The Medicare GLP-1 Bridge Program
GLP-1 drugs to be available to treat obesity for all Medicare Part D enrollees.
The Centers for Medicare & Medicaid Services (CMS) recently announced the Medicare GLP-1 Bridge program, running from July 1, 2026 through 2027. Under this "demonstration" program, all enrollees in Medicare Part D, including individual and group MAPD plans and standalone Prescription Drug Plans (PDPs), will be able to fill GLP-1 prescriptions for the treatment of obesity by paying a $50 copay for each month of supply. Covered drugs including Foundayo®, Wegovy® and Zepbound® are subject to a negotiated net price of $245 per prescription. CMS will fund the remaining balance of $195 per prescription via payments to pharmacies.
This program promises to supercharge already massive demand for these weight control drugs in the non-Medicare population. A separate voluntary program for participating Part D plans to offer GLP-1 drug coverage under the Part D plan – the BALANCE Model – is delayed to at least 2028, possibly longer, due to lack of sufficient participation interest by Part D sponsors.
Implications for Part D enrollees
First-time access to GLP-1 drugs for obesity at a subsidized cost
$50 monthly co-pay for eligible individuals meeting clinical criteria with a prescription and prior authorization
Program operates outside Part D; co-pays do not count toward True Out-of-Pocket (TrOOP) maximum
GLP-1 use for conditions other than obesity (e.g., diabetes) remains covered through Part D
Implications for group plan sponsors
Group Part D Plan (EGWP) enrollees are eligible; program operates outside of EGWP plan design and funding
Employers now covering GLP-1s for obesity under their EGWP should communicate to retirees about the pros and cons of each program
Program expires after 2027; unclear on whether or when BALANCE Model takes effect
For employers considering a shift from group plan sponsorship to an individual market exchange approach:
Individual Part D enrollees can use the Bridge program on the same terms as under the EGWP, using employer HRA funding (if offered) to cover copays
Adopting an HRA-based defined contribution approach eliminates EGWP sponsor risk if the possible future BALANCE Model imposes costly benefit mandates on EGWPs
Why the individual marketplace is increasingly advantageous
The individual marketplace helps employers step away from uncertainty to support retirees.
The marketplace enables employers to:
Establish predictable costs through defined contribution
Reduce exposure to regulatory and funding volatility
Simplify administration and plan management
The marketplace supports retirees by providing:
Broad access to individual Medicare options
Personalized guidance from licensed Benefit Advisors
Ongoing support as plans, needs, and policies evolve
The bottom line
The Medicare GLP-1 Bridge expands access to high-cost obesity treatments, signaling continued bipartisan support for enhancements to Medicare. With continuing individual coverage improvements and no clear long-term replacement for the Bridge program, employers should evaluate whether group plan sponsorship remains the most effective and sustainable approach.
