Natalie Powers, who is a pharmacist and the director of clinical programs at Kinney Drugs, joins us to talk about the new Medicare Bridge program as it relates to GLP-1s.

But before we dive into what that is all about, just to make sure we're all on the same page, can you explain to us what a GLP-1 is?

It's been in the news so much.

I think most people have heard of them or their brand names at least, but what are they?

What do they do?

- Yes, that's a great question.

Great way to kick this off today.

So a GLP-1 stands for glucagon-like peptide-1.

This is a natural hormone that your body produces in response to eating.

And so what that hormone does is it regulates your blood sugar and it helps with appetite.

So a new hot topic, like you just said, is GLP-1 medications.

And these medications mimic that natural GLP-1 hormone in your body to help reduce your appetite and control your blood sugar.

So they are very effective in helping patients with type two diabetes, aiding and weight loss, as well as reducing some cardiovascular complications or outcomes that patients can have.

So like you said, GLP-1 is the class of medications, and then there's a lot of different brand names people are more familiar with.

So Ozempic, Mounjaro, Wegovy, Zepbound, and the newest one on the market is Fundayo.

- Probably seen some of those commercials for folks watching TVs.

Let's talk about this new Medicare bridge program that launched back on July 1st.

What has changed?

What is new about that that folks should know about?

- Yes.

So July 1st of 2026, the GLP-1 Bridge program was released.

So this is an exciting program for Medicare patients who are interested in taking a GLP-1 medication for weight loss.

So prior to July 1st, Medicare patients could only get a GLP-1 medication covered if they had a certain medical condition.

So type two diabetes, obstructive sleep apnea, those are a couple conditions where Medicare would cover the medication, but if a patient wanted to use the medication for weight loss, they had to either pay out of pocket, use a discount card, which was still resulting in a copay of hundreds, if not thousands of dollars every month, or be disappointed and kind of go without the medication.

- What prompted the bridge program?

- So the Center for Medicare and Medicaid Services, otherwise known as CMS, are evaluating different coverage options.

So this is going to be a temporary program that runs from July 1st of 2026, and it runs through December 31st of 2027.

And during these 18 months, CMS is evaluating the impact that patients taking these medications for weight loss is going to have on the overall healthcare system and patient outcomes.

So during this temporary program, CMS is really diving in to say, okay, when we have overweight patients or obese patients, a lot of times this brings on other medical conditions.

So this could put patients at increased risk for heart attacks, stroke, diabetes, hospitalizations, kidney disease.

So CMS is looking to show these plans.

We think that if we can get patients to lose weight before these other conditions come on, we can improve patient outcomes and save money in the healthcare system overall.

So really they're providing 18 months of a lower cost pathway to get these medications for Medicare beneficiaries for weight loss exclusively.

And then we'll see after that 18 months is up, maybe more plans will come on or maybe this will turn into something more long-term.

- I'm guessing there's some more fine print here in terms of who actually qualifies.

- Yes.

So great question.

Yes.

So for our viewers at home, everybody's thinking, "Ooh, I'm going to go get one."

But yes, you're right.

But it is pretty.

We can help you determine if you're eligible for the program as well as your primary care physician as well.

But basically, if you are a Medicare recipient already receiving a medication for a condition such as type two diabetes or obstructive sleep apnea, you are going to continue using your Medicare plan for that because your Medicare plan will cover it for those conditions.

But if you are a Medicare recipient who wants to use these medications to lose weight, you are likely eligible.

So there's three eligibility buckets.

So that first eligibility bucket is if you have a BMI of 35 or greater, automatically you'll be able to enroll in the bridge program.

If your BMI is between 30 and 35, you do need an additional condition to qualify.

And that is if you have uncontrolled hypertension, so taking two or more blood pressure medications and still not able to control your blood pressure, heart failure or chronic kidney disease, then you'll be eligible.

And then that third bucket is a lower BMI of 27 to 30, but you do have to have either prediabetes, a prior heart attack or stroke or have symptomatic peripheral artery disease.

So I know that's a lot of information, but really, truly, if you're a Medicare patient and you fit in one of those buckets and you're not taking it for type two diabetes or sleep apnea, then you will be eligible for the program.

- So for our Medicare patients who may be eligible, or even for folks at home who aren't quite at the point of Medicare yet, but they're thinking about a GLP-1, what are some of the pros and cons?

What are the benefits?

What are the side effects?

- Absolutely.

So we always start patients out on the lowest dose possible.

This is a hormone your body already makes, but we don't want to give you too much of that hormone, otherwise you're going to experience some undesirable side effects.

