Medicare GLP-1 Bridge eligibility: the published criteria, tier by tier
CMS has published the actual clinical criteria for the GLP-1 Bridge — three BMI tiers, each with specific qualifying conditions. Even more important is a rule almost nobody covers: the criteria are measured at the time you started GLP-1 therapy, not the day you apply. Here’s the full picture so you can have an informed conversation with your doctor.
First, the two gate questions
Before the clinical criteria matter at all, two things must be true:
1. You're enrolled in an eligible Part D plan type. The Bridge is open to people in a standalone Part D plan (PDP) or a Medicare Advantage coordinated care plan with drug coverage — HMO, HMOPOS, or local/regional PPO. [v2-10] Some plan types can't participate (details in the plan-types guide). [v2-10]
2. Your GLP-1 isn't already routed through Part D by your diagnosis. CMS is explicit: "Type 2 diabetes, moderate to severe obstructive sleep apnea, and noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) indications are eligible for Part D coverage. Beneficiaries with these diagnoses are eligible to receive GLP-1s through their Part D plan and therefore are ineligible to receive them through the Medicare GLP-1 Bridge, even if they otherwise meet the Medicare GLP-1 Bridge clinical criteria." [v2-9] So if you have one of those three diagnoses, the Bridge is not your path — your Part D plan is (see the diabetes guide).
The published clinical criteria — three tiers
The baseline requirements: the GLP-1 is used to reduce excess body weight and maintain weight reduction alongside ongoing lifestyle intervention, and you are 18 or older. [v2-7] Then you must fall into one of three tiers: [v2-7]
Tier 1 — BMI ≥ 35 (at the time of therapy initiation), no additional condition required. [v2-7]
Tier 2 — BMI ≥ 30, plus at least one of: [v2-7]
- Heart failure with preserved ejection fraction [v2-7]
- Uncontrolled hypertension — systolic above 140 or diastolic above 90 while on two antihypertensive medications [v2-7]
- Chronic kidney disease, stage 3a or higher [v2-7]
Tier 3 — BMI ≥ 27, plus at least one of: [v2-7]
- Pre-diabetes (as defined by the ADA) [v2-7]
- History of heart attack (myocardial infarction) [v2-7]
- History of stroke [v2-7]
- Symptomatic peripheral arterial disease [v2-7]
One clarification worth underlining: pre-diabetes is a qualifying condition, not a disqualifier. Type 2 diabetes routes you to Part D [v2-9], but pre-diabetes appears in the ≥27 tier as a listed qualifying condition, not an exclusion. [v2-7] "Pre-diabetes ≠ diabetes" is exactly the distinction CMS's own criteria draw. [v2-7] [v2-9]
Who checks these criteria? Not you, and not a form you fill out: your prescribing doctor attests to the clinical criteria in the prior authorization they submit. [v2-7] [v2-11] That's why the right next step after reading this page is a conversation with your prescriber.
The timing rule almost everyone misses
CMS states that eligible beneficiaries must meet the clinical criteria "at the time of GLP-1 therapy initiation" — and this includes people who started therapy before they enrolled in Part D and before the Bridge launched. [v2-8]
CMS gives its own example: a beneficiary started GLP-1 therapy in September 2024 with a BMI of 37; by July 2026, when they seek the Bridge, their BMI is 34. Their doctor attests based on the BMI at initiation — 37, which meets the ≥35 tier — so the later BMI of 34 does not disqualify them. [v2-8]
Read that again if you've been paying cash for a GLP-1 and your BMI has come down: the progress you made does not lock you out. [v2-8] Our guide for people already paying cash covers the pay-cash-today situation in full.
Quick self-check walkthrough
- Are you 18+ and using (or considering) a GLP-1 for weight reduction and maintenance, with ongoing lifestyle intervention? [v2-7]
- Do you have type 2 diabetes, moderate-to-severe OSA, or noncirrhotic MASH? If yes → Part D path, not the Bridge. [v2-9]
- Are you in a standalone PDP or an MA-PD coordinated care plan (HMO/HMOPOS/local or regional PPO)? [v2-10]
- At the time you started (or will start) GLP-1 therapy, did/do you meet one of the three tiers above? [v2-7] [v2-8]
- Write down the numbers and dates behind your answers — your BMI and diagnoses as of therapy initiation. That's the information your prescriber would reference when attesting in the PA — bring it to the conversation. [v2-7] [v2-8] [v2-11]
This walkthrough helps you prepare for that conversation; it is not a determination. The official patient entry points are Medicare.gov/glp1bridge and 1-800-MEDICARE. [v2-12]
This page summarizes public CMS guidance as of July 2026 and is general information, not medical or insurance advice. Eligibility under the Bridge is attested by your prescriber in the prior authorization, and program details are set by CMS and may change. Always confirm current rules on the official CMS Medicare GLP-1 Bridge page and at Medicare.gov/glp1bridge. [v2-12]
Frequently asked questions
My BMI is 31 and I have high blood pressure. Do I qualify?
The ≥30 tier requires uncontrolled hypertension specifically — SBP above 140 or DBP above 90 while on two antihypertensive medications. [v2-7] Whether your situation matches is exactly what your doctor attests to in the PA. [v2-7]
I have pre-diabetes. Does that block me the way diabetes does?
No — pre-diabetes (ADA definition) is a qualifying condition in the BMI ≥27 tier. [v2-7] Type 2 diabetes routes the drug through Part D instead. [v2-9]
I have sleep apnea. Can I use the Bridge?
If you have moderate-to-severe obstructive sleep apnea, CMS says GLP-1s for that indication are covered through Part D, making you ineligible for the Bridge even if you otherwise meet the clinical criteria. [v2-9]
My BMI qualified when I started the drug, but it's lower now. Am I out?
The criteria are measured at the time of GLP-1 therapy initiation — CMS's own example is someone who started at BMI 37 and applied at BMI 34, qualifying on the initiation-time number. [v2-8]
Where is the official criteria list?
On the CMS provider page for the Bridge; your doctor uses it when submitting the PA. [v2-7] [v2-11] Patient entry: Medicare.gov/glp1bridge or 1-800-MEDICARE. [v2-12]
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