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Obesity treatment: 5 things to know about coverage through the Medicare GLP-1 Bridge program

Health2026-08-17

(BPT) - Key takeaways

A Centers for Medicare & Medicaid Services (CMS) program creates an access pathway for eligible Medicare Part D patients who meet the Medicare GLP-1 Bridge Clinical Criteria and other CMS eligibility requirements.
Find five things to know and questions to ask your healthcare provider.
Obesity is a chronic disease, and it is never too late to ask for support.

Obesity is a chronic disease, similar to heart disease or high blood pressure, and for some people, diet and exercise alone may not be enough.

Until now, weight management medications have not been broadly covered by Medicare even though about two in five U.S. adults aged 65 and older are living with obesity.

Now, a Centers for Medicare & Medicaid Services (CMS) program called the Medicare GLP-1 Bridge program creates an access pathway for eligible Medicare Part D patients who meet the Medicare GLP-1 Bridge Clinical Criteria and other CMS eligibility requirements.

Terms apply. Eligibility based on Medicare GLP-1 Bridge Clinical Criteria. Prescription required. Talk to your doctor to learn more.

"It can be frustrating when treatments for obesity aren't covered like other chronic conditions," said Deb, a patient. "Seeing more options open up for those living with obesity - and knowing there may finally be a way to get access through Medicare Part D - feels like a step in the right direction."

If you or someone you care for has been managing obesity, here are five things to know about the Medicare GLP-1 Bridge program and tips for talking with your healthcare provider.

1.What is the Medicare GLP-1 Bridge program and what does it mean for you?

Medicare GLP-1 Bridge is a CMS program that creates a coverage pathway for eligible Medicare Part D patients who are living with obesity and meet the Medicare GLP-1 Bridge Clinical Criteria and other CMS eligibility requirements.

This is a meaningful milestone. Expanding coverage through the Medicare GLP-1 Bridge program reflects what Lilly believes is a broader shift in how obesity is understood - not as a lifestyle choice, but as a complex, potentially treatable medical condition.

Eligible Medicare Part D patients should talk with their healthcare provider about what it could mean for them and the next steps that may be required.

Seeing more options open up for those living with obesity - and knowing there may finally be a way to get access through Medicare Part D - feels like a step in the right direction.

- Deb, a patient

2. How do you find out if you are eligible for the Medicare GLP-1 Bridge program?

You may be eligible if you have a valid prescription, have Medicare Part D drug coverage and meet the Medicare GLP-1 Bridge Clinical Criteria and other CMS eligibility requirements.

Your healthcare provider can help determine whether a prescription obesity management medication may be right for you. They or your pharmacist can also explain coverage requirements and submit required documentation such as prior authorization.

3. Which Lilly FDA-approved obesity medicines are included?

Two of Lilly's obesity medicines are included in the Medicare GLP-1 Bridge program:

Foundayo™ (orforglipron), the only GLP-1 pill that can be taken any time of day - no planning around food or drink.*

What is Foundayo? Foundayo is a prescription medicine used with a reduced-calorie diet and increased physical activity to help adults with obesity, or some adults with overweight who also have weight-related medical problems, to lose excess body weight and keep the weight off. Foundayo should not be used with other GLP-1 receptor agonist medicines. It is not known if Foundayo is safe and effective for use in children. Please see Indications and Safety Summary with Warnings for Foundayo below.
Click here to learn more about treatment with Foundayo.
*Swallow tablets whole. Do not break, crush or chew the tablet. If you miss a dose, take it as soon as possible. Do not take more than 1 tablet per day. Foundayo is taken orally.

Foundayo Select Safety Information

Warning: Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, medicines that work like Foundayo caused thyroid tumors, including thyroid cancer. It is not known if Foundayo will cause thyroid tumors, or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Do not take Foundayo if you or any of your family have ever had MTC or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Zepbound^® (tirzepatide), the most prescribed branded injectable weight-management medicine.*

What is Zepbound? Zepbound is an injectable prescription medicine that may help adults with obesity, or some adults with overweight who also have weight-related medical problems, to lose excess body weight and keep the weight off, along with a reduced-calorie diet and increased physical activity. Zepbound contains tirzepatide and should not be used with other tirzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if Zepbound is safe and effective for use in children. Please see Indications and Safety Summary with Warnings for Zepbound below.
Click to learn more about treatment with Zepbound.
*Based on IQVIA^® National Prescription Audit Data, representing 94% of US prescription data as of January 14, 2025.

