How Forus supports the Medicare GLP-1 Bridge Program

Over the last several years, GLP-1s have redefined what is possible in weight management. For many patients, the limiting factor shifted from the possibility of treatment to the cost.

On July 1st, the Centers for Medicare & Medicaid Services launched the Medicare GLP-1 Bridge Program, taking a giant leap in improving affordable access to GLP-1s. The program provides eligible Medicare Part D beneficiaries affordable access to select GLP-1 medications for weight management for the first time. Upon approval by the program, patients get their medication for $50 per month, regardless of income, through December 31, 2027.

For providers, this means revisiting treatment conversations with patients who may previously have been priced out of access, while also supporting those who formerly paid out-of-pocket and now want to access treatment through this new coverage option.

However, turning that opportunity into treatment requires a workflow distinct from standard Part D prior authorization. The Bridge program involves a CMS-established central processor for all patients, regardless of their specific insurance provider, requiring a specific prior authorization form, unique clinical and product requirements, and a pharmacy-first rejected-claim process.

To create a process that is seamless for practices and patients, Forus partnered with Jeffrey H. Schneider, MD, DABOM, a dual board-certified gastroenterologist and obesity medicine physician.

Through an initial pilot with Dr. Schneider, we identified where the process could break down and built infrastructure to simplify as much as possible.

Who qualifies for the Medicare GLP-1 Bridge program?

A patient may qualify if they are enrolled in an eligible Medicare Part D plan, are prescribed a covered GLP-1 for weight management alongside ongoing lifestyle modification, and meet one of these CMS clinical criteria when therapy began:

• BMI of at least 35; or
• BMI of at least 30 with heart failure with preserved ejection fraction, uncontrolled hypertension despite two antihypertensive medications, or chronic kidney disease stage 3a or above; or
• BMI of at least 27 with prediabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease.

CMS uses the patient’s clinical status from when GLP-1 therapy was initiated, even if treatment began before the Bridge launched.

Who does not qualify? A patient is not eligible for the Bridge if they already filled a GLP-1 medication through their Part D plan or if the drug is prescribed for a Part D-covered indication, such as type 2 diabetes, moderate-to-severe obstructive sleep apnea, qualifying MASH, or reduction of cardiovascular-event risk. In those cases, coverage requests must go through the patient’s Part D plan.

CMS currently includes Foundayo, Wegovy injection and tablets, and only the Zepbound KwikPen as options covered by the Bridge. Zepbound single-dose pens and vials are not included. Because the list may change, providers should check the current CMS product guidance before prescribing.

How does Forus support Medicare GLP-1 Bridge prescriptions?

Forus manages the Bridge process from prescription intake through approval and pharmacy fulfillment. Forus verifies benefits, identifies prescriptions that may qualify, and navigates the multi-stakeholder coordination.

In order to minimize back-and-forth, Forus works directly with the pharmacy to ensure the claim is processed through the Bridge using the correct patient and program information at each step. This requires:

• Process execution: Completing and submitting the specific prior authorization forms required by the Bridge program.
• Proactive problem-solving: Identifying and resolving clinical or administrative issues early to prevent claim rejections or misprocessing.
• End-to-end coordination: Managing the flow of the prescription between the practice and pharmacy to ensure correct Bridge routing and fulfillment.
• Transparent communication: Keeping the care team and patient informed at every step, removing the burden of follow-up from your staff.

For patients, navigating a new program that has its own rules, paperwork, and fulfillment process can be confusing. Forus helps patients understand what is happening and handles the ongoing questions and follow-up that might otherwise fall to practice staff.

Providers also have visibility into each and every prescription throughout the process, so they know if any action is required. If a patient’s clinical or insurance status changes in a way that affects eligibility, Forus can help transition the prescription between the Bridge and ordinary insurance coverage. Providers remain in control of every clinical decision, and Forus automates the surrounding administrative work.

What do providers need to send to Forus?

First, confirm if the prescription you are sending is eligible for the Medicare GLP-1 Bridge Program. Prescriptions are eligible if they are for:

1. Foundayo (tablets), Wegovy (injection and tablets), or the Zepbound KwikPen. Zepbound single-dose pens and vials are not covered.
2. A patient with an obesity diagnosis with an E66 ICD-10 code.

For the fastest processing, send the electronic prescription to Forus Access Support from your EHR and:

1. For eligible patients, include the diagnosis code directly on the prescription.
2. Document the patient’s BMI when GLP-1 therapy was initiated, plus any relevant qualifying conditions.
3. Include the CMS-recommended annotation, “SEND TO BRIDGE FOR WEIGHT MANAGEMENT,” in the note to pharmacy so Forus and the pharmacy can identify and route the prescription correctly. It can also speed up processing at the pharmacy to include the member’s Medicare Part A/B ID in the note to pharmacy.

CMS recommends the diagnosis code and Bridge annotation to support correct routing.

Built from real clinical experience

This workflow began with an experienced physician trying to help Medicare patients access treatment without adding another complicated process to his staff’s day. Dr. Schneider’s collaboration helped Forus test the process, uncover failure points, and build a more reliable path for the many providers who will use it next.

At Forus, we believe all technology used in healthcare should be built this way: in close partnership with providers, testing new workflows in real-world settings to ensure optimal patient outcomes.

Whether you are already getting your Medicare GLP-1 Bridge approvals with help from Forus or are looking to support a patient with Forus for the first time, we’re here to help expand GLP-1 access for your patients.

Common questions

Does the patient need to meet the BMI criteria now?

No. CMS bases eligibility on the patient’s BMI when GLP-1 therapy was initiated, even if treatment began before the Bridge program launched.

Does the patient need a Part D denial first?

No. The pharmacy may bill the claim directly to the Bridge program. Note that a Bridge claim must be run to obtain a prior-authorization-required response before an authorization request can be submitted.

Are the diagnosis and pharmacy annotation required?

CMS strongly recommends including both to support correct routing, but neither is part of the clinical eligibility criteria or technically required for claim processing.

How quickly will a decision be made?

CMS states that a determination will be communicated within 72 hours of submission.

Can a Bridge denial be appealed?

The Bridge has no appeal process. If information was incorrect, incomplete, or updated, the prescriber may resubmit the authorization request. Forus will help determine available next steps.

Sources: CMS Medicare GLP-1 Bridge overview · CMS provider FAQs · CMS prior authorization form

Program details are based on CMS guidance last reviewed on July 1, 2026 and may change. Coverage is subject to CMS eligibility and prior authorization requirements; approval is not guaranteed.