The Medicare GLP-1 Bridge has been making news headlines and appears to be off to a good start. Prior authorization and claims processing seem to be working well, although pharmacies seem to be generally more aware of the program and eligibility requirements than prescribers. During an update CMS gave at the NCPDP August work group meeting, they reminded pharmacies and PBMs that any claim history with a Part D plan in 2026 for a GLP-1 drug for a Part D-covered indication will make a beneficiary ineligible for the Bridge program.
CMS went further, saying that program integrity audits will include reviewing prescription drug event deletion rates to detect plans that are attempting to shift utilization to the Bridge program. Pharmacies should report plans that ask them to reverse claims to sign a patient up for the Bridge program to avoid being made complicit in such a scheme. You can report those plans here.
Click here for NCPA’s prior update on what pharmacies need to know about the GLP-1 Bridge or visit the CMS FAQ page for pharmacies.
