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Understanding the Medicare GLP-1 Bridge Program

On July 1, 2026, a new healthcare initiative, the Medicare GLP-1 Bridge program, will commence, offering Medicare Part D patients access to two medications designed for weight management: Foundayo (orforglipron) and Zepbound (tirzepatide). This valuable program is expected to make a significant impact on managing obesity, particularly in the senior population, where obesity rates are alarmingly high.

What is the Medicare GLP-1 Bridge Program?

The GLP-1 Bridge program is an important step in recognizing obesity as a chronic condition that affects quality of life for countless Americans. Traditionally, Medicare has offered limited coverage for weight management medications, but this initiative marks a watershed moment, indicating a shift in the approach towards recognizing and treating obesity among older adults.

Coverage Details

Eligible patients will be able to access either Foundayo or Zepbound under this program for just $50 per month. This represents a groundbreaking opportunity not only for those who have struggled with obesity but also for healthcare providers looking for viable treatment options. Since two in five U.S. adults aged 65 and older are classified as obese, the program is expected to benefit around 20 million Medicare patients who may meet eligibility requirements.

How to Qualify for the Program

Patients who wish to access these medications through the GLP-1 Bridge program must meet specific clinical criteria set forth by the Centers for Medicare & Medicaid Services (CMS). Here are the key eligibility requirements:

• - Must be at least 18 years old.
• - Have Medicare Part D drug coverage (certain plan types may not qualify).
• - Possess a valid prescription while using or planning to use Foundayo or Zepbound alongside recommended lifestyle changes.
• - Have a body mass index (BMI) of 35 or higher, or a BMI of 27 or higher with associated weight-related health issues.

It’s important to note that individuals currently using GLP-1 medications or those with conditions such as type 2 diabetes or severe obstructive sleep apnea may not qualify.

The Medications: Foundayo and Zepbound

Foundayo

Foundayo is a novel oral medication taken daily and is designed for individuals suffering from obesity or overweight individuals with related health issues. It provides the flexibility of consumption without interfering with meal timings, making it a convenient option for patients.

Zepbound

Zepbound, on the other hand, is the most prescribed injectable medication for weight management in the United States. It is particularly effective in reducing appetite and caloric intake, thus helping patients maintain long-term weight loss when used in conjunction with dietary changes and increased physical activity.

Efficacy in Older Adults

Clinical studies indicate that both Foundayo and Zepbound are effective for patients aged 65 and older. For example, in one study of Foundayo, older adults experienced an average weight loss of up to 13%, while a separate study on Zepbound showed significant results, with over half of non-diabetic participants achieving weight loss of at least 20%.

Steps to Access the Medications

Eligible patients can initiate their journey toward treatment in five simple steps starting on July 1, 2026:
1. Consult with a healthcare provider to discuss whether Foundayo or Zepbound is suitable for them.
2. Request the healthcare provider to send a prescription to LillyDirect Pharmacy or any chosen retail pharmacy.
3. Work closely with the chosen pharmacy to facilitate the prescription process.
4. Ensure that the healthcare provider completes the necessary prior authorization procedures.
5. Upon approval, patients will be required to pay $50 monthly for their chosen medication.

For further details on eligibility, patients can visit the Lilly Direct site or call the customer service number provided.

Conclusion

The Medicare GLP-1 Bridge program is a pivotal development in the management of obesity, especially among the aging population. Access to Foundayo and Zepbound under this initiative will offer patients essential treatment options and improve their overall health outcomes. This program reflects a broader acknowledgment of the importance of addressing obesity as a significant health concern, paving the way for more comprehensive care in the treatment landscape. As we approach the implementation date, this program stands as a beacon of hope for many struggling with weight management in the Medicare community.