On July 1, eligible Medicare Part D beneficiaries can access GLP-1 medications — Ozempic, Wegovy, Mounjaro and Zepbound — at a $50 monthly copay through the Medicare GLP-1 Bridge program, a temporary federal initiative running through December 2027. The program runs outside patients’ existing Part D plans through a separate pathway administered by Humana, and requires prior authorization for eligible patients who meet specific BMI and clinical criteria for obesity management.
The program marks the first time Medicare has covered weight-loss drugs, opening access for millions of seniors who previously had no affordable pathway to GLP-1 therapy, creating new pressures on prior authorization systems and clinical workflows at health systems nationwide.
Chris Klomp, CMS’ Medicare director, said at an Aspen Institute event last week that he expects participation to reach into the “single-digit millions” initially, according to a June 29 report by CNN. “But we’ll see where it scales over time,” he said.
Ahead of the program’s launch, pharmacy leaders at health systems across the country are working through a common set of operational challenges: educating staff and providers, managing a new prior authorization pathway, and a looming question about what happens to patients when the program sunsets.
Awareness before volume
Pharmacy leaders said their most immediate priority heading into July 1 is not managing a patient surge — it’s making sure clinicians and pharmacy staff understand the program exists and how it works.
Benjamin Smith, PharmD, associate chief pharmacy officer for population health and ambulatory services at Duke University Health System in Durham, N.C., told Becker’s his team has been pushing communications through huddles and disseminating a clinical decision algorithm developed by the health system’s primary care network. The algorithm walks providers through program criteria and eligibility requirements.
“Prescribers don’t always think about what kind of insurance the patient has,” he said, noting that a key message to reinforce is that this benefit applies specifically to Medicare patients.
Karen Bamert, PharmD, associate chief pharmacy officer at UW Medicine in Seattle, echoed that framing. Her team has been educating front-line pharmacy staff, pharmacists embedded in clinics, and billing technicians through staff meetings, memos, and drop-in learning sessions. Because the bridge program runs outside a patient’s existing Medicare Part D plan — processed through a separate pathway administered by Humana — Dr. Bamert said staff need to understand the claims routing. Her guidance: if a prescription is rejected on a patient’s Part D plan, try the bridge.
Kelley Curtis, PharmD, MBA, chief pharmacy officer and VP of pharmacy and lab at St. Luke’s Health System in Boise, Idaho, noted that the operational complexity goes beyond any one workflow.
“This program touches multiple teams and workflows rather than fitting neatly into one existing process,” she said. Prior authorization management, patient eligibility, benefits coordination, dispensing workflows, and patient education all intersect.
Prior authorization is the sharpest near-term concern for leaders. The bridge program requires PA for eligible patients, and Dr. Smith said he expects meaningful volume increases as providers and patients become aware of the benefit. CMS has indicated it will turn around authorization decisions in 48 to 72 hours, but Dr. Smith expressed skepticism about whether that timeline will hold in practice.
Dr. Curtis said St. Luke’s has invested in electronic PA tools and automation, while also working through broader internal PA workflow improvements she hopes will be well-timed for the launch.
Demand forecasting: more art than science
None of the three leaders said their health system has done formal demand forecasting for the bridge program, and all described a similar rationale: too many variables remain unknown.
Dr. Smith said Duke hasn’t conducted proactive patient outreach, citing bandwidth constraints and uncertainty about uptake patterns. He expects utilization to ramp gradually as patients come in for appointments or telehealth visits, rather than spike immediately on July 1.
“We’ll just have to see exactly how it all ramps up,” he said.
Dr. Curtis offered a similar view from St. Luke’s. Many Medicare patients currently on GLP-1 therapy for diabetes will remain on Part D, she noted, meaning the bridge program is primarily relevant to a subset using the medications for obesity management who meet specific BMI and clinical criteria.
“Our approach has been to build flexible workflows rather than rely on a single volume forecast,” she said.
Supply chain risk — a persistent concern during earlier GLP-1 shortages — was also flagged, though Dr. Smith said the supply picture has improved considerably and he is cautiously optimistic that constraints won’t recur.
The 2027 cliff: a conversation no one has a good answer to
The bridge program is structured as a temporary measure running through December 2027, bridging to fuller Medicare Part D coverage that CMS extended after the BALANCE Model’s Medicare component failed to launch as scheduled. That sunset creates a clinical and strategic tension that all three pharmacy leaders acknowledged.
Dr. Curtis said the uncertainty compounds what is already a known clinical challenge: GLP-1 discontinuation and subsequent weight regain.
“Patients are beginning therapy with the expectation of long-term treatment, but there is limited clarity about what coverage will look like beyond 2027,” she said. “We are concerned about creating situations where patients achieve meaningful health improvements only to face disruptions in access later.”
Dr. Bamert said the sunset is an important conversation for prescribers to have directly with patients before initiating therapy.
“There’s no way that at the end of 2027 the health system can start paying the cost of all these agents for patients,” she said. “It’ll be very interesting to see what CMS does at the end of that time.”
Dr. Smith said the uncertainty around 2027 is a factor in how aggressively health systems promote the program, but it is not a reason to withhold access. “If a patient would benefit from the medication and can afford the $50 copay, we still want those patients to have access,” he said.
Dr. Curtis said St. Luke’s is taking a long-term perspective operationally — building scalable processes rather than provisional ones — while watching how Medicare Advantage plans, manufacturers, and policymakers shape the post-2027 landscape.
“The bridge program is an important step,” she said, “but many questions remain about what patients will transition to when the program ends.”
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