Medicare GLP-1 Bridge Open Enrollment Checklist

Open enrollment for Medicare plans runs October 15 to December 7, and the Bridge program rules have been clarified since its launch in July in ways that might affect which plan you pick. The Bridge program now runs through December 31, 2027, so you're choosing a plan that has to work with it for another full year. Seven things to check before the deadline.

Who This Helps

This is for you if you're on Medicare and either taking a GLP-1 at $50 or planning to. If you want the full eligibility rules, our guide to the $50 copay covers those in depth.

1. The Bridge runs through 2027, so you don’t reapply if already approved

The original plan had the Bridge ending this December with a Part D model taking over in 2027. CMS extended the Bridge through December 31, 2027 and said it will delay implementation of the Part D component for now (CMS). If you read anywhere that you need to find a participating plan for next year, that's out of date or slightly inaccurate - plans don’t have to opt-in to participate during the demonstration period, they are either an eligible Part D plan or they are not.

2. Check your plan type, not your plan

Plans carry no risk here and don't opt in, so calling to ask whether yours participates won’t help here. The question to ask is whether they are eligible. The category is what decides it. Standalone Part D plans qualify. Medicare Advantage drug plans qualify in the HMO, HMO-POS, Local PPO and Regional PPO forms, as do Special Needs Plans, employer group plans and LI NET.

Private fee-for-service plans, cost plans, health care prepayment plans, PACE, fallback plans and religious fraternal benefit plans don't qualify unless you also carry a standalone Part D plan. Switching into a Medicare plan without an eligible Part D plan would leave your pharmacy receiving a rejection. CMS states its plan-type rule for 2026, so confirm 2027 rules haven't shifted before you commit.

Find a provider in your state

Answer a few questions and see live pricing from the providers that ship where you live.

Get started

3. Two separate checks can rule you out, and they are not the same check

These are criteria for those new to applying for the Bridge program, but if you’re already approved for the Bridge in 2026 you most likely don’t need to worry about this. These two qualifying checks happen at different moments, and either one alone ends your eligibility.

Your diagnosis, reviewed at prior authorization. Type 2 diabetes, moderate to severe sleep apnea, noncirrhotic MASH with moderate to advanced fibrosis, or a prescription written to reduce cardiovascular risk all route to Part D instead, whether or not your plan covers a GLP-1 for it.
A Part D fill during 2026, checked when the pharmacy submits the claim. CMS looks at the whole calendar year, and says this applies even where a plan covered the drug as supplemental weight-management coverage (CMS).

They overlap for most people, since the conditions Part D covers are the ones sent back to Part D. These criteria can also be checked independently. If you have one of those diagnoses, Part D is the route designed for you, and a formulary exception is the tool if a specific product isn't on your plan's list.

4. Paying cash does not count as a Part D fill

Worth separating out, because it changes what starting now means. Medicare says someone who began a GLP-1 for weight loss through a self-pay program, rather than through their Medicare drug coverage, before July 1, 2026, they may still be eligible for the Bridge program (Medicare.gov). Manufacturer cash pricing doesn't run through your plan. It also earns you nothing toward your out-of-pocket maximum (just like your $50 payment to the Bridge program), so it's a different trade rather than a free one.

5. Your prior authorization carries into 2027

Once approved, it stays valid through December 31, 2027, including through refills and dose changes. The exception is switching to a different covered GLP-1, which needs a new prior authorization (Medicare.gov). So if you're already approved, there's nothing to redo in January.

6. The out-of-pocket cap is rising, and the $50 still doesn't count

The Part D maximum goes to $2,400 in 2027 from $2,100, and the maximum deductible to $700 from $615 (Medicare.gov). Bridge copays count toward neither, and the deductible doesn't apply to them.

If you take other expensive drugs, that matters for planning. A year of Bridge fills is $600 that moves you no closer to your ceiling. Keep in mind any cash-pay program will also not count towards your maximum out of pocket or maximum deductible figures.

7. Manufacturer cash prices and copay cards reset on December 31

Several self-pay offers are dated to the end of this year. Lilly's savings card for Zepbound expires December 31, 2026, and its reduced-price tiers depend on refilling within 45 days (Lilly). If you use a manufacturer program for Wegovy or anything else, check its own terms for an end date rather than assuming it rolls over.

None of these can be combined with a Bridge claim. Coupons and discount programs can't be applied (CMS). They're an alternative route, not a discount on top.

What gets claims rejected

The first claim comes back with code 75, meaning prior authorization required. That starts the authorization rather than denying you. Beyond that, the documented causes and fixes (CMS):

Wrong billing number. The Bridge uses BIN 028918 and PCN MEDDGLP1BR. CMS encourages plans receiving a misrouted claim to return a message pointing the pharmacy to those numbers.
Non-covered version. The Zepbound KwikPen is covered; the single-dose pen and vials aren't. Neither are pen needles.
A prior Part D GLP-1 fill, or an ineligible plan type. Both return code 65, and neither has a fix inside the Bridge.
Days supply or quantity. Fills are 28 or 30 days only. No 90-day supplies and no partial fills.
Refill too soon. Resubmit once more than 75% of the supply would be used.

There's no appeals process under the Bridge. A prescriber can resubmit a corrected authorization, and that's the remedy (CMS). Our rejection guide walks through each code.

Final Takeaway

The extension takes pressure off this open enrollment rather than adding to it. Confirm your 2027 plan is a type the Bridge accepts, understand which of the two eligibility checks might apply to you, and remember the $50 buys you a medication and not a single dollar toward your out-of-pocket ceiling. The deadline is December 7, and changes start January 1 (Medicare.gov).

If you enjoy posts like these, you can subscribe to receive newsletter updates.

Frequently Asked Questions

Do I need to re-enroll in the Bridge for 2027?

There's no enrollment step at all. If you're already approved, your authorization runs through December 31, 2027 unless you switch to a different covered GLP-1.

I take Ozempic through Part D for diabetes. Can I move to the Bridge?

Probably not, and for two reasons rather than one. Ozempic is prescribed for type 2 diabetes, which routes to your Part D plan rather than the Bridge. Separately, the Part D fill itself ends Bridge eligibility for the year. Part D is the route built for that diagnosis, and a formulary exception is the tool if you want a different product on it.

Who do I call when something goes wrong?

As a patient, 1-800-MEDICARE, which is where CMS and Medicare.gov direct Bridge questions, eligibility checks and prior authorization status. The other two aren't patient lines: prescribers use 855-273-0102 and pharmacies use 844-673-0910, so pass those along rather than calling them yourself.

Does any of this apply to Medicaid?

No. State Medicaid programs set their own rules, and several tightened them in 2026. Our Michigan Medicaid explainer shows what that looks like in one state.

Medicare GLP-1 Bridge: Your Open Enrollment Checklist