Medicare GLP-1 Bridge Program

Medicare’s new Bridge program could open access to GLP-1 medications starting July 1, 2026, with an expected $50 monthly copay for eligible beneficiaries. We walk through the exact qualification rules and the practical safety steps we use when prescribing GLP-1s for adults 65 and older. 

• Medicare Bridge program timeline and why it could influence commercial insurance coverage 
• How Bridge eligibility differs from FDA-approved GLP-1 indications 
• BMI 35+ qualification and why highest documented BMI matters 
• BMI 30+ plus qualifying conditions like heart failure, resistant hypertension, or CKD stage 3A+ 
• How to spot CKD in labs using eGFR on a BMP or CMP 
• BMI 27+ pathways including prediabetes, prior heart attack or stroke, and symptomatic PAD 
• PAD basics and symptoms to bring to your clinician 
• Older adult safety basics including slow titration and avoiding dehydration 
• Nutrition priorities including adequate calories, protein, and micronutrients 
• Strength and mobility support through PT and beginner-friendly strength training 
• Why medication doses for blood pressure and diabetes may need adjustment during weight loss 
• Osteoporosis screening around age 65 and why it matters during GLP-1 treatment 

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Transcript

Welcome And Medical Disclaimer

Dr. Lindsay Ogle, MD 0:00

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you.

What The Medicare Bridge Program Is

Dr. Lindsay Ogle, MD 0:43

What is the Medicare Bridge program? This is a very exciting program that is starting July 1st, 2026 that is going to allow many patients on Medicare have access to GLP1 agonist medications. So we're going to talk about who would qualify for this program, what it means, and are GLP1 medications really safe in people who are 65 and older, which is most of the people who are on Medicare. So the Bridge program that's going to start on July 1st, 2026, is a program for individuals who have Medicare in the United States. It is now slated to last until December 31st, 2027. So right now it is expected to last for at least 18 months. And the hope is that if they see positive health improvements and they're seeing good outcomes, then maybe this program will be extended even further. And the hope, as with most things, once Medicare starts covering it, then commercial insurers follow suit. And so hopefully this is the first step to, or one of the first steps, to improve GLP1 coverage for all individuals in the United States who qualify and would benefit from it.

