Dodge County ADRC Explains New Medicare GLP-1 Bridge Program

DODGE COUNTY – A temporary federal program is giving some Medicare beneficiaries a new way to obtain certain GLP-1 weight-management medications for a $50 monthly copay.

During a July 21 appearance on Community Comment, Amanda Higgins of the Aging and Disability Resource Center of Dodge County said the new Medicare GLP-1 Bridge could change conversations the agency has with residents seeking help with prescription coverage. Higgins encouraged people interested in the program to start by speaking with their health care provider. She said the ADRC can also help beneficiaries work through coverage or billing questions.

The Centers for Medicare and Medicaid Services launched the nationwide program July 1. It is scheduled to operate through Dec. 31, 2027, for eligible people with Medicare Part D prescription drug coverage. That can include a standalone drug plan or certain Medicare Advantage and other plans that include prescription coverage.

The covered medications are Foundayo tablets, Wegovy injections or tablets and the Zepbound KwikPen. Single-dose Zepbound pens and vials are not covered through the bridge program.

Eligibility is based partly on a beneficiary’s body mass index when GLP-1 therapy begins. Someone 18 or older may qualify with a BMI of at least 35. A person with a BMI of at least 30 must also have certain forms of heart failure, difficult-to-control high blood pressure or chronic kidney disease at stage 3a or higher.

People with a BMI of at least 27 must also have prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease. A prescribing provider must certify that the medication is being used with a lifestyle program focused on diet and exercise.

The bridge is intended for eligible beneficiaries using the medications for weight management. People who have already received a GLP-1 medication through their Part D plan are generally not eligible for the bridge. Medicare also says people with type 2 diabetes, moderate-to-severe sleep apnea or certain fatty liver disease diagnoses should seek coverage through their regular Part D plan rather than the bridge.

A doctor or other qualified provider must send a prescription to the pharmacy and complete prior authorization when requested. Once approved, the beneficiary pays $50 for a 28- or 30-day supply.

Because the program operates outside the normal Part D payment system, the copay does not count toward a beneficiary’s Part D deductible or annual out-of-pocket limit. Extra Help and the Medicare Prescription Payment Plan cannot be used to reduce or spread out the charge.

Dodge County residents with Medicare questions can contact the ADRC at 920-386-3580. The agency’s benefit specialists provide information and assistance involving Medicare Parts A, B, C and D, prescription-drug costs, grievances and appeals.

Patients should speak with their health care provider about whether a GLP-1 medication is medically appropriate and whether they meet the program’s requirements.

Dodge County ADRC Explains New Medicare GLP-1 Bridge Program

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