June GLP-1 trends: Oral Wegovy mix stabilizes; CMS launches Bridge Program

研报英文原文证据摘录

June GLP-1 trends: Oral Wegovy mix stabilizes; CMS launches Bridge Program

Medicaid Services

limited than headline obesity prevalence in Medicare suggests. While 13MM Medicare

beneficiaries were estimated to have obesity/overweight in 2023, a recent KFF analysis GLP-1 – glucagon-like peptide-1

estimates only 3.8MM would meet the program’s eligibility requirements. The Medicare MASH - metabolic dysfunction-

GLP-1 Bridge Program runs from July 2026 to December 2027 and provides qualifying associated steatohepatitis

beneficiaries access to Wegovy, Zepbound, and Foundayo for a $50 monthly co-pay.

However, eligibility criteria is more narrow than the product’s FDA approved labels, NRx – new prescription

requiring specific BMI and comorbidity thresholds while excluding patients already

OSA – obstructive sleep apneacovered for GLP-1s through existing Medicare indications such as type 2 diabetes, OSA,

or MASH. Chris Klomp, director of Medicare at CMS, recently stated participation is PA – prior authorization

expected to be in the “single-digit millions” initially, broadly consistent with KFF.

PBM – pharmacy benefit manager

CoverMyMeds opportunity may exceed Bridge eligibility

TRx – total prescriptionFor MCK, the implications for CoverMyMeds may be more favorable than the KFF

analysis suggests. Prior authorizations (PAs) are required to establish eligibility for the

program. As a result, PA volumes could exceed final approvals, particularly during the

initial launch period as providers screen a broad pool of beneficiaries. Based on our

channel checks, CoverMyMeds can earn a transaction fee from processing PA requests

regardless of the outcome, suggesting the addressable opportunity is tied more closely

to authorization activity than final program enrollment.