Medicare
GLP-1 Bridge
The Medicare GLP-1 Bridge program
People who meet all of the following:
- Adult patients (18+)
- Covered through Medicare Part D
- Prescribed medicine for chronic weight management
- Meet BMI and clinical criteria
- Foundayo™ (orforglipron)
- Zepbound® (tirzepatide) Single-Patient-Use KwikPen® for weight management
Zepbound Single-Dose Pen and Single-Dose Vial are not covered.
- $50 cost to you after prior authorization (PA) approval
- No new PA required for refills
- New PA only if patient switches to a different GLP-1 medication
- Medicare GLP-1 Bridge billed as primary insurance
- Coverage begins July 1, 2026 for new and existing weight management patients
Indication: Foundayo™ (fown-DAY-OH) is an oral 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.
Indications: 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. 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.
- I am 18 years of age or older.
- I have Medicare Part D drug coverage. (Not all plan types are covered. If you’re not sure what type of plan you have, call 1-800-633-4227. TTY users call 1-877-486-2048.)
- I am or I will be using Foundayo or Zepbound KwikPen for weight management, and not for type 2 diabetes, moderate-to-severe obstructive sleep apnea, or fatty liver disease. (Your Medicare Part D plan may already cover those conditions)
- I have a Body Mass Index (BMI) of 35 or higher OR I have a BMI of 27 or higher with certain weight-related medical conditions. Or, this was true at the time I started a GLP-1 medicine. These are specific Medicare GLP-1 Bridge Program Clinical Criteria.
- I have a prescription.
BIN: 028918
PCN: MEDDGLP1BR
GROUP: GLP1Bridge
Medicare number or the last 4 digits of SSN
BIN: 028918
PCN: MEDDGLP1BR
GROUP: GLP1Bridge
Medicare number or the last 4 digits of SSN
LillyDirect Pharmacy
NPI: 1912889320 | NCPDP: 1574056
1555 S Harding St, Ste 171-B68, Indianapolis, IN 46221
If you don’t have a provider, we can help you find a doctor.
If you choose to fill at a retail pharmacy, be sure to have with you the special claim routing information below along with your Medicare number. Present this information to the pharmacist:
BIN: 028918
PCN: MEDDGLP1BR
Group ID: GLP1Bridge
Medicare number or the last 4 digits of SSN
After your chosen pharmacy processes your prescription, the Medicare GLP-1 Bridge program will confirm if you are eligible for coverage. If you are, your doctor will receive a request to complete a prior authorization (PA).
Once the request is submitted, you will receive a PA approval or denial letter in the mail. This can take several days. The PA process only has to happen the first time you fill your prescription.
If you choose LillyDirect, you can get your medicine delivered for just $50 per month.
If you choose a retail pharmacy, they will text or call you directly to confirm when you can pick up your medicine.
Use this during checkout
Depending on the pharmacy you choose, you may need to provide certain information. It can be helpful to have these details ready, including your Medicare number (MBI) or the last 4 digits of your SSN.
Ask the pharmacy to add the BIN/PCN as primary insurance.
028918
PCN
MEDDGLP1BR
GROUP NAME
GLP1Bridge
What to say at the pharmacy: “I am starting the Medicare GLP-1 Bridge program. Please bill my prescription using the BIN and PCN above as primary insurance. My cost should be $50. Please do not bill Medicare Part D.”
Pharmacy choice: You may use LillyDirect® Pharmacy (home delivery available) or any retail pharmacy of your choice.
ONCE WEEKLY · KWIKPEN ONLY
Available Doses & NDC Codes
- 2.5 mg/0.6 mL 0002-3566-11
- 5 mg/0.6 mL 0002-3555-11
- 7.5 mg/0.6 mL 0002-3544-11
- 10 mg/0.6 mL 0002-3533-11
- 12.5 mg/0.6 mL 0002-3522-11
- 15 mg/0.6 mL 0002-3511-11
Once-weekly injection. Fills are for a 28-day supply.
KwikPen for Single-Patient Use for weight management. Single-Dose Vial and Single-Dose Pen (auto-injector) are NOT covered under Medicare GLP-1 Bridge. Remind patients to purchase KwikPen pen needles separately. With LillyDirect, pen needles are automatically included in patients' checkout carts for an additional fee.
ONCE DAILY · ORAL TABLET
Available Doses & NDC Codes
- 0.8 mg 0002-4178-31
- 2.5 mg 0002-4503-31
- 5.5 mg 0002-4794-31
- 9 mg 0002-4803-31
- 14.5 mg 0002-4839-31
- 17.2 mg 0002-4953-31
Oral tablet taken once daily. Fills are for a 30-day supply.
When the Medicare GLP-1 Bridge program launches on July 1, 2026, send the prescription for weight management to LillyDirect Pharmacy or patient's choice of retail pharmacy location.
LillyDirect Pharmacy
NPI: 1912889320 | NCPDP: 1574056
1555 S Harding St, Ste 171-B68, Indianapolis, IN 46221
- Provide their Medicare Number (on Medicare card) or last 4 digits of SSN to confirm eligibility starting July 1, 2026.
- Wait until prior authorization is approved. Do not go directly to the pharmacy.
- Remember that Zepbound KwikPen pen needles are required and sold separately through their pharmacy or online.
Add this exact note to all Medicare GLP-1 Bridge prescriptions: "SEND TO MEDICARE GLP-1 BRIDGE FOR WEIGHT MANAGEMENT"
- This note tells the pharmacy to route the script to the Central Processor. If omitted, the wrong Prior Authorization will be triggered and can cause significant coverage delays. Add to the Note field if electronic, or as an annotation if non-electronic.
- Do not proactively submit a PA—the pharmacy will initiate it.
- Pharmacy submits claim: LillyDirect or retail pharmacy submits the claim to the Medicare GLP-1 Bridge Central Processor.
- PA request routed to your office: Processor denies claim, requests PA. Pharmacy initiates and routes via ePA (e.g., CoverMyMeds) or fax—typically within 24–72 hours.
- You complete the PA: Complete the PA per form instructions. Electronic preferred; fax accepted; phone not accepted.
- Approved—patient pays $50/month: Most PAs auto-adjudicate instantly; remaining decisions return within 72 hours. Once approved, patient pays $50/month. No new PA needed for refills unless they switch to a different GLP-1 medication.
For HCPs and patients with questions about Foundayo®, Zepbound®, or LillyDirect® Pharmacy.
For questions about the Medicare GLP-1 Bridge program, call 1-800-MEDICARE.
Zepbound® is a registered trademark and Foundayo™ is a trademark of Eli Lilly and Company. For Medicare Part D Bridge Program use only. Valid July 2026–December 2027.
CMAT-32827 06/2026 ©Lilly USA, LLC 2026. All rights reserved.