Zepbound Select Safety Information

Warning: Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rats, Zepbound and medicines that work like Zepbound caused thyroid tumors, including thyroid cancer. It is not known if Zepbound will cause thyroid tumors, or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Do not take Zepbound if you or any of your family have ever had MTC or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Other weight management medications are also covered under the program. Coverage began on July 1, 2026, for new and existing patients and will run through December 31, 2027.

4. How much do Foundayo (orforglipron) and Zepbound (tirzepatide) cost through the program?

Medicare Part D patients may be eligible for Foundayo or Zepbound for no more than $50 per month for weight management if they meet the Medicare GLP-1 Bridge Clinical Criteria and other CMS eligibility requirements.

Terms apply. For eligible Medicare Part D patients with Foundayo or Zepbound prescription for weight management. Not a guarantee of coverage. Eligibility based on Medicare GLP-1 Bridge Clinical Criteria. Talk to your doctor to learn more.

To learn more, visit www.lilly.com/lillydirect/medicare. Patients can also talk with their healthcare providers about whether they qualify or refer to https://www.medicare.gov/coverage/weight-loss-drugs.

5. What should Medicare Part D patients ask their healthcare provider?

Consider asking your healthcare provider the following questions:

Am I eligible for the Medicare GLP-1 Bridge program?
Could a prescription obesity medicine be right for me?
What coverage or approval steps may be required?
Which FDA-approved treatment options best fit my health needs and lifestyle?
How can I make sure I am accessing medicine through appropriate, regulated channels?

Obesity is a chronic disease, and it is never too late to ask for support. To learn more, visit www.lilly.com/lillydirect/medicare.

INDICATION AND SAFETY SUMMARY WITH WARNINGS FOR FOUNDAYO
Foundayo™ (fown-DAY-oh) is a prescription medicine used with a reduced-calorie diet and increased physical activity to help adults with obesity, or some adults with overweight who also have weight-related medical problems, to lose excess body weight and keep the weight off.

Foundayo should not be used with other GLP-1 receptor agonist medicines.
It is not known if Foundayo is safe and effective for use in children.

Warnings - Foundayo may cause tumors in the thyroid, including thyroid cancer. Watch for possible symptoms, such as a lump or swelling in the neck, hoarseness, trouble swallowing, or shortness of breath. If you have any of these symptoms, tell your healthcare provider.

Do not use Foundayo if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC).
Do not use Foundayo if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Do not use Foundayo if you have had a serious allergic reaction to orforglipron or any of the ingredients in Foundayo.

Foundayo may cause serious side effects, including:

Inflammation of the pancreas (pancreatitis).Stop taking Foundayo and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without nausea or vomiting. Sometimes you may feel the pain from your abdomen to your back.

Severe stomach problems.Stomach problems, sometimes severe, have been reported in people who use Foundayo. Tell your healthcare provider if you have stomach problems that are severe or will not go away.

Dehydration leading to kidney problems.Diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems. It is important for you to drink fluids to help reduce your chance of dehydration. Tell your healthcare provider right away if you have nausea, vomiting, or diarrhea that does not go away.

Low blood sugar (hypoglycemia).Your risk for getting low blood sugar may be higher if you use Foundayo with medicines that can cause low blood sugar, such as an insulin or sulfonylurea. Signs and symptoms of low blood sugar may include dizziness or light-headedness, sweating, confusion or drowsiness, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, mood changes, hunger, weakness, or feeling jittery.

Serious allergic reactions.Stop using Foundayo and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, or very rapid heartbeat.

Changes in vision in patients with type 2 diabetes. Tell your healthcare provider if you have changes in vision during treatment with Foundayo.

Gallbladder problems. Gallbladder problems have happened in some people who use Foundayo. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include pain in your upper stomach (abdomen), fever, yellowing of skin or eyes (jaundice), or clay-colored stools.

Food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation).Foundayo may increase the chance of food getting into your lungs during surgery or other procedures. Tell your healthcare providers that you are taking Foundayo before you are scheduled to have surgery or other procedures.

Common side effects
The most common side effects of Foundayo include nausea, constipation, diarrhea, vomiting, indigestion, stomach (abdominal) pain, headache, swollen belly, feeling tired, belching, heartburn, gas, and hair loss. These are not all the possible side effects of Foundayo. Talk to your healthcare provider about any side effect that bothers you or doesn't go away.

