The GLP-1 Bridge eligibility checklist

Five things to know about yourself before you message your doctor. Gather these and the conversation gets dramatically easier — for both of you.

1. Your drug coverage

• Do you have Medicare drug coverage — a standalone Part D plan, or a Medicare Advantage plan that includes drugs?
• If you're in PACE, a cost plan, or private fee-for-service: are you also enrolled in a standalone Part D plan? (Those plan types qualify only with one.)
• Your plan name is on your drug coverage card. Never enter your Medicare ID number on third-party websites — including this one. We never ask for it.
• Have your Medicare number (your MBI) on hand for your doctor's office — they need it to submit the prior authorization. Share it directly with your clinician, never through a website.

2. Your GLP-1 history — the question that trips people up

Since January 2026, have you received a GLP-1 through your Medicare drug plan? If yes, CMS's June 2026 FAQ sends your request through your Part D plan rather than the Bridge — and the timing matters: the rule is tied to receipt during 2026, so a plan-paid GLP-1 from an earlier year doesn't count here. Here's the part people get wrong: paying cash doesn't count either. If you've been buying Wegovy or Zepbound through LillyDirect, NovoCare, a coupon, or a compounding pharmacy, you have not "received a GLP-1 through your plan" — and the Bridge remains open to you.

3. Your BMI — now and when you started

The program looks at your BMI at the time GLP-1 therapy starts. If you're not on a GLP-1 yet, that's your current BMI. If you already take one, dig up your starting weight — receipts, old chart notes, or your patient portal can help. Many self-pay users have lost significant weight; the starting number is the one that counts, and that usually works in your favor.

4. Your diagnoses

• Qualifying conditions (these help if your BMI is 30+ or 27+): HFpEF, uncontrolled high blood pressure (above 140/90 despite two BP medications), chronic kidney disease stage 3a+, prediabetes, prior heart attack, prior stroke, or symptomatic peripheral artery disease.
• Routing conditions (these send the request through Part D instead): type 2 diabetes, moderate-to-severe sleep apnea (mild doesn't count), or MASH (a form of fatty liver disease).
• Only diagnosed conditions matter — what's in your chart, not what you suspect.

5. Your weight-management story

Notes on what you've tried — diet changes, exercise, programs, prior medications — help your doctor see the full picture and document the visit properly. A few honest sentences are plenty.

Putting it together: which pathway are you on?

Once you've gathered the five, your situation usually lands in one of these lanes:

• BMI 35 or higher at therapy start — the most direct pathway.
• BMI 30–34.9 with a qualifying condition (HFpEF, uncontrolled hypertension, CKD stage 3a+, prediabetes, prior heart attack or stroke, or symptomatic PAD).
• BMI 27–29.9 with a qualifying risk condition from that same list.
• Routed to Part D instead if you have type 2 diabetes, moderate-to-severe sleep apnea, MASH, or a plan-paid GLP-1 from 2026 — not a dead end, just a different lane (see the Bridge vs. Part D guide).

You don't have to diagnose yourself — your clinician confirms which lane fits. The point is simply to walk in knowing roughly where you stand.

Sources and review status: Content reviewed June 27, 2026, based on published CMS materials including the prescriber fact sheet (CMS Product No. 12235). Check current CMS materials: CMS Bridge overview, beneficiary fact sheet (PDF), provider information.