Enrollment
Forms & Downloads
Download and complete the forms below, or have a licensed Medicare agent walk you through them step by step.
PDF
Medicare GLP-1 Bridge Prior Authorization Request
Complete this form with your prescriber to request coverage for GLP-1 weight loss medications through your Medicare Part D plan.
↓ Download PA RequestPDF
Medicare GLP-1 Bridge — $50/Month Program Overview
Program guide explaining eligibility, covered medications, and the pathway to $50/month pricing for qualified beneficiaries.
↓ Download Program Guide