Medicare GLP-1 Bridge Program: Key Insights and Implications

A recent study by KFF reveals that 3.8 million enrollees in Medicare Part D could qualify for the Medicare GLP-1 Bridge program. This development follows an announcement from the Centers for Medicare and Medicaid Services (CMS) about an initiative aimed at giving Medicare and Medicaid participants access to GLP-1 medications. Known as the Better Approaches to Lifestyle and Nutrition for Comprehensive Health (BALANCE) Model, it was initially scheduled to launch for Medicare Part D enrollees in July 2026 but faced delays due to insufficient insurer participation. CMS has since introduced the GLP-1 Bridge program, enabling beneficiaries to access GLP-1 medications outside the Part D plan.

An analysis of 2023 data on traditional Medicare and Medicare Advantage (MA) participants indicated that 9.7 million Medicare beneficiaries met the clinical criteria for the Bridge program. Among these, 39%—or 3.8 million individuals—qualified for the Bridge, while others could access medications via standard Medicare provisions. Eligibility for the program requires Medicare Part D enrollment, meeting clinical standards, prior authorization, and a $50 co-pay.

The financial implications for the federal government hinge on program utilization. With projections estimating that 10% to 75% of eligible Medicare Part D participants might engage with the Bridge program in its initial 18 months, costs could range from $1.3 billion to $10 billion by the end of 2027. At that juncture, the program is expected to conclude, with the responsibility of providing GLP-1 medication access transitioning back to Part D plan sponsors.