​​​​​​The Centers for Medicare & Medicaid Services (CMS) launched the Medicare GLP-1 Bridge, a temporary federal program (only running from July 1, 2026, to December 31, 2027), providing eligible Medicare Part D beneficiaries access to certain GLP-1 drugs for weight management only.

This temporary program from the federal government is not a plan-sponsored benefit through Independence Blue Cross (IBX). It is independent of IBX coverage; it uses a different submission process and requires medical necessity to access formulary GLP-1 drugs.

How the Medicare GLP-1 Bridge works

• Operates outside of the Medicare Part D coverage benefit

• IBX and other Part D plans are not responsible for administering the Bridge program

• CMS will use a central system for:

• Prior authorizations

• Claims processing

• Pharmacy reimbursement

Providers should submit Medicare beneficiary requests for access to the Bridge program through the central system and not to IBX.

IBX coverage is not changing

IBX will continue to cover GLP-1 drugs for Medicare Advantage members when prescribed for FDA-approved medical conditions. Continue submitting GLP-1 prior authorization requests using standard IBX processes. 

IBX Medicare Advantage members that meet medical necessity through the enclosed link should have a prior authorization submitted through IBX. Providers can use the Eligibility & Benefits transaction in the Practice Management application on the Provider Engagement, Analytics & Reporting (PEAR) portal to confirm patients' eligibility, coverage limitations, prior authorization requirements, and any associated out-of-pocket costs.

Provider reminder: Requests for GLP-1 Bridge drugs submitted to IBX will be denied and may delay patient access.

GLP-1 drugs included for weight management under the bridge

• Foundayo®
  

• Wegovy® (injection and tablets)

• Zepbound® (KwikPen® only)​​

How to route GLP-1 requests through the Medicare GLP-1 Bridge Program

CMS GLP-1 Bridge requests must be submitted through the CMS process. To avoid delays, submit CMS' prior authorization request forms through the appropriate pathway based on the patient's diagnosis. For more information, please review the information in the CMS Provider FAQ.

Use the CMS Medicare GLP-1 Bridge system when:

• The prescription is for weight management.

• The patient would not qualify for GLP-1 under current IBX Medicare Advantage coverage.​​​