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To address that gap, CMS launched a temporary Medicare GLP-1 Bridge program: starting July 1, 2026, eligible beneficiaries can access certain GLP-1 medications for about $50 per month, with eligibility tied to BMI thresholds (for example, a BMI of 35 or higher, or 27 or higher with other clinical criteria)
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What insurance companies look for: Common prior authorization criteria include documented BMI meeting the FDA-approved threshold, documentation of weight-related comorbidities (for patients with BMI 27 to 29.9), evidence of previous weight loss attempts (diet, exercise, behavioral modification), a letter of medical necessity from your provider, and sometimes documentation that you have tried and failed other weight loss medications first (step therapy)
