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The jargon, translated

Every term the program, your plan, and your pharmacy will throw at you — in plain English, with links to the full guides.

Last verified against CMS: July 21, 2026

Jump to: GLP-1 Bridge (the program) · GLP-1 · Prior authorization (PA) · Central processor · Part D · TrOOP · Out-of-pocket cap · Extra Help / LIS · BMI (body mass index) · Tier 1 / 2 / 3 · Routing conditions · KwikPen · Titration · A1c · eGFR · HFpEF · Claudication · AHI · MASH · BALANCE Model · AEP / Open Enrollment · TPMO

GLP-1 Bridge (the program)
The CMS demonstration (July 1, 2026 – Dec 31, 2027) covering Wegovy, Zepbound KwikPen, and Foundayo at $50/month for eligible Medicare drug-plan members. More →
GLP-1
A class of medications (glucagon-like peptide-1 receptor agonists) that reduce appetite and slow stomach emptying — the drug class behind Wegovy, Ozempic, Zepbound, and Mounjaro.
Prior authorization (PA)
The approval your prescriber must obtain before the program covers your fills — they submit documentation of your BMI and any qualifying condition to the program's central processor. More →
Central processor
The single national administrator (run by Humana) that handles all Bridge prior authorizations and pharmacy claims — the reason the program works identically in every state and plan.
Part D
Medicare's prescription drug benefit, delivered through private plans — either standalone (PDP) or built into Medicare Advantage (MA-PD). Enrollment in one is a Bridge prerequisite. More →
TrOOP
'True out-of-pocket' — your running total of Part D drug spending that counts toward the annual cap. Bridge copays generate no TrOOP; that's one of the program's quirks. More →
Out-of-pocket cap
The annual limit (~$2,100 in 2026) on what you pay for covered Part D drugs, after which they're free for the year. Bridge payments don't count toward it.
Extra Help / LIS
The Low-Income Subsidy that reduces Part D costs for lower-income beneficiaries. It does NOT reduce the Bridge's $50 — a key piece of fine print. More →
BMI (body mass index)
The height-to-weight ratio the program's tiers are built on: 35+ qualifies alone; 30+ and 27+ qualify with specific conditions. Your provider's measurement is the one that counts. More →
Tier 1 / 2 / 3
The program's three eligibility levels: BMI 35+ alone (Tier 1); BMI 30+ with CKD, heart failure, or uncontrolled hypertension (Tier 2); BMI 27+ with prediabetes, prior heart attack/stroke, or symptomatic PAD (Tier 3). More →
Routing conditions
Our shorthand for the three diagnoses (type 2 diabetes, moderate-to-severe sleep apnea, noncirrhotic MASH with fibrosis) that move you from the Bridge to standard Part D coverage under existing indications.
KwikPen
The multi-dose pen form of Zepbound — the ONLY form the Bridge covers. Vials and single-dose pens won't process; prescriptions should specify KwikPen. More →
Titration
The gradual dose-escalation schedule these drugs start with — low doses stepping up over months — designed to manage the digestive side effects.
A1c
A blood test reflecting average blood sugar over ~3 months. 5.7–6.4% = prediabetes (a Tier 3 qualifying condition); 6.5%+ = type 2 diabetes (a routing condition). More →
eGFR
The kidney-function number in routine bloodwork. 59 or below generally means CKD stage 3a or worse — a Tier 2 qualifying condition many people don't know they have. More →
HFpEF
Heart failure with preserved ejection fraction — the most common form in older adults, often described to patients in softer terms. Any heart failure diagnosis qualifies under Tier 2. More →
Claudication
The signature symptom of peripheral artery disease: leg cramping when walking that eases with rest. 'Symptomatic PAD' — a Tier 3 condition — usually means this. More →
AHI
Apnea-hypopnea index, from a sleep study: 5–14 = mild, 15–29 = moderate, 30+ = severe. Moderate-to-severe OSA routes you to Part D (where Zepbound's OSA indication applies); mild does not. More →
MASH
Metabolic dysfunction-associated steatohepatitis (formerly NASH) — the inflammatory, scarring form of fatty liver disease. Noncirrhotic MASH with fibrosis is a routing condition; simple fatty liver is not. More →
BALANCE Model
CMS's planned successor program — voluntary GLP-1 coverage through Part D plans — whose Medicare component was shelved in 2026 when too few plans joined. The Bridge is its stopgap. More →
AEP / Open Enrollment
October 15 – December 7 each year: the window to switch Medicare drug plans, effective January 1. Irrelevant to Bridge eligibility, crucial for the Part D paths.
TPMO
Third-party marketing organization — the CMS category covering companies (like this site) involved in Medicare-related marketing, with required disclaimers and conduct rules. See ours in the footer.

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