Since July 1, Medicare has been paying for GLP-1 drugs for weight loss for Part D enrollees who qualify. It's a temporary program called the Medicare GLP-1 Bridge, and it runs through December 31, 2027.
The catch is on the approval form. Before a patient gets the drug, the prescriber has to vouch for diet and exercise support that the program doesn't supply.
That's where a GLP-1 clinic or coaching team comes in. Here's what the Bridge covers, what the prescriber is actually signing, and what we'd offer the prescribers in your market.
Who the Medicare GLP-1 Bridge covers
According to CMS's provider FAQ, the Bridge covers Foundayo tablets, Wegovy injections and tablets, and the Zepbound KwikPen when they're prescribed for weight. Patients need a standalone Part D drug plan or most kinds of Medicare Advantage plan with drug coverage, and they have to be at least 18 with one of these:
- A BMI of 35 or higher
- A BMI of 30 or higher plus heart failure with preserved ejection fraction, uncontrolled high blood pressure or stage 3a kidney disease or worse
- A BMI of 27 or higher plus prediabetes, a past heart attack or stroke, or symptomatic peripheral artery disease
BMI is judged at the point the patient started the drug, so people who began a GLP-1 before July can still qualify.
It's for weight only. Patients with type 2 diabetes, moderate-to-severe sleep apnea or MASH (a form of fatty liver disease) get their GLP-1 through their regular Part D plan instead. The copay is $50 per fill (fills are one month at a time), it doesn't count toward the patient's out-of-pocket limit, and there's no low-income subsidy to help with it.
What the prescriber signs for
CMS describes the requirement this way: the patient is prescribed the drug…
…in combination with current and ongoing lifestyle modification including structured nutrition and physical activity
CMS, Medicare GLP-1 Bridge provider FAQ
On the prior authorization form, that isn't a separate checkbox. It's written into the question every request passes through, with one exception added: physical activity can be left out when it isn't clinically appropriate. The prescriber then signs a declaration, under penalty of perjury, that the information is true and correct.
Three things about that signature matter if you're the one providing the support:
Who provides the support
If the prescribing practice runs its own nutrition and activity program, the answer's easy. If it doesn't, the support has to come from somewhere else.
Medicare isn't paying for that support under the Bridge. So the practice pays for it, the patient pays for it, or a partner program steps in. For a GLP-1 clinic or coaching company, that's an opening: prescribers who don't run a program of their own need one they can point their patients to.
Five things we'd offer prescribers
This is our advice, not CMS guidance. Whether any program meets the Bridge's wording is the prescriber's call, since they're the one signing.
A program with a real structure
A named curriculum, a set schedule, and both halves of the requirement: nutrition and physical activity. Saying "we'll check in when you need us" doesn't give a prescriber anything concrete.
A record they can keep
Send the prescriber the enrollment date and what the patient has completed, on a schedule they agree to. If anyone ever asks what "ongoing" meant for a patient, the prescriber has an answer in the chart.
An option for patients who can't exercise
The form allows for patients who can't safely do physical activity. Have a version of the program built around nutrition and daily habits, and work within whatever activity limits the prescriber sets.
A plan for when the drug stops
The Bridge ends December 31, 2027, and CMS hasn't confirmed what comes after it. Some patients will lose access, and others will stop for their own reasons. A program that only works while the patient is on the drug leaves them at the hardest point, which is why GLP-1 discontinuation coaching belongs in the offer from the start.
A price patients can see
Bridge patients are already paying a $50 copay for every monthly fill, with no low-income help. If the support costs them extra, say what it costs up front, and offer a version they can afford.
Where Avidon fits
Avidon runs structured courses, coaching and check-ins on one platform. Two of its courses are built for patients on weight loss medication, and nearly 8 in 10 members who enrolled in each one finished it. Every course, session and check-in is tracked and can be exported, so you can send prescribers a participation record on whatever schedule you agree.
If you're putting together that kind of offer for prescribers in your market, see how Avidon works for GLP-1 and metabolic clinics.
