Copy it, print it, or download the PDF
Make it easy for your doctor to say yes.
The Bridge is brand new, and most clinicians haven't prescribed through it yet. The Doctor Request Packet turns your screener answers into something your doctor can act on in minutes — including the exact prescribing steps from CMS's own fact sheet.
What's free, and what the $19 adds
The screener and your doctor message are free — run it, copy the message, send it today, no charge. The packet is for the next step: giving your doctor everything they need to act on a program they've likely never prescribed through.
The clinician prescribing sheet
Packet only — the centerpiece
Built from the CMS prescriber fact sheet (Product No. 12235): covered drugs and formulations (including the Zepbound KwikPen-only rule), the E66 diagnosis code, the "SEND TO BRIDGE FOR WEIGHT MANAGEMENT" pharmacy note, and the prior-authorization timeline. This is the page your doctor acts on — and the part you can't get from the free screener.
A one-page patient summary
Packet only
Your coverage type, BMI history, relevant diagnoses, and how they compare to the published criteria pathways — organized the way a clinic reads it, with a documentation checklist and visit questions.
PDF download & print formatting
Packet only
One clean document to attach in your patient portal, email ahead of your visit, or hand across the desk.
Your message, in your voice
Free with the screener
A warm, clear portal message ready to paste into MyChart, Healow, or an email. Free because asking the question should cost nothing — the packet exists to make the answer easy.
One-time packet access
$19
Complete the free screener first — you'll see your result and doctor message at no cost. The $19 unlocks the full packet: the formatted summary, the clinician reference sheet, and PDF download.
Payment is processed by Stripe Checkout; we never see your card number. The charge appears on your card statement as COLUMBIA SOFTWARE LLC, the company that operates this site. A purchase doesn't include medical care, prescribing, prior authorization submission, or any coverage outcome — those are between your clinician and the program.
Start with the free screenerWhy get it now, before July 1?
The Bridge can't process a claim until July 1 — but everything else can happen early, and probably should. Medicare appointments often book two to six weeks out, so a visit scheduled today likely lands after launch anyway. Your starting weight may take some digging to document. And your doctor will much prefer reviewing a new program's prescribing rules before your visit than during it. Patients who arrive prepared in the first week are the ones whose prescriptions go out first — the packet is how you become one of them.
Why the clinician sheet matters
The Bridge works differently from regular Part D: the prescription needs an obesity diagnosis code (E66 family) and the note "SEND TO BRIDGE FOR WEIGHT MANAGEMENT" so the pharmacy routes the claim to the right place. Then the Bridge triggers a prior-authorization request back to your doctor, usually within 24–72 hours. A doctor who knows those steps in advance can handle your request in one pass instead of three.
Payment and privacy
Your packet is generated in your browser and shown after Stripe verifies your payment. We don't store your health answers on a server, and we never ask for your Medicare number.
Refunds
If a duplicate charge occurs or a site error prevents packet access after payment, contact us within 14 days and we'll make it right. Refunds aren't based on whether a clinician prescribes or whether coverage is approved — we can't control those outcomes and don't promise them. Details in the Terms of Use.