Tell your doctor if you have any side effects. You can report side effects at 1-800-FDA-1088 orwww.fda.gov/medwatch.

Before taking Foundayo

Tell your healthcare provider about all the medicines you take. Foundayo may affect the way some medicines work, and some medicines may affect the way Foundayo works.
Pregnancy Exposure Registry: There will be a pregnancy exposure registry for women who have taken Foundayo during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry, or you may contact Eli Lilly and Company at 1-800-LillyRx (1-800-545-5979).
If you take birth control pills by mouth, talk to your healthcare provider before you take Foundayo. Birth control pills may not work as well while taking Foundayo.Your healthcare provider may recommend another type of birth control for 30 days after starting Foundayo and for 30 days after each dose increase of Foundayo.
Talk to your healthcare provider about low blood sugar and how to manage it.Tell your healthcare provider if you are taking medicines to treat diabetes including an insulin or sulfonylurea.

Review these questions with your healthcare provider:

Do you have other medical conditions, including problems with your pancreas or kidneys, or severe problems with your liver, severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems digesting food?
Do you have a history of diabetic retinopathy?
Are you scheduled to have surgery or other procedures that use anesthesia or deep sleepiness (deep sedation)?
Are you pregnant or plan to become pregnant? Foundayo may harm your unborn baby.
Are you breastfeeding or plan to breastfeed? Breastfeeding is not recommended during treatment with Foundayo.
Do you take any other prescriptions or over-the-counter medicines, vitamins, or herbal supplements?

How to take

Take Foundayo exactly as your healthcare provider tells you to.
Use Foundayo with a reduced-calorie diet and increased physical activity.
Take Foundayo by mouth 1 time each day, with or without food.
Swallow tablets whole. Do not break, crush, or chew the tablet.
If you miss a dose, take it as soon as possible. Do not take 2doses of Foundayo in the same day.
Do not take more than 1 tablet per day.
If you miss taking Foundayo for 7 or more days in a row, call your healthcare provider to talk about how to restart your treatment.
If you take too much Foundayo, call your healthcare provider or Poison Help line at 1-800-222-1222 or go to the nearest hospital emergency room right away.

Learn more
Foundayo is a prescription medicine available in 0.8 mg, 2.5 mg, 5.5 mg, 9 mg, 14.5 mg, or 17.2 mg oral tablets. For more information, call 1-800-545-5979 or go to foundayo.lilly.com.

This summary provides basic information about Foundayo but does not include all information known about this medicine. Read the information that comes with your prescription each time your prescription is filled. This information does not take the place of talking with your doctor. Be sure to talk to your doctor or other healthcare provider about Foundayo and how to take it. Your doctor is the best person to help you decide if Foundayo is right for you.

OG CON BS APR2026

Foundayo^™ is a trademark of Eli Lilly and Company.

INDICATIONS AND SAFETY SUMMARY WITH WARNINGS FOR ZEPBOUND

Zepbound^® (ZEHP-bownd) is an injectable prescription medicine used with a reduced-calorie diet and increased physical activity to help adults with:

obesity, or some adults with overweight who also have weight-related medical problems, to lose excess body weight and keep the weight off.
moderate-to-severe obstructive sleep apnea (OSA) and obesity to improve their OSA.

Zepbound contains tirzepatide and should not be used with other tirzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if Zepbound is safe and effective for use in children.

Warnings -Zepbound may cause tumors in the thyroid, including thyroid cancer. Watch for possible symptoms, such as a lump or swelling in the neck, hoarseness, trouble swallowing, or shortness of breath. If you have any of these symptoms, tell your healthcare provider.

Do not use Zepbound if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC).
Do not use Zepbound if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Do not use Zepbound if you have had a serious allergic reaction to tirzepatide or any of the ingredients in Zepbound.

KwikPen^®: Do not share your KwikPen with other people, even if the pen needle has been changed.You may give other people a serious infection or get a serious infection from them.

Zepbound may cause serious side effects, including:

Severe stomach problems.Stomach problems, sometimes severe, have been reported in people who use Zepbound. Tell your healthcare provider if you have stomach problems that are severe or will not go away.

