Hello and may this blog find you well, with your Medicare insurance keeping things simple.
Questions about Medicare Supplements, Medicare Advantage, or why my brother’s dog Teddy is so well trained (electric collar🐶)? Email Gray@TheBig65.com or book a time on my calendar. We’ll do our best.
It was so much fun to be back in Virginia with my brothers last week.
One of Haas’ buddies runs a place in Staunton called the Valley Smoke House. It’s only open Thursday through Sunday, and they know how to cook👨🍳🔥🥩!
Eating all that delicious food did remind me about the new Medicare GLP-1 Bridge program that could help some Medicare beneficiaries access certain weight-loss medications.
CMS plans to launch a temporary program beginning July 1st through December 31st, 2026.
The goal is to give certain Medicare Part D beneficiaries access to specific GLP-1 medications used for weight reduction. Currently most GLP-1 are only available for diabetes and certain heart conditions.
CMS currently lists these GLP-1 drugs for the Bridge program when used to reduce excess body weight and maintain weight reduction:
- Foundayo
- Wegovy including injection and tablets
- Zepbound KwikPen
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CMS notes that Zepbound single-dose vials and single-dose pens are not included in this Bridge program.
For eligible beneficiaries, the pharmacy will collect a $50 copay. The rest of the pharmacy payment will be handled through a CMS central processor, outside the normal Part D payment system.
That detail matters: CMS says the $50 copay does not count toward the person’s Part D true out-of-pocket costs, and low-income cost-sharing subsidies do not reduce the $50 amount.
Life is all about the details, right? Like when I got back home to Colorado, it snowed again! We needed the moisture, but the bees were not happy.
The program is nationwide, but it is not automatic. A person must be enrolled in a Medicare drug plan, either a standalone Part D plan or a Medicare Advantage plan with drug coverage, and must meet prior authorization rules.
CMS says the prescribing provider must submit a prior authorization request confirming that the medication is being used along with ongoing lifestyle modification, including structured nutrition and physical activity. The person must also meet BMI and health-condition criteria, such as:
- BMI of 35 or higher, or
- BMI of 30 or higher with certain conditions such as heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or higher, or
- BMI of 27 or higher with certain conditions such as pre-diabetes, prior heart attack, prior stroke, or symptomatic peripheral artery disease.
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Many clients have been frustrated because GLP-1 drugs for weight loss have often been very expensive or not covered in the way they expected.
This new CMS Bridge program may help some access these medications at a much lower monthly cost.
If you think this might be helpful for you, the next step is to talk with your physician. Once CMS releases more operational details, reach out directly to your Part D drug plan so you’ll be ready to move.
Our exchange student Miti was ready for Mother’s Day and she made my wife smile. Keep looking for ways to make others smile!
Keep asking, “What’s the next big thing?”
If family or friends need help… referrals are the lifeblood of my business.
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Karl Bruns-Kyler
(877) 850-0211
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Karl Bruns-Kyler is a Medicare insurance broker and independent Medicare agent licensed to help Medicare recipients in thirty-three states from around the country, including:
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The Big 65 Medicare Insurance Services does not offer every plan available in your area. Currently, we represent 10 organizations that offer 50 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