Eligibility Rules And BMI Cutoffs

Dr. Lindsay Ogle, MD 2:10

With this bridge program, it has a little bit different indications for coverage than the FDA approved indications for GLP1 medications. And so I want to go over those today because it can be a little bit confusing. And in general, it's confusing because just because something is FDA approved for the treatment of obesity, legally, right now in the United States, insurance is not required to cover it. And so the insurance plan can set their own qualifying metrics, and the bridge program is doing that as well. So the first qualification, the easiest is a BMI of 35 or greater, will qualify you for GLP1 coverage. Oh, and I will say when I say coverage for the bridge program, there will be an expected $50 co-pay for the medication. So it would be $50 a month to pay for your GLP1 medication, which is a relatively high copay. I definitely get that. But many people, if you are paying out of pocket for GLP1 medications for brand name, it is at least $250 up to $450 a month. So this is significant savings to drop down to $50 a month for brand name GLP1 medications. So that first qualifying BMI is $35 or greater. So any individual who is on Medicare and has a BMI of $5 or greater will qualify. And it is important for all of these classifications to use your highest BMI. This is the same as what we would do for any other chronic medical condition. You will use your starting, I guess, metric. So an example is blood pressure. And if your blood pressure was consistently over the threshold for what we consider hypertension, then you have hypertension even if your blood pressure is controlled on medications or with lifestyle. Same thing with type 2 diabetes. Once your A1C has been over 6.5, with two readings, we need to to um solidify that diagnosis. But even once your A1C is down to a normal range, you still technically have type 2 diabetes. It is just in remission. So same thing for the disease of obesity. So if your BMI is or has been 35 or greater, then get that documented. You know, have your old clinical notes, have your doctor put that explanation in your visits, and then you should qualify. The next BMI cutoff is 30. So a BMI of 30 or greater with a couple of weight-related conditions. So you only need one of these to qualify. It would be heart failure, hypertension, a blood pressure of 140 over 90, but this is hypertension uncontrolled with two medications. So you need to have that high blood pressure of 140 over 90 despite being on at least two antihypertensives, two blood pressure medications. And then chronic kidney disease, um, a CKD, stage 3A or higher. And this chronic kidney disease is something that is extremely common, but many people don't know that they actually carry this diagnosis. And so the way to look would be to, of course, ask your doctor. You can also look in your chart that typically would have a list of your chronic medical conditions, and you may see chronic kidney disease listed. Or you can look at your most recent labs. And what you are looking for is on the metabolic panel. This could be either a basic metabolic panel, a BMP, or a comprehensive metabolic panel, CMP. You're looking for the estimated glomerular filtration rate, which is the EGFR, and you're looking for a number of 59 or less. So the lower the GFR, the more significant the chronic kidney disease. So for this cutoff, we're looking for an EGFR of 59 or less, and you qualify if you have that chronic kidney disease stage 3A and a BMI of 30 or greater, then you would qualify. The next cutoff is a BMI of 27. And so if you have a BMI of 27 or greater and you have a diagnosis of prediabetes, which um again, this is another condition that many people have. One in three American adults have prediabetes, and most of them don't know that they have this diagnosis. They've either never been told or they've, you know, maybe been told but told not to worry about it. So this is another thing to look into your chart to ask your doctor about. The diagnosis is made by an A1C of 5.7 to 6.4, or a fasting blood sugar, a fasting glucose between 100 and 125. Um, those are the most common ways that it's diagnosed. There are a couple of other ways that it can be diagnosed, but typically that's how it is diagnosed. So ask your doctor, look in your chart for that prediabetes diagnosis, or look in your recent labs or get new labs to see if you have this diagnosis. And if you have prediabetes and a BMI of 27 or greater, then you would qualify. Also, if you've had a history of a heart attack or a stroke and a BMI of 27 or greater, you would qualify. And then lastly, if you have peripheral arterial disease, PAD, and having symptoms, then you would qualify. And what is PAD? That's another thing that doesn't often get diagnosed, but um what that is is basically just like there is plaque buildup in the arteries that supply blood to the heart that can lead to heart disease or a heart attack, that happens in other arteries throughout the body. And for PAD, that's happening to the peripheral arteries. So most commonly we're seeing this in the lower extremities in your legs, and the symptoms that you would have would be potentially when you're walking, and because there's decreased blood flow from the um plaque buildup in those arteries, you may have pain in your legs, you may be more fatigued, your legs are tired as you're walking when previously you didn't have those symptoms, maybe feel a little bit more crampy. Sometimes we see um less um hair on the legs because there's you know less of the blood flow going to support the hair follicle, and sometimes the skin changes in just the color and how it looks. So, again, something that can often get undiagnosed or um kind of brushed off as older age. But if you're having any of those symptoms and definitely talk to your doctor and see if you have that diagnosis as they confirm, can confirm that diagnosis. And if you have the PAD and having those symptoms and have a BMI of 27 or greater, then you would also qualify for the bridge program and could get a GLP1 medication for $50 a month. So I'm very excited about this program. I have several patients that I am planning on getting their GLP1 medications this way starting July. Um so I will update you on my Instagram and TikTok about how the bridge program is going for

