From The Centers for Medicare & Medicaid Services
The Medicare GLP-1 Bridge tests new approaches to care delivery under Medicare and is supported by CMS, including centralized processes for claims adjudication and payment to pharmacies. This structure allows CMS to expand access while working closely with providers, pharmacies, and other partners to support a consistent and coordinated experience for patients.
What to Know
Medicare beneficiaries with Part D coverage may be eligible to access certain GLP-1 medications at $50 for a monthly supply. Beneficiaries can talk to their doctor to determine whether a GLP-1 medication is right for them. Threshholds relate to specific body mass index standards, health conditions and other factors. About 10 % of Medicare recipients would qualify under the current standards:
- You have a body mass index (BMI) of 35 or more.
- You have a BMI between 30-34.99 and have at least one of these conditions:
- Diastolic heart failure (also called heart failure with preserved ejection fraction)
- Uncontrolled high blood pressure (also called hypertension)
- Chronic kidney disease at stage 3a or higher
- Prediabetes
- A previous heart attack (also called myocardial infarction) or stroke
- Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms
- You have a BMI between 27-29.99 and have at least one of these conditions:
- Prediabetes
- A previous heart attack (also called myocardial infarction) or stroke
- Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms
