How to apply for the Medicare GLP-1 Bridge

Short answer: your prescriber sends a prescription, the pharmacy submits a Bridge claim, and then the prescriber completes prior authorization (PA). Patients do not submit the PA themselves.

CMS process checked October 5, 2026

1. Check your coverage and starting records

Confirm your eligible Part D plan and clinical criteria. CMS uses BMI at the start of GLP-1 therapy, even before Medicare enrollment or July 2026. Bring your drug-plan card, medication list, starting height and weight records, and records of any qualifying diagnosis. A GLP-1 paid through Part D in 2026 rules out Bridge coverage for 2026.

2. Ask your prescriber to send the prescription

Your prescriber checks whether the medication is appropriate and which coverage route applies. Covered Bridge products are Wegovy injections and tablets, Foundayo tablets and Zepbound KwikPen. Zepbound vials and single-dose pens are excluded. CMS recommends a Bridge routing annotation and an obesity diagnosis code to help the pharmacy route the claim; these annotations are not required for claim processing.

3. The pharmacy submits a Bridge claim first

Ask the pharmacy to check Bridge processing using BIN 028918, PCN MEDDGLP1BR. A Part D denial is not required first. Even an otherwise eligible initial Bridge claim is rejected to request PA. This expected request for authorization is different from a clinical PA denial.

4. The prescriber completes PA after the pharmacy claim

The pharmacy sends the request to the prescriber, typically within 24–72 hours. Submitting PA before the pharmacy claim can cause a “patient not found” error. If no request arrives within 72 hours after the pharmacy claim, CMS allows the prescriber to download and submit its fax form. CMS says the PA decision is mailed to the patient and sent electronically or by fax to the prescriber within 72 hours of submission.

5. Fill after approval and check the total cost

The drug copay is $50 per covered 28-day or 30-day fill. It does not count toward Part D out-of-pocket spending, and Extra Help does not reduce it. Provider visits or optional service memberships can add costs. Zepbound KwikPen needles are purchased separately.

If a request is denied

Get the exact reason from the prescriber or pharmacy. CMS has no Bridge appeals process, but the prescriber may resubmit incorrect, updated or additional information for re-review. Correcting records does not guarantee approval. A denial by your regular Part D plan has a separate process. See the denial and resubmission guide.

Check the published eligibility criteria →

Sources: CMS prescriber fact sheet · CMS PA form · CMS provider questions and answers