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56 lines
No EOL
2.2 KiB
Markdown
# Medicare GLP-1 Bridge Program
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**Type:** Federal demonstration program
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**Domain:** Health policy, obesity treatment, Medicare coverage
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**Status:** Active (July 1 - December 31, 2026)
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**Parent Agency:** Centers for Medicare & Medicaid Services (CMS)
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## Overview
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The Medicare GLP-1 Bridge Program is a temporary demonstration program providing coverage for GLP-1 receptor agonists (Wegovy and Zepbound) for obesity treatment in Medicare Part D beneficiaries. The program operates from July 1 through December 31, 2026, as a bridge to the longer BALANCE Model demonstration launching in January 2027.
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## Program Structure
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**Eligibility:**
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- BMI ≥35 alone, or
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- BMI ≥27 with clinical criteria
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- Must be enrolled in Medicare Part D
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**Cost-Sharing:**
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- Fixed $50 copayment per prescription
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- Copay does NOT count toward Part D deductible
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- Copay does NOT count toward $2,100 out-of-pocket cap
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- Low-Income Subsidy (LIS) cost-sharing subsidies do NOT apply
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**Covered Medications:**
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- Wegovy (semaglutide)
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- Zepbound (tirzepatide)
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## Legal Architecture
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Medicare is statutorily prohibited from covering weight-loss drugs under standard Part D benefits. The Bridge program operates as a temporary exception requiring CMS demonstration authority, not durable legislative change. This legal constraint forced the program to operate outside standard Part D benefit structures, which creates the LIS exclusion.
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## Eligible Population
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Up to ~14 million Medicare beneficiaries had diagnosed overweight/obesity in 2020, representing the potential eligible pool.
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## Continuity Planning
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Beneficiaries who want continued GLP-1 coverage in 2027 may need to switch Part D plans during open enrollment, as the Bridge program is temporary and does not guarantee continued coverage.
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## Related Programs
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- **BALANCE Model (Medicare Part D):** Launches January 2027 as longer-term demonstration
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- **BALANCE Model (Medicaid):** Launches May 2026
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## Timeline
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- **2026-04** — Program announced by CMS
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- **2026-07-01** — Program begins
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- **2026-12-31** — Program ends
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- **2027-01** — BALANCE Model (Medicare Part D) launches
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## Sources
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- KFF Health Policy analysis (April 2026)
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- CMS program documents |