Every patient that starts the medication can expect some gastrointestinal side effects at the start of it.

And every time we increase that dose for our patients, they also can experience it at that point.

So this is going to be obviously a decreased appetite.

You're not going to really feel hungry because that's really the mechanism of action of these drugs.

Along with that, we have indigestion, nausea, vomiting, constipation, diarrhea.

So these are common side effects that you're going to experience when you initiate the medication and as you increase your dose.

A misconception sometimes that patients do find with these medicines is they think, "I'll just go on a GLP-1 for a little bit, lose a whole bunch of weight, and then I'll just diet and exercise."

And it could be possible if your lifestyle changes are significant, but for the most part, these are more of a longer term medication.

So patients need to think of that that way.

It's a medication similar to a blood pressure medication.

To control your blood pressure, you have to take it every day.

For these GLP-1s, it's the same thing.

You have to either take the oral tablet daily or the injectable once a week for you to maintain that BMI that you want to do.

So I think that - It's a for - Life sort of - Maintenance program then?

Yes.

Yes.

We do really encourage patients to do this in combination with lifestyle changes.

So take the medication, lose weight.

We want you to remain strong, so we want you to exercise.

We want you to have a healthy diet in order to get all the benefits from the medication.

So - That's key.

The exercise still matters.

It doesn't give us a green card to get out of it, - Right?

That's correct.

Yes.

- It's 18 months.

So folks who do qualify, who are thinking about it, there might be some fear that I get to the end of that 18-month period and then what?

- Absolutely.

And a lot of patients are feeling that way.

The program is 18 months.

It goes until December 31st of 2027.

And at that point, CMS is hoping that they have grabbed enough data to really prove to other insurance companies, Medicare, Medicaid, and commercial payers, the benefit that these medications can have on weight loss and the money these plans could potentially save with having their patients lose weight and not be at increased risk for these other medical conditions.

So I think I wouldn't hesitate to get on the medication because you're afraid that the program's going to end.

Our hope as a healthcare system is that these medications will be covered in a different capacity by the end of this program.

It's called the Bridge Program because it's hoping to be a bridge for a longer term program.

- And if you're on it long-term, you talked about some of those side effects.

Are they permanent or do they improve with time?

- With time, they do improve.

And again, when you start the medication or when you increase the doses, when those side effects are greatest.

So once you've lost weight and you're on more of a maintenance dose and you're on that same dose and you're not jumping up to different higher doses, then those side effects really should get better.

Your appetite is not going to come back because as long as you're on these medications, it's helping control your blood sugar as well as your appetite.

So you're not going to have a huge appetite, but other than that, you shouldn't experience all of those gastrointestinal side effects forever until your body's used to having that natural GLP-1 peptide hormone a little bit higher in your system.

- It becomes part of the norm of your body.

- Exactly.

- So if someone qualifies or if they're still curious if they qualify, they have questions, they're curious about GLP-1s and what it means for them, what should the next steps be?

- Absolutely.

So I should point out that if you are eligible for the bridge program, you're going to get these medications at a $50 monthly copayment.

So I think that's an important piece and every single GLP-1 is not included in the bridge program.

So the three drugs that are included in the program are Wegovy, which is an injectable as well as a tablet.

Fundayo, which is the newest on the market, it's a tablet version, as well as Zepbound Quickpens, which is a once weekly injection.

So you will need to obtain a prescription from your physician for one of those three medications.

Again, you can't qualify for the program if you have a different condition that will go under regular Medicare.

So if you have type two diabetes or sleep apnea, that's going to go to Medicare.

So for weight loss specifically, we'll receive that prescription at the pharmacy.

We will send a prior authorization to the doctor's office.

The doctor's office will get with the bridge program and say, yes, this patient falls in one of those three buckets.

They'll approve the medication.

And once they do that, that's one time only.

So the first time you get prescribed a medication, it could take a few days for that to come through and for us to be able to fill your medication.

But after that, you're a prior auth, it's not like it's needed every month.

You need to do it again.

Exactly.

So then know it will be approved and we'll be able to fill the medication at Kinney for you.

We can only do one month at a time on the program.

Again, $50 copayment.

But yeah, that's the details.

- Natalie, thank you so much.

Check with your doctor then if you're interested for more information or your pharmacist.

Appreciate it.

- Yeah, thanks so much.

Thanks, - Natalie.

People with Medicare can learn more about Medicare's GLP-1 Bridge program and check if they might qualify at medicare.gov/glp1bridge.

Another source is kinneydrugs.com.