MASH (fatty liver disease): covered through Part D, not the Bridge
Short answer: Noncirrhotic MASH with fibrosis — the advanced, inflammatory form of fatty liver disease — routes you out of the Medicare GLP-1 Bridge and into standard Part D, where GLP-1 therapy is covered under a MASH indication. Simple fatty liver without that diagnosis does not trigger the routing.
Program facts last verified against CMS: July 21, 2026
Which liver diagnoses trigger the routing
The routing applies specifically to MASH (metabolic dysfunction-associated steatohepatitis, formerly called NASH) that is noncirrhotic but shows fibrosis — scarring measured by biopsy or, increasingly, by non-invasive tests like FibroScan. Plain fatty liver (steatosis without inflammation or scarring), which is extremely common, is not MASH and leaves you in the Bridge's normal eligibility framework.
If you've been told you have 'fatty liver,' the operative question for your doctor is: 'Is it MASH with fibrosis, or simple steatosis?' The answer determines which Medicare coverage path you're on.
The Part D path for MASH patients
Semaglutide (Wegovy) earned FDA approval for noncirrhotic MASH with moderate-to-advanced fibrosis, and Part D plans cover it under that indication with plan-specific prior authorization — typically requiring the fibrosis documentation. As with the other routing conditions, the Part D path's cost structure differs from the Bridge's flat $50: Extra Help applies, and payments count toward the annual out-of-pocket cap.
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Common questions
I have fatty liver. Am I excluded from the Bridge?
Only if it's specifically MASH with fibrosis (and no cirrhosis). Simple fatty liver — the most common form — does not route you out; the normal Bridge tiers apply.
What if I have cirrhosis?
The Part D MASH indication covers noncirrhotic disease; cirrhosis changes the clinical picture and treatment options. That's a conversation with your hepatologist about what's appropriate and covered in your case.
How is fibrosis documented?
Traditionally by biopsy; increasingly by non-invasive tests like FibroScan (elastography) or blood-marker panels. Your gastroenterologist or hepatologist will know which your plan's prior authorization accepts.
Related
Criteria source: CMS — Medicare GLP-1 Bridge · KFF