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Family Practice Associates of Lexington

FPA Guide to Medicare GLP-1 Bridge Program

Medicare GLP-1 Bridge Program 

Patient Information & Frequently Asked Questions Effective July 1, 2026 


What is the Medicare GLP-1 Bridge Program?

The Medicare GLP-1 Bridge Program may provide coverage for certain weight-loss medications for eligible Medicare patients.


Who Qualifies?

You must:

Have Medicare Part D prescription coverage and have not received GLP-1 medication previously through your Medicare Part D.


You must NOT have:

Type 2 Diabetes

Moderate-to-Severe Sleep Apnea

Metabolic Dysfunction-Associated Steatohepatitis (MASH)


You must meet ONE of the following criteria:

BMI 35 or higher; or


BMI 30 or higher plus one of these conditions:

  • Heart Failure with Preserved Ejection Fraction (HFpEF)
  • Uncontrolled High Blood Pressure
  • Chronic Kidney Disease (Stage 3a or higher)


BMI 27 or higher and one of these conditions:

  • Prediabetes
  • Prior Heart Attack
  • Prior Stroke
  • Symptomatic Peripheral Artery Disease (PAD)


Your provider can help you determine if you meet all program requirements.


Covered Medications 

Wegovy® injections and tablets 

Zepbound® KwikPen® ****Single-dose Zepbound pens and vials are not covered.

Foundayo® tablets

  • Do I Need an Appointment?

    Yes. An appointment with your provider is required before starting a GLP-1 medication or for any dose changes. This visit may be completed in person, by telephone, or through telehealth. The appointment will be billed to your insurance according to your plan benefits, and any applicable copays, deductibles, or coinsurance may apply.

  • Will I Need Follow-up Appointments?

    Yes. Monthly follow-up appointments are required to monitor your progress and provide medication

    refills.


    Please schedule your next appointment at the end of your initial visit or contact our office before your medication runs out to avoid any interruption in treatment.


    In addition, an in-person visit every 3 to 6 months will be required to evaluate your progress and obtain any necessary laboratory testing.

  • Can I Discuss Other Health Concerns During These Visits?

    No. These appointments are specifically for weight management and GLP-1 medication follow-up only.


    Any additional concerns will require a separate appointment.

  • How Long Does the Process Take?

    Medicare must first determine your eligibility. If eligible, it may take up to two weeks before the prior authorization is submitted. Once prior  authorization is submitted, decisions are typically returned within 72 hours.

  • Who Should I Contact for Updates?

    Please contact your pharmacy directly for updates regarding your prescription.

  • How Often Can My Medication Be Filled?

    Only 28-day or 30-day prescriptions are covered through the program.

  • Will I Need Another Prior Authorization?

    Usually, a new prior authorization is only required if you switch to a different covered GLP-1 medication.

Questions? 


Please contact Family Practice Associates of Lexington at (859) 278-5007 or via Sophie, the ChatBot on the website at www.fpalex.com to schedule an appointment with a provider to discuss whether you qualify for the Medicare GLP-1 Bridge Program.   

Accepted Insurance Plans

Payment Policy:
We, at Family Practice Associates of Lexington, require payment on the date of service. Please be prepared to pay all co-pays, deductibles, and any outstanding balances at the time of your visit. Call us today to learn more.


Patients with High-Deductible Health Plans are required to make a $100 deposit on the date of service. At this time, Family Practice Associates (FPA) does not accept Medicaid or WellCare plans.


For Marketplace plans, we currently accept CareSource only.

For all other plans, please contact our Billing Department. There are too many small plans to list—thank you for your understanding!


Medicare Plans Accepted

  • Traditional Medicare (Red, White & Blue Card)
  • Railroad Travelers Medicare
  • Medicare Advantage Plans:
  • Aetna (No Dual Advantage Plans)
  • Anthem (No Dual Advantage Plans)
  • Humana (No Dual Advantage Plans)
  • UnitedHealthcare (No Dual Advantage Plans)


Commercial Insurance Plans Accepted

  • Aetna (Not Aetna Better Health)
  • Administrator Concepts
  • All Savers
  • Allied Benefit Systems
  • Anthem Blue Cross Blue Shield (Not Transition Pathway X)
  • Assurant Health
  • Bankers Life / Fidelity
  • CareSource Marketplace KY (Not Humana CareSource)
  • ChampVA (Not accepting new patients)
  • Cigna
  • Coordinated Benefits
  • Custom Design Benefits
  • First Health
  • Fiserv
  • Freedom Life
  • Golden Rule
  • GEHA
  • HealthComp
  • Imagine360
  • International Benefits Administrators (IBA)
  • Kentucky Health Administrators (KHA)
  • Liberty HealthShare
  • Loomis
  • Medica
  • Medico
  • MedBen
  • MultiPlan
  • Meritain
  • Medi-Share
  • Mutual of Omaha
  • Nippon Life
  • PHCS
  • Physicians Mutual
  • Principal Life
  • Tricare (Not accepting new patients)
  • Thrivent
  • TPA
  • United World Life
  • UnitedHealthcare
  • United HealthShare
  • UMR


Self-Pay Policy

  • Established Patients: $50 deposit at check-in
  • New Patients: $100 deposit at check-in
  • Remainder of visit cost will be collected at checkout and/or through a payment agreement.
  • Paid in Full on Date of Service: Eligible for a 30% discount


Insurance Plans Not Accepted

  • No MVA (Motor Vehicle Accidents) or Workers’ Compensation
  • No Tricare Primary
  • No Medicaid (Primary or Secondary)
  • No UK HMO (Patients must stay within the UK network)
  • No Anthem Transition Pathway HMO

Understanding Insurance

At Family Practice Associates of Lexington - Hamburg Pavilion, we're committed to providing exceptional healthcare while helping you navigate the complexities of insurance. As a Patient Centered Medical Home serving Central Kentucky since 1983, we work with various insurance companies, including Medicare, to ensure you receive the care you need. As a locally owned private practice, we're here to assist you with your insurance questions. Don't hesitate to reach out for more information about how we can help you maximize your insurance benefits. Our office requires payment on the date of service. Please settle your co-pays, deductibles, and other outstanding balances at the time of your visit. High Deductible plans will be required to make a $100 deposit on the date of service. Call us today.



At this time, FPA does not accept Medicaid or WellCare plans. For Marketplace plans, we only accept CareSource.

**For any other plans, please call our billing dept. There are too many small plans to list! Thank you.

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We Work With Insurance Providers


We accept most insurance plans, including Medicare, to help make your care more accessible. Contact us to verify your coverage or learn more.

Call us today to learn more

(859) 278-5007