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Prescription Drug Assistance Programs

Medicare GLP-1 Bridge — Program description and how to access

Program description

• Purpose: Provide Medicare beneficiaries and their caregivers with targeted assistance to navigate coverage, prior authorization, appeals, and affordability for GLP‑1 receptor agonist therapies (e.g., semaglutide, liraglutide) prescribed for FDA‑approved indications.

• Core services:

  • Coverage assessment (Part B vs Part D, plan-specific rules)

  • Prior authorization preparation and submission support

  • Appeal and exception guidance and documentation help

  • Identification and enrollment in manufacturer assistance, copay programs, and other savings options

  • Coordination with prescribers, specialty pharmacies, and care teams

• Limitations: We provide informational and administrative support only. We do not change plan benefits, guarantee coverage decisions, or act as a plan sponsor, insurer, or pharmacy.

Who is eligible

• Medicare beneficiaries prescribed a GLP‑1 therapy, or their authorized caregivers/representatives, who need help with coverage, prior authorization, appeals, or cost‑saving options.

How to access the program (step-by-step)

1. Prepare basic information:

   • Medicare ID and plan details (Part D carrier name and plan, or Part B details)

   • Prescription: medication name, dose, frequency, prescriber name

   • Relevant medical records supporting medical necessity (diagnosis, recent labs, prior medication history)

   • Contact details for the beneficiary and prescriber

2. Request assistance:

   • Online intake form (if available on the program website)

   • Phone: call 1-800-555-GLP1 (example contact)

   • Email: support@medicareglp1bridge.org (example contact)

   • Alternatively, ask your prescriber or clinic to initiate a referral to the program.

3. Intake and review:

   • Program staff review your plan and clinical information to determine coverage pathways and documentation needed.

   • Staff will explain what services are free vs. any fee-based casework (e.g., extended appeals management) and obtain consent to handle PHI.

4. Authorization and coordination:

   • The team prepares and submits prior authorization or appeal requests, works with the prescriber to supply supporting clinical documentation, and follows up with the plan or pharmacy.

   • They will identify cost‑saving resources and help enroll in eligible assistance programs if appropriate.

5. Outcome and next steps:

   • You’ll be informed of plan decisions and next steps (approval, denial, or additional documentation needed).

   • If denied, the team can advise on or assist with appeals and exceptions where appropriate.

Timing and expectations

• Typical review and submission timeline: intake to submission within a few business days once documentation is complete.

• Plan response times vary (standard prior authorizations often take 7–14 days; expedited reviews may be faster).

• Staff will keep you informed of progress and expected timelines.

Privacy and consent

• Assistance requires your authorization to access or exchange health information. The program will provide a Privacy Notice and obtain consent before handling PHI.

What to have ready when you contact the program

• Medicare ID and plan name/ID

• Prescription details (drug, dose, prescriber)

• Recent clinical notes or lab results supporting the prescription

• Preferred contact method and authorized caregiver information (if applicable)

If you’d like to begin, call 1-800-555-GLP1 or complete the program’s online intake form.