KFF Cost Projection Analysis Released: Medicare GLP-1 Bridge Runs $1.3 Billion at 10% Participation to $10 Billion at 75% Participation Over the 18-Month Demonstration on a $195/Month Net Federal Payment Per Beneficiary After the $50 Copay
KFF (formerly Kaiser Family Foundation) published cost-projection detail on the Medicare GLP-1 Bridge demonstration this week that goes beyond the 3.8 million eligibility headline into the fiscal outlay Medicare actually books. The math: Medicare's net drug payment runs $195 per beneficiary per month ($245 negotiated net drug price minus the $50 patient copay). At 10% participation of the 3.8 million eligible Part D enrollees, monthly refills across the 18-month program cost Medicare roughly $1.3 billion; at 25% participation, $3.3 billion; at 50% participation, $6.7 billion; at 75% participation, $10 billion. CMS Medicare Director Chris Klomp told reporters on the launch call that the agency expects participation to run in the 'single-digit millions' at first with volume ramping through Q3 and Q4 2026, suggesting the middle of the KFF range as the most probable outcome. The Bridge operates outside the standard Part D risk pool, meaning Part D plan sponsors do not carry actuarial risk for these drugs; beneficiary spending under the Bridge does not count toward the Part D $2,100 annual out-of-pocket cap for 2026. The cost-projection frame is the piece analysts and Congressional staff will use to judge Bridge success over the next 18 months.