This fall, CMS will start sharing monthly utilization reports with Part D plans on how their enrollees are using the Medicare GLP-1 Bridge program.
The agency said in an Aug. 5 memo that the reports will be organized at both the contract and plan level and will include claims-level data such as the date of service, drug dispensed, quantity, days supply, prescriber, fill number and beneficiary identifier. All Part D plans will be covered, except for PACE organizations, cost plans and private fee-for-service plans.
CMS uses a central processor to handle prior authorization, claims adjudication and pharmacy reimbursement, meaning Part D sponsors don’t carry risk for GLP-1 drugs furnished through the demonstration. The utilization reports would give insurers a window into how their own members are using the program despite having no direct role in administering it.
The Bridge program launched July 1 and runs through the end of 2027. It provides eligible Part D beneficiaries access to Wegovy, Zepbound and Foundayo for weight management at a $50 monthly copay. Manufacturers provide the drugs at a net price of $245, with CMS covering the remaining $195.
CMS originally intended to transition GLP-1 weight loss coverage into Part D benefits through the voluntary BALANCE model, but shelved that component indefinitely after insufficient sponsor participation. The Bridge program was extended through 2027 as a result.
At the time of the BALANCE delay, CMS had said it planned to share Bridge utilization data with sponsors ahead of any future implementation of the model in Part D.
