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The BMI thresholds, the conditions that count, and the situations where a GLP-1 is not appropriate.
GLP-1 eligibility for weight management comes down to two thresholds that appear on the FDA labelling of every approved product. A BMI of 30 or higher qualifies on its own. A BMI of 27 or higher qualifies if you also have at least one weight-related health condition.
That is the framework, but it is not the whole answer. A telehealth platform can decline you for reasons unrelated to BMI, insurance applies its own separate criteria that are often stricter, and the new Medicare GLP-1 Bridge program uses different thresholds again.
This guide covers all three, plus the contraindications that matter — because "do I qualify" and "is this safe for me" are different questions, and the second one is more important.
These thresholds appear on the FDA labelling for approved weight-management GLP-1s and are what most telehealth providers apply.
| Your BMI | Category | Do you qualify? |
|---|---|---|
| 30 or higher | Obesity | Yes — qualifies on BMI alone |
| 27 to 29.9 | Overweight | Yes, but only with at least one weight-related condition |
| Below 27 | Normal or overweight | Generally not, under standard labelling |
BMI is a screening tool, not a diagnosis. It does not distinguish muscle from fat and performs differently across ethnic groups. Your prescriber makes the final clinical judgement.
If your BMI is between 27 and 29.9, you generally need at least one weight-related comorbidity. Commonly accepted conditions include:
The exact list a given provider or insurer accepts varies. Document any diagnosis you have before your consultation — an undiagnosed condition you suspect you have does not count.
From July 1, 2026, the Medicare GLP-1 Bridge program requires you to be 18 or older and meet its own criteria when starting GLP-1 therapy — including a BMI of 35 or higher under one pathway. Reporting on the program also describes pathways at BMI 30 to 35 with associated conditions such as uncontrolled hypertension or advanced chronic kidney disease. These are stricter than the standard label criteria, so qualifying clinically does not automatically mean qualifying for Medicare coverage. Check Medicare.gov for the current requirements.
Meeting the label criteria and getting your insurance to pay are two different hurdles. Commercial plans routinely add requirements on top of the FDA labelling: prior authorization, documented participation in a supervised diet and exercise program for a set period, step therapy requiring you to fail a cheaper medication first, or a higher BMI threshold than 30.
Some plans exclude weight-management medication entirely as a category, regardless of your BMI or conditions. That exclusion is a benefit design decision, not a clinical one, and no amount of documentation will overcome it.
This is why checking your formulary before choosing a provider matters more than most people realise. If your plan covers Wegovy at a $25 copay, an insurance-billing provider is dramatically cheaper than any cash-pay platform. If your plan excludes the category, manufacturer-direct self-pay at $149 to $299 a month is your realistic floor.
These are the situations where a GLP-1 may be contraindicated or requires particular caution. This is not a complete list — the full prescribing information for each product is.
Disclose your full medical history honestly at intake. An intake questionnaire is not a formality — it is how the prescriber identifies whether a GLP-1 is safe for you specifically.
Most platforms begin with a health questionnaire covering your height and weight, medical history, current medications, allergies and any relevant family history. Some then route you to a video visit; others review asynchronously and follow up with questions.
Providers differ considerably in how thorough this is, and it is worth paying attention to. A platform that approves you within minutes of a short form has not meaningfully assessed you. One that asks follow-up questions about your history, checks your other medications for interactions, and discusses realistic expectations is doing the job properly.
Lab work is not universally required. Some providers order baseline labs, many do not, and requirements vary by state and by clinical situation. If you have not had recent bloodwork — particularly HbA1c, a lipid panel, liver and kidney function — it is reasonable to ask for it regardless of whether the platform requires it.
You can be declined, and that is not always bad news. A provider who says no because of a contraindication in your history is doing exactly what you are paying them for.
Yes, but only if you also have at least one weight-related health condition such as type 2 diabetes, prediabetes, high blood pressure, high cholesterol, sleep apnea or PCOS. A BMI between 27 and 29.9 alone is generally not enough under standard labelling. A BMI of 30 or higher qualifies on its own.
A BMI of 30 or higher qualifies on BMI alone. A BMI of 27 or higher qualifies with at least one weight-related condition. The Medicare GLP-1 Bridge program uses stricter criteria, including a BMI of 35 or higher under one pathway.
Yes. Licensed telehealth providers can prescribe GLP-1 medications in all 50 states after evaluating you. The depth of that evaluation varies significantly between platforms — some conduct live video visits, others review a questionnaire asynchronously.
It depends on the provider and your clinical situation. Some platforms order baseline labs, many do not, and requirements vary by state. Sesame includes lab tests in its program, which is unusual. Even where labs are not required, it is reasonable to ask for baseline bloodwork if you have not had recent testing.
GLP-1s are generally contraindicated with a personal or family history of medullary thyroid carcinoma or MEN 2, and require caution or avoidance with a history of pancreatitis, gastroparesis, gallbladder disease, type 1 diabetes, pregnancy or breastfeeding, an eating disorder history, or known hypersensitivity. This is a summary — read the full prescribing information and disclose your complete history to your prescriber.
Common reasons include a BMI below threshold, no qualifying comorbidity at BMI 27 to 29.9, a contraindication in your history, an interacting medication, or state licensing limits. Being declined for a contraindication is the system working correctly. If you believe the assessment was wrong, seek a second opinion from a provider who conducts live video visits.
No, and insurance is usually stricter. Plans commonly add prior authorization, documented supervised diet and exercise participation, step therapy, or a higher BMI threshold. Some exclude weight-management medication entirely as a benefit design decision, which no clinical documentation can overcome.
If your BMI is 30 or higher, yes — that qualifies on its own. If your BMI is between 27 and 29.9, you generally need a documented weight-related condition. A condition you suspect you have but have never been diagnosed with will not count, so it is worth getting evaluated first.
Getting your plan to pay
Different eligibility rules
What to expect once you start
Find one that fits your situation
A relevant contraindication explained
Choosing a medication
Claims on this page trace to the following sources, checked on August 30, 2026.
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This article summarizes general eligibility criteria and is for informational purposes only. It is not medical advice, a diagnosis, or a treatment recommendation, and it is not a complete list of contraindications or warnings. Only a licensed healthcare provider who has evaluated your full medical history can determine whether a GLP-1 medication is appropriate for you. Always read the full prescribing information. This page contains affiliate links, and we may earn compensation if you use them.
Date reviewed: August 30, 2026