Tier 2: BMI 30+ plus one qualifying condition
Short answer: With a BMI of 30 or higher, you qualify for the Medicare GLP-1 Bridge if you also have at least one of three conditions: chronic kidney disease at stage 3a or beyond, heart failure, or high blood pressure that medication hasn't brought under control. One condition is enough — you don't need all three.
Program facts last verified against CMS: July 21, 2026
The three Tier 2 qualifying conditions
Chronic kidney disease at stage 3a or higher — meaning kidney function (eGFR) has declined to about 59 or below. Many people with early-stage CKD don't know they have it; it's identified from routine bloodwork your doctor may already have.
Heart failure — any diagnosis of heart failure qualifies, including heart failure with preserved ejection fraction (HFpEF), which is common in older adults and often underdiagnosed.
Uncontrolled high blood pressure — hypertension that stays above goal despite taking blood-pressure medication. Well-controlled hypertension on medication does not qualify under this tier.
If you're BMI 30+ without these conditions
You may still qualify: the Tier 3 conditions (prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease) apply at BMI 27 and up, which includes you. Prediabetes in particular is extremely common after 65 and frequently undiagnosed — about half of older adults meet the definition, and a simple A1c blood test settles it.
Quick BMI check
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Common questions
Does controlled high blood pressure count?
No — the criterion is hypertension not controlled by medication. If your readings are at goal on your current prescription, this particular condition doesn't qualify you, but check the Tier 3 conditions, which also apply at your BMI.
How do I know my CKD stage?
Ask your doctor for your eGFR number from your most recent bloodwork. An eGFR of 59 or below generally corresponds to stage 3a or higher.
Do I need to prove the condition?
Your provider documents the diagnosis in the prior authorization they submit to the program's central processor. You don't submit anything yourself.
Related
Criteria source: CMS — Medicare GLP-1 Bridge · KFF