Gallbladder problems. Gallbladder problems have happened in some people who use Zepbound. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include pain in your upper stomach (abdomen), fever, yellowing of skin or eyes (jaundice), or clay-colored stools.

Inflammation of the pancreas (pancreatitis). Stop using Zepbound and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without nausea or vomiting. You may feel the pain from your abdomen to your back.

Serious allergic reactions. Stop using Zepbound and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, or very rapid heartbeat.

Low blood sugar (hypoglycemia).Your risk for getting low blood sugar may be higher if you use Zepbound with medicines that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugarmay include dizziness or light-headedness, sweating, confusion or drowsiness, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, mood changes, hunger, weakness or feeling jittery.

Changes in vision in patients with type 2 diabetes.Tell your healthcare provider if you have changes in vision during treatment with Zepbound.

Food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation).Zepbound may increase the chance of food getting into your lungs during surgery or other procedures. Tell all your healthcare providers that you are taking Zepbound before you are scheduled to have surgery or other procedures.

Common side effects

The most common side effects of Zepbound include nausea, diarrhea, vomiting, constipation, stomach (abdominal) pain, indigestion, injection site reactions, feeling tired, allergic reactions, belching, hair loss,and heartburn. These are not all the possible side effects of Zepbound. Talk to your healthcare provider about any side effect that bothers you or doesn't go away.

Tell your doctor if you have any side effects. You can report side effects at 1-800-FDA-1088 orwww.fda.gov/medwatch.

Before using Zepbound

Your healthcare provider should show you how to use Zepbound before you use it for the first time.
Talk to your healthcare provider about low blood sugar and how to manage it. Tell your healthcare provider if you are taking medicines to treat diabetes including an insulin or sulfonylurea.
If you take birth control pills by mouth, talk to your healthcare provider before you use Zepbound. Birth control pills may not work as well while using Zepbound.Your healthcare provider may recommend another type of birth control for 4 weeks after you start Zepbound and for 4 weeks after each increase in your dose of Zepbound.

Review these questions with your healthcare provider:

Do you have other medical conditions, including problems with your pancreas, or severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems digesting food?
Do you take diabetes medicines, such as insulin or sulfonylureas?
Do you have a history of diabetic retinopathy?
Are you scheduled to have surgery or other procedures that use anesthesia or deep sleepiness (deep sedation)?
Do you take any other prescription medicines or over-the-counter drugs, vitamins, or herbal supplements?
Are you pregnant, plan to become pregnant, breastfeeding, or plan to breastfeed? Zepbound may harm your unborn baby. Tell your healthcare provider if you become pregnant while using Zepbound. Zepbound may pass into your breast milk. You should talk with your healthcare provider about the best way to feed your baby while using Zepbound.

Pregnancy Exposure Registry:There will be a pregnancy exposure registry for women who have taken Zepbound during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry, or you may contact Lilly at 1-800-LillyRx (1-800-545-5979).

How to take

Read the Instructions for Use that come with Zepbound.
Use Zepbound exactly as your healthcare provider says.
Use Zepbound with a reduced-calorie diet and increased physical activity.
Inject Zepbound under the skin (subcutaneously) of your stomach (abdomen), thigh, or have another person inject in the back of the upper arm. Do not inject ZEPBOUND into a muscle (intramuscularly) or vein (intravenously).
Use Zepbound 1 time each week, at any time of the day.
Change (rotate) your injection site with each weekly injection. Do not use the same site for each injection.

If you take too much Zepbound, call your healthcare provider, call the Poison Help line at 1-800-222-1222 or go to the nearest hospital emergency room right away.

Zepbound is approved as a 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg injection.

Learn more

Zepbound is a prescription medicine. For more information, call 1-800-LillyRx (1-800-545-5979) or go to www.zepbound.lilly.com.

This summary provides basic information about Zepbound but does not include all information known about this medicine. Read the information that comes with your prescription each time your prescription is filled. This information does not take the place of talking with your healthcare provider. Be sure to talk to your healthcare provider about Zepbound and how to take it. Your healthcare provider is the best person to help you decide if Zepbound is right for you.

ZP CON BS 25FEB2026

Zepbound^®, its delivery device base and KwikPen^® are registered trademarks owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates.

Source: BrandPoint

The news, reports, views and opinions of authors (or source) expressed are their own and do not necessarily represent the views of CRWE World.

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