The GLP-1 Bridge program is proving pretty popular with Medicare patients. If you’re considering participating in the GLP-1 Bridge program, or already working with it, here’s a refresher on important things to keep in mind.
The 18-month program covers GLP-1 drugs with a $50 copay for eligible patients’ Medicare Part D plan. Remember that:
1. Total reimbursement to the pharmacy for the GLP-1 drug NDCs in the program is WAC + $3 within 14 days.
2. The Bridge has an open network, and pharmacies can submit claims electronically to the central processor based on details in the payer sheet linked below.
3. There is a prior authorization process to ensure appropriate utilization. The PA is kicked off by a rejected claim from the Bridge program’s central processor.
You can find the payer sheet here. CMS has more details on the Medicare GLP-1 Bridge on its website and has created an eligibility wizard.
See here for a table of reject codes for the Medicare GLP-1 Bridge. Several reject codes have specific messages to the pharmacy from the Bridge central processor, and the table includes information on how to resolve each of the reject codes.
NCPA members can watch the webinar NCPA hosted with CMS experts here. We also have links to prescriber and pharmacy fact sheets, as well as the prior authorization form, here.
If you need help with your NCPA member login, chat with us online or email membership@ncpa.org.
