Medicare GLP-1 Bridge Program: How Modern Drug Helps Patients and Providers in Fresno
The Medicare GLP-1 Bridge Program is a time-limited CMS program designed to help eligible Medicare Part D beneficiaries access certain GLP-1 medications for weight management, including specific formulations of Wegovy®, Foundayo®, and Zepbound®, from July 1, 2026 through December 31, 2027, unless CMS announces changes.
At Modern Drug, our team is helping Fresno-area patients and medical providers navigate the GLP-1 Bridge process by coordinating prescriptions, supporting prior authorization workflows, confirming required information, and keeping patients informed throughout the process.
Quick summary: The GLP-1 Bridge Program may help eligible Medicare Part D patients access certain weight management GLP-1 medications, but the process requires accurate prescription details, clinical documentation, and prior authorization coordination between the provider, patient, pharmacy, and program processor.
Who Is Eligible for the Medicare GLP-1 Bridge Program?
Eligibility is determined through the Medicare GLP-1 Bridge prior authorization process. In general, beneficiaries must be enrolled in an eligible Medicare Part D plan, such as a standalone Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, and must meet the required clinical criteria for weight management therapy. Providers should include appropriate diagnosis information, including ICD-10 codes, when submitting prescriptions and prior authorization documentation.
The beneficiary is at least 18 years old and has a BMI greater than or equal to 35 at the time GLP-1 therapy is initiated; or
The beneficiary is at least 18 years old and has a BMI greater than or equal to 30 at the time GLP-1 therapy is initiated, plus a diagnosis of heart failure with preserved ejection fraction, uncontrolled hypertension despite treatment with two antihypertensive medications, or chronic kidney disease stage 3a or above; or
The beneficiary is at least 18 years old and has a BMI greater than or equal to 27 at the time GLP-1 therapy is initiated, plus a diagnosis of prediabetes, previous heart attack, previous stroke, or symptomatic peripheral artery disease.
Which Wegovy, Foundayo, and Zepbound Formulations Are Included?
Providers should note that the GLP-1 Bridge Program applies only to specific eligible products and formulations. These may differ from the four-pen packages commonly used under standard Medicare Part D coverage for diabetes-related indications. When sending prescriptions, please verify that the intended product and NDC align with current program requirements.
Foundayo® NDCs: 0002-4178-31, 0002-4503-31, 0002-4794-31, 0002-4803-31, 0002-4839-31, 0002-4953-31
Wegovy® NDCs: 0169-4525-14, 0169-4505-14, 0169-4501-14, 0169-4517-14, 0169-4524-14, 0169-4415-31, 0169-4404-31, 0169-4409-31, 0169-4425-31, 0169-4572-14.
Zepbound® NDCs: 0002-3566-11, 0002-3555-11, 0002-3544-11, 0002-3533-11, 0002-3522-11, and 0002-3511-11.
How Providers Can Help Streamline the GLP-1 Bridge Process
Include eligible ICD-10 diagnosis codes on electronic prescriptions for obesity or weight management when appropriate.
Provide the patient’s Medicare Beneficiary Identifier (MBI) when it is needed for coordination of benefits and program processing.
Add a clear note such as “GLP-1 Bridge Access Program” in the electronic prescription notes.
When available, include the patient’s BMI and relevant clinical information that may support the prior authorization request or fax it to the pharmacy.
For Zepbound® patients, send a separate prescription for pen needles when needed, because the GLP-1 Bridge Program uses the Zepbound® KwikPen® rather than single-use pens.
How Patients Can Help Avoid Delays
Keep your pharmacy profile current, including your phone number, address, insurance information, and prescriber information.
Provide your Medicare Beneficiary Identifier to the pharmacy if it is needed to process the request.
Download Rx365 to manage your profile, track prescription progress, upload insurance cards, and message our team through secure pharmacy communication tools.
Allow time for the prior authorization process. Depending on the plan, provider response time, and required documentation, requests may take 1–10 business days.
Ask your doctor to send our pharmacy an eligible electronic prescription.
How Modern Drug Helps Coordinate GLP-1 Bridge Access
We help initiate the prior authorization workflow on behalf of the prescriber through CoverMyMeds when appropriate. Our team completes available pharmacy information so the provider can review and answer required clinical questions through the faxed request or prior authorization portal.
We follow up with the clinic within 72 hours when additional information or status updates are needed.
We keep patients informed about prior authorization status, expected next steps, and any information still needed from the provider or patient.
Once the prior authorization is approved and the product is available through our wholesaler, we order the medication and typically receive it within 1–2 business days.
Need help with a GLP-1 Bridge prescription? Patients and providers in the Fresno area can contact Modern Drug for help coordinating prescription intake, prior authorization support, and status updates related to eligible GLP-1 Bridge Program medications.
Prior authorization does not guarantee approval, but our team will help eligible patients complete the process as smoothly as possible.
References
Centers for Medicare & Medicaid Services. (n.d.). Medicare GLP-1 Bridge Program. U.S. Department of Health & Human Services. https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge