GLP-1 Coverage Navigator

A mobile-first PWA that turns GLP-1 insurance chaos into a step-by-step path — eligibility check, cost comparison, prior authorization letter draft, and denial appeal wizard in one place.

Problem

Starting July 1, 2026, Medicare's GLP-1 Bridge program offers eligible Part D enrollees Wegovy, Zepbound, or Foundayo for $50/month — but the eligibility rules are non-trivial (BMI thresholds, qualifying comorbidities, enrollment in a Humana-administered authorization system), and no patient-facing tool explains them. On the commercial side, 88% of people who have any GLP-1 coverage still face prior authorization requirements, and 41 million people saw their Wegovy coverage disappear in 2026 alone. A person whose doctor just wrote a GLP-1 prescription faces an information maze — eligibility rules, PA forms, cost tiers, appeal timelines — with no unified tool to navigate it.

Target user

Adults with BMI ≥ 30 who are trying to start or stay on a GLP-1 prescription: Medicare Part D enrollees deciding whether the Bridge program applies to them, commercially insured patients staring at a prior authorization denial letter, and the newly uninsured millions comparing direct-to-consumer pricing vs. compounding alternatives. Secondary: primary care providers who need a fast eligibility pre-check before writing a prescription.

MVP scope

• Medicare GLP-1 Bridge eligibility quiz: BMI, qualifying comorbidities (heart failure, hypertension, prediabetes, etc.), plan type — outputs a clear yes/no with the specific criterion met and a step-by-step enrollment checklist
• Side-by-side cost comparison across four lanes: Medicare Bridge ($50/month), manufacturer savings programs, direct-to-consumer pricing (Wegovy $149–$349/month, Zepbound $299/month), and compounding alternatives (~$99/month) — pre-filled with the user's state and income for LIS/Extra Help eligibility
• Prior authorization letter generator: given health profile and insurer name, drafts the clinical justification letter a provider signs and submits — aligned with the PA form published by the insurer
• Denial appeal wizard: walks through the 5-level Medicare appeal process or the commercial insurer internal/external appeal path, pre-filling deadlines, required identifiers, and the medical necessity argument
• Push reminders for PA expiration dates and appeal response deadlines

Monetization

Freemium: eligibility quiz and cost comparison are free and serve as acquisition. Pro at $7/month or $59/year unlocks the PA letter generator, appeal wizard, and deadline reminders. Targets the 88% who hit the prior-authorization wall. Secondary B2B tier: clinics and obesity medicine practices pay a flat monthly fee to white-label the PA and appeal tools for their patient panel.

Why now

The Medicare GLP-1 Bridge launches July 1, 2026 — creating a six-day window of peak demand from Medicare beneficiaries who need eligibility guidance before the program is live. Separately, 2026 saw a 42% year-over-year increase in Americans losing commercial Wegovy coverage, pushing over 41 million people into active replanning mode. KFF Health News reported in June 2026 that no patient-facing guide explains the central authorization process run through Humana, and that low-income enrollees are at particular risk of missing the program because the $50 copay does not count toward Part D out-of-pocket caps. The moment patients need a navigator is now, before July 1, not after.

Risks & open questions

• Demand-side: patients are accustomed to free but shallow tools (GoodRx, RxSaver); converting them to $7/month requires a clear, immediate win on the PA or appeal use case — demo video must show a denial letter going in and a complete appeal packet coming out
• Build-side: insurer-specific PA forms change frequently; maintaining an accurate form library across the top 10-15 commercial payers is the ongoing operational load, likely requiring a mix of web scraping, partner agreements, or a community-contributed update model
• Regulatory: the app generates documents that inform medical decisions — must include clear disclaimers, cannot call itself medical advice, and should have a healthcare attorney review the PA letter generator copy before launch
• Market: Honest Care already does GLP-1 denial appeals; differentiation is the Medicare Bridge eligibility layer and the cost comparison across all four lanes, not just appeals
• Retention: GLP-1 coverage changes with annual plan renewals; the app has natural annual re-engagement but needs a reason to keep Pro subscribers between their PA renewal cycle

Next step

Build a one-day landing page that collects email addresses with a "Check your Medicare GLP-1 Bridge eligibility before July 1" CTA; if 500 signups in 48 hours, proceed to MVP build.

Sources

• https://kffhealthnews.org/medicare/cheaper-glp-1-weight-loss-medicare-bridge-wegovy-zepbound-foundayo/ — Medicare GLP-1 Bridge patient pain points, $50 copay details, low-income access gaps (June 2026)
• https://www.stretchdollar.com/posts/how-to-afford-glp-1s-in-2026-what-to-know-about-insurance-coverage-and-alternative-options — 41M Wegovy coverage losses, 88% prior-auth rate, DTC pricing tiers
• https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge — CMS authoritative eligibility and program structure
• https://www.medicarerights.org/medicare-watch/2026/06/04/glp-1-weight-loss-drug-demonstration-begins-july-2026 — Medicare Rights Center summary of July 2026 demonstration details