{"name":"GLP-1 Coverage and Prior-Authorization Evidence Tracker","description":"A source-first tracker that separates confirmed public programs from insurer-specific claims that still need reproducible evidence.","snapshotId":"2026-08-26","updatedAt":"2026-08-26","cadence":"Monthly and after CMS or plan changes","license":"CC BY 4.0","methodology":["Prefer CMS, plan documents, and manufacturer coverage tools.","Separate eligibility rules from observed approval rates.","Do not infer national coverage from a provider’s patient sample.","Publish numerator, denominator, dates, payer mix, and exclusions before reporting proprietary rates."],"columns":[{"key":"program","label":"Program","definition":"Coverage or access program."},{"key":"status","label":"Status","definition":"Confirmed public status."},{"key":"population","label":"Population","definition":"Who may be eligible."},{"key":"price_or_benefit","label":"Published benefit","definition":"Confirmed price or program feature."},{"key":"unknowns","label":"Unknowns","definition":"What must still be confirmed."},{"key":"source_id","label":"Source","definition":"Source ledger identifier."}],"rows":[{"program":"Medicare GLP-1 Bridge","status":"Active beginning July 1, 2026","population":"Eligible Medicare Part D beneficiaries","price_or_benefit":"$50 monthly access to certain GLP-1 drugs","unknowns":"Individual eligibility and covered product","source_id":"cms-bridge"},{"program":"Ro insurance check","status":"Provider-published service","population":"Ro prospects seeking select GLP-1 coverage","price_or_benefit":"Free coverage check published","unknowns":"Plan-specific outcome and prior-authorization decision","source_id":"ro-pricing"},{"program":"FormBlends proprietary approval-rate dataset","status":"Not published","population":"None until methodology is complete","price_or_benefit":"No rate reported","unknowns":"Sample, payer mix, dates, numerator, denominator, exclusions","source_id":"formblends-products"}],"sources":[{"id":"cms-bridge","title":"Medicare GLP-1 Bridge","publisher":"Centers for Medicare & Medicaid Services","url":"https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge","accessedAt":"2026-08-25","sourceType":"regulatory"},{"id":"ro-pricing","title":"Weight Loss Program Pricing","publisher":"Ro","url":"https://ro.co/weight-loss/pricing/","accessedAt":"2026-08-25","sourceType":"company"},{"id":"formblends-products","title":"Product Finder: GLP-1 Programs & Peptide Research","publisher":"FormBlends","url":"https://formblends.com/products","accessedAt":"2026-08-25","sourceType":"company"}],"findings":[{"id":"finding-1","text":"Public program eligibility is not the same as an approval-rate estimate.","url":"https://formblends.com/report/data/glp1-coverage-prior-authorization-tracker#finding-1"},{"id":"finding-2","text":"The Medicare GLP-1 Bridge creates a time-bounded national access pathway for eligible beneficiaries.","url":"https://formblends.com/report/data/glp1-coverage-prior-authorization-tracker#finding-2"},{"id":"finding-3","text":"FormBlends should not publish PBM-specific percentages until the underlying sample is reproducible.","url":"https://formblends.com/report/data/glp1-coverage-prior-authorization-tracker#finding-3"}],"caveats":["Coverage is plan- and indication-specific.","This tracker does not guarantee coverage or replace a benefits determination."],"attribution":"FormBlends Research, GLP-1 Coverage and Prior-Authorization Evidence Tracker, snapshot 2026-08-26"}