for the attestation-support language you'll write most often.

Step 3: Set Up Longitudinal Tracking via Metrics: Bridge patients need an ongoing record, not a single visit note. Create Custom Metrics for weight, BMI, protein intake, and body composition, and add them to your GLP-1 charting template so each visit updates the patient's Metrics graph automatically. If you use connected scales or wearables, Healthie syncs with Apple Health, Fitbit, and iHealth to pull this data in without manual entry.

Step 4: As relevant, configure your Cash-Pay GLP-1 Support Program: Build your companion track as a Program, with modules for initial assessment, protein and muscle-preservation coaching, GI-symptom management, and a taper/maintenance plan for after 2027. Price and bill it with Packages and/or offer it as no charge as part of building longitudinal relationship with your patients. 

Step 5 — Set Up Referral and Follow-Up Workflows

• Create a recurring appointment type for "GLP-1 Follow-Up" with your Bridge charting template as the default.
• Use Tasks to flag patients due for a check-in or whose prescriber is waiting on documentation.
• Use Direct Secure Messaging to send prescribers visit summaries without a phone tag.

Evolution of Bridge

CMS is evolving this demonstration and we will update this guide as we continue learning more. Specifically,

• Whether CMS releases more detailed documentation standards for the lifestyle-modification attestation beyond the current fax/ePA form.
• Whether the BALANCE Model gets a new Medicare Part D timeline, or whether the Bridge demonstration gets extended again.

Key Resources

• CMS: Medicare GLP-1 Bridge
• CMS: Information for Providers
• CMS: Information for Pharmacies
• CMS: Prescriber Fact Sheet (PDF)
• KFF: Nearly Four Million Medicare Beneficiaries Could Be Eligible for the Bridge
• KFF: Section 402 and CMMI Demonstration Authority, Explained
• Medicare.gov: Medical Nutrition Therapy and Obesity Behavioral Therapy
• CBS News: Cubanski on the 2027 coverage cliff
• Related: our CMS BALANCE Model guide covers Bridge prior-authorization routing and Part D mechanics in more technical depth for any indication, not just weight management

Healthie help docs referenced in this article: Charting Templates, Smart Fields, Smart Phrases, Custom Metrics, Client Tags, Client List and Management, Programs, Client Packages, Tasks, Direct Messaging

Questions about setting up your Healthie workflows for Medicare’s GLP-1 Bridge Demonstration? Contact our team.

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