Tier 1: BMI 35 or higher qualifies on its own
Short answer: If your BMI is 35 or higher and you have Medicare drug coverage, you meet the GLP-1 Bridge program's first eligibility tier — no additional health conditions are required. Your provider still needs to submit a prior authorization confirming your BMI before you can fill at the $50/month rate.
Program facts last verified against CMS: July 21, 2026
What Tier 1 means in practice
Tier 1 is the simplest path into the program. CMS set BMI 35 as the threshold at which body-mass index alone — without any other diagnosis — establishes eligibility for the $50/month copay on Wegovy, Zepbound (KwikPen), or Foundayo.
For reference, BMI 35 corresponds to roughly 216 pounds at 5'6", 242 pounds at 5'10", or 258 pounds at 6'0". Use the calculator below to check yours, and remember your provider's measurement at the prior-authorization stage is what counts, not a home estimate.
What you still need even at Tier 1
Three things: Medicare drug coverage (a Part D plan or Medicare Advantage plan with drug coverage), no routing condition (type 2 diabetes, moderate-to-severe sleep apnea, or MASH — those move you to standard Part D coverage instead), and a provider-submitted prior authorization to the program's central processor, which is administered by Humana.
Quick BMI check
Take the full 2-minute eligibility check →
Common questions
Does a BMI of exactly 35 qualify?
Yes — CMS's criterion is BMI 35 or higher. If you're on the borderline, your provider's measured height and weight at the prior-authorization stage is what counts.
Do I need diabetes or heart problems to qualify at Tier 1?
No. At BMI 35+, no additional condition is required. In fact, if you have type 2 diabetes you'd be routed to standard Part D coverage instead of the Bridge.
How much will I pay?
A flat $50 per month, with no deductible. Note the $50 does not count toward your Part D out-of-pocket cap, and Extra Help (LIS) does not reduce it.
Related
Criteria source: CMS — Medicare GLP-1 Bridge · KFF