GLP-1 Safety After Age 65

Dr. Lindsay Ogle, MD 10:07

them. But also, I wanted to talk about GLP1 medication use in patients who are 65 or greater, because again, that is most of the patients who are on Medicare. It's important to know that older adults, um 65 or greater, are often excluded from studies, which is unfortunate because many of our adults are 65 or greater, and this age population is expanding as we are, you know, continuing to live longer. Um, so this is a really important population, and you know, hopefully we're living into our 80s and 90s, and so that is 20 or 30 years that you're going to live in this 65 plus category. So that's a lot of time, that's decades of your life, and we want to optimize your health during that period because we don't just want to live longer, we want to live healthier and better and fuller lives so we can actively participate in those lives. And I do think that for many, many people, GLP1 medications can help achieve those goals. It just needs to be done deliberately. And ideally, with somebody who is very experienced in prescribing GLP1 medications, that could be an obesity medicine physician, an endocrinologist, a primary care doctor, and whoever you're seeing who's prescribing this medication, if they are not as well-versed, then supplementing that care with a registered dietitian, um, a physical therapist, personal trainer, um, joining a GOP1 support group and community. I'll link some of those below and some people who I recommend following to get some advice while you're on these medications because that goes a long way is building that team around you to support you, andor joining a community to get that support if you can't get the individual guidance. So a couple things that I truly recommend to all of my patients, but are even more important in this age population is that we want to make sure that we are titrating the medication very slowly. So we never want to push the titration to the point where somebody is having significant side effects that's causing them to be sick. And we are particularly worried about dehydration. So if the medication dose is too high and someone's not drinking enough water, then that can make them very sick, cause dehydration, and can worsen kidney disease if kidney disease is present or cause kidney issues. It could also lead to light-headedness, dizziness falls, and so we want to go very slowly. We want to emphasize hydration and nutrition in general. So we want to make sure we're getting enough calories, eating regular meals throughout the day, making sure we're getting adequate protein and carbohydrates and healthy fats and getting our micronutrients and maybe supplementing with a multivitamin. We want to be again very diligent here, and working with a dietitian along with your doctor can help you achieve those goals. We also want to make sure that we are moving our body. This is something that needs to be done cautiously if it is new for you. If you are new to activity, if you don't have a lot of balance or strength, then I definitely recommend working with a physical therapist. You can ask your doctor for a referral, or in many states you can self-refer to physical therapy and you can ask for help with mobility, balance, strength training, and they can assess you and give you exercises to do with them. They can guide you through it, and then also you can continue those exercises regularly at home. I would also recommend a program called GLP Strong, which was created by an obesity medicine physician and a physical therapist and trainer. And this is an extremely approachable exercise program, and it's something that you do for 20 minutes two times a week, and it's specifically designed for people who are starting strength training and who are on GLP1 medications to help maintain and grow their muscle mass and lean body mass. And there are different levels: beginner, intermediate, and advanced. And so you can start at that beginner level, work on the body weight exercises, and then build up your strength and endurance over time, and then go to the intermediate and more advanced levels. It's $20 a month and you can cancel anytime. I'll include that link below if you are interested in joining that program. Another thing that is really important when utilizing GLP1 medications in an older population is that other chronic medical conditions are more common in this population. And so if you are starting a GLP1 and you have high blood pressure, if you have diabetes, if you have heart disease, um, again, kidney disease, any other medical conditions, I also think of like hypothyroid um disease, you want to talk to your doctor about continuing to monitor these other conditions because for many people, once they have started to lose weight and typically around that even as low as 5% total body weight, but definitely by 10 and then 20 to 20% of their initial body weight, you're going to see changes in your other medical conditions. And so you are likely going to need to adjust your other medications. So if you are on medications to lower your blood pressure, you are likely going to need lower doses of those medications over time or be able to stop them completely. So regularly seeing your doctor for check-ins on your other medical conditions is very important while on a GLP1

Bone Health Monitoring And Wrap-Up

Dr. Lindsay Ogle, MD 16:11

medication. And then I also want to highlight the importance of screening for osteoporosis. I just did an interview with Dr. Uzma Khan, who is an endocrinologist and joining my practice at Missouri Metabolic Health, and she did a lovely overview of what osteoporosis is, how we screen for it, what the risk factors are, what we can do to prevent it. We did not get into treatment because we had so much wonderful information to review during that talk. Depending on when that's released, it's either has already been released or will be released very soon. But I highly recommend, and I'll include that link once it's available. Osteoporosis is something that is often also overlooked, unfortunately, and we and it's asymptomatic, so you do need to screen for it to know you have that diagnosis. But it's very important because we do have great treatment options. And if you are somebody who has a lot of chronic medical conditions, and then you're on a GLP1 medication, and maybe you're not optimizing your nutrition or your physical activity, then you are going to further increase your risk for osteoporosis. And we talked a little bit about the association between GLP1 medications and low bone density and osteoporosis. Um again, check out that talk for more. But I wanted to highlight the importance of screening for it. Um, women, the current guidelines say all women should be screened by age 65 or at age 65. Um, many would qualify for earlier screenings. And the recommendations for men vary depending on which organization you're looking at. But it does it never hurts to bring this up with your doctor to ask if they think that you should be screened for osteoporosis because you may be surprised at the results. So it's something to think about around age 65 for really everybody, but definitely if you are on or starting a GLP1 medication. So I hope that helps to introduce you to the Medicare Bridge program for GLP1 medications. In summary, this is going to allow patients who have Medicare to access GLP1 medications for a copay of $50. There are different um categories of approval compared to the FDA-approved GLP1 um indications. So that's something to be aware of. Not everybody will qualify for this, unfortunately. Hopefully, this is opening the door for commercial insurers to start paying for GLP1 medications or covering them. And then an overview of using GLP1 medications in a population who is 65 or older. Um, I hope this was beneficial. If you know somebody who has Medicare and you know would be interested in starting a GLP 1 or you think it could be a good fit for them, don't hesitate to share this with them. I think it'll make a big difference, and I look forward to seeing you next week. Take care. Thank you for listening and loving how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.