GLP-1 Random 1
A beneficiary says, “My Medicare Part D plan already covers my GLP-1 medication prescription. Can I still use the Bridge instead?” What should you advise?
No, if the Part D plan already covers the medication, the member is not eligible for the Bridge
A provider asks, “Can I just call in the prior authorization request over the phone?” What should you say?
No, requests must be submitted electronically or by fax
How is the prior authorization request typically initiated after the first claim denial?
An automated prior authorization request is sent to the provider
A beneficiary is standing at the pharmacy, and the claim is not found. What should you advise next?
Let them know the pharmacy can contact the pharmacy support team
A pharmacist calls directly and says, “I need help processing a GLP-1 Bridge claim.” What should you do?
Provide the pharmacy support number and transfer the call to the pharmacy team
A provider calls to check whether a patient’s authorization was approved or denied. Which system shows this information?
PAHub
A representative says, “I’ve never called before, but the member gave me permission to ask about the claim status.” According to the process, what is needed?
A verbal POA attestation and documentation in CRM
A beneficiary calls and says: “How will I know if my prior authorization for the GLP‑1 Bridge was approved or denied?”
Both the provider and the patient will receive a letter explaining whether the request was approved or denied
A provider calls about an authorization. After you go through the proper steps, the system shows the authorization is denied. What should you do?
Provide the denial reason and discuss whether a new request should be pursued
A beneficiary says, “Why isn’t this going through my Part D plan?” What is the best response?
“The Bridge is separate from your regular Part D benefit.”
A beneficiary says, “The pharmacy ran the claim, and it was denied. They told me it needs a prior authorization.” What is the best next step?
A beneficiary asks, “Can I use a coupon or discount card with the Bridge?” What is the correct response?
No, coupons and discount programs cannot be used with the Bridge
A beneficiary asks: “Will I need a new prior authorization every time I refill my medication?”
No, refills do not require a new prior authorization unless the medication changes
A provider says, “I need help with CoverMyMeds for this patient.” What should you do?
Provide general guidance only and refer to CoverMyMeds support if needed
A beneficiary calls and says, “They’re telling me they can’t get my GLP-1 prescription to go through.” Of these choices, what should you do?
Authenticate the caller in DomaniRx
A beneficiary asks: “How much will I pay each month for a GLP‑1 medication through the Bridge?”
A fixed $50 monthly copay
A provider calls and says, “How do I get a prior authorization started for my patient?” What is the best answer?
"Send a prescription for an eligible GLP-1 medication to the pharmacy.”
A beneficiary says, “I’ve been paying the $50 copay. Why hasn’t that reduced my Part D deductible?” What should you say?
“Bridge copays do not count toward your Part D deductible or out-of-pocket totals.”
A beneficiary asks, “Can I submit the prior authorization myself since my doctor is busy?” What is the best response?
No, only a provider can submit a prior authorization request
A provider asks: “Do Part D plans need to participate for my patient to access the Bridge?”
No, plans do not need to opt in
Which patients are generally eligible for the GLP‑1 Bridge program?
Medicare Part D beneficiaries who lack access to GLP‑1 drugs through their plan for weight loss
What is the Medicare GLP‑1 Bridge?
A short‑term CMS demonstration providing access to certain GLP‑1 drugs outside Part D
A caller asks: “What is the very first step to getting a GLP‑1 medication through the Bridge?” What is the correct choice?
The patient talks to their provider about GLP‑1 medications for weight loss
What happens when the pharmacy first submits a claim for a GLP‑1 medication under the Bridge?
The claim is denied indicating prior authorization is required
A beneficiary calls about a claim, but they cannot locate their MBI. What is the best next step?
Provide only general information and give self-service ways to locate the MBI