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.
2. Your GLP-1 history — the question that trips people up
Have you ever received a GLP-1 through your Medicare drug plan? If yes, the published rules send your request through your Part D plan rather than the Bridge. But here's the part people get wrong: paying cash doesn't count. 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.
Frequently asked questions
Does paying cash for a GLP-1 disqualify me?
No. Only a GLP-1 received through your Part D plan changes the route. Self-pay use doesn't count against you.
Which BMI counts if I already started therapy?
Your BMI when therapy began. Gather both numbers — the screener uses the right one automatically.
Should I send my Medicare ID in a portal message?
Usually no — your clinic already has it, and you should never enter it on outside websites.
Sources and review status: Content reviewed June 12, 2026, based on published CMS materials including the prescriber fact sheet (CMS Product No. 12235). Check current CMS materials: CMS Bridge overview, beneficiary information, provider information.