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Health NetTraditional Medicare · Prior Auth · Prior Authorization · Endocrinology, Family Medicine, Internal Medicine +2 moreHigh impact

26-878 Medicare GLP-1 Bridge Program for Weight Loss Began July 1, 2026

Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Jul 18, 2026

Summary

Effective July 1, 2026, a new CMS Medicare GLP-1 Bridge Program provides Medicare Part D coverage for three GLP-1 medications (Wegovy, Foundayo, Zepbound) prescribed exclusively for weight management. Providers must identify eligible patients, include obesity diagnosis code E66 and notation 'SEND TO BRIDGE FOR WEIGHT MANAGEMENT' on prescriptions, and submit prior authorization through a CMS-designated processor if not received within 72 hours.

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What to do

by Jul 1, 2026 · 5 steps
01Providers must update prescribing workflows to identify Medicare Part D patients eligible for weight management with GLP-1 medications.
02Billing and clinical staff must modify prescription generation to include obesity diagnosis code E66 and add notation 'SEND TO BRIDGE FOR WEIGHT MANAGEMENT' on all eligible GLP-1 prescriptions.
03Update prior authorization procedures: establish monitoring for electronic/fax PA requests from CMS processor (must arrive within 72 hours); if not received, manually submit the CMS GLP-1 Bridge PA form to the designated processor.
04Train providers to verify patients do not have other Medicare Part D-covered indications for GLP-1 medications (such as diabetes).
05Configure billing system to route claims for Wegovy, Foundayo, and Zepbound (KwikPen only) for weight management to the CMS processor, not standard Medicare Part D adjudication.
If missed: Failure to properly route prescriptions and obtain PA will result in claim denials and patient access delays.

Codes mentioned

E66

Original notice

26-878 Medicare GLP-1 Bridge Program for Weight Loss Began July 1, 2026
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
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Related policy hubs

Health Net policiesEndocrinologyFamily MedicineInternal MedicineBariatric SurgeryGeriatricsCode E66

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