You can estimate by calculating your Body Mass Index (BMI) using your height and weight:

• Underweight: <18.5
• Normal: 18.5-24.9
• Overweight: 25-29.9
• Obese: 30+

Typical qualification criteria: 

• BMI: 30+
• BMI: >27 with related condition, such as: High Blood Pressure, Type 2 Diabetes, High Cholesterol, Sleep Apnea

Absolute contraindications:

• Personal or family history of medullary thyroid cancer (MTC) or MEN 2 
• Known serious allergy to the medication 
• Pregnancy or breastfeeding

Use With Caution If You Have: 

• History of pancreatitis 
• Gastroparesis or severe digestive issues 
• Inflammatory bowel disease (IBD) 
• Severe kidney disease 
• Diabetic retinopathy

Additional Considerations:

• History of eating disorders (use caution) 
• Gallbladder disease (increased risk of gallstones) 
• Mental health conditions, including prior suicidal thoughts (monitor closely)

There are two GLP-1 medications used for weight loss: 

1. Zepbound (tirzepatide)
2. Wegovy (semaglutide)

Both medications are effective options for weight loss. 

If you are paying out of pocket, you have two main pathways: 

1. Brand-name medications (through manufacturer programs):

• Discounted pricing may be available directly form the manufacturer. 

1. Compounded versions (from licensed compounding pharmacies):

• Often more affordable
• Typically administered as injections

The Medicare GLP-1 Bridge Program is a temporary Medicare program that began July 1, 2026. It allows eligible Medicare Part D beneficiaries to receive certain FDA-approved weight loss medications for a flat $50 monthly copay. The program is currently scheduled to run through December 31, 2027. 

Currently, the program includes:

• Wegovy® (injectable and tablet) 
• Zepbound® KwikPen 
• Foundayo® (tablet) 

Coverage is limited to specific formulations approved by Medicare. 

To be eligible, you must:

• Have Medicare Part D (or a Medicare Advantage plan with prescription drug coverage) 
• Meet Medicare's medical eligibility requirements 
• Receive a prescription from your healthcare provider 
• Have an approved prior authorization 
• Participate in a lifestyle program that includes healthy eating and physical activity.  

No. Eligibility is determined by Medicare based on your medical history and current health conditions. Some patients who already qualify for GLP-1 coverage through traditional Medicare Part D (such as for diabetes or certain other FDA-approved indications) may not qualify for the Bridge Program because those medications should instead be covered through their regular Part D benefit. 

Eligible patients pay a $50 copay for a one-month supply of medication. 

No. The Medicare GLP-1 Bridge Program operates separately from your regular Medicare Part D prescription benefit. The $50 copay does not apply toward your deductible or annual out-of-pocket spending limit. 

No. Because the Bridge Program is separate from the Part D benefit, the Extra Help (LIS) program does not reduce the $50 copay. 

Yes. Medicare requires a prior authorization before the medication can be dispensed. Your healthcare provider must submit the required documentation and certify that the medication is being used as part of a comprehensive weight management program. 

Approval times vary. Please allow several business days after your provider submits the prior authorization. If Medicare requests additional information, the process may take longer.

Yes. If you meet the medical criteria and the medication is appropriate for you, your primary care provider can prescribe a covered GLP-1 medication and complete the required prior authorization.

No. GLP-1 medications are not appropriate for every patient. Your provider will review your medical history, medications, and health conditions to determine whether treatment is safe and appropriate.

If you are not eligible for the Medicare GLP-1 Bridge Program, our office can discuss other evidence-based weight management options that may be appropriate for you.

Eligibility and coverage decisions are determined by Medicare, not our office. While we are happy to help determine whether you may qualify and submit the required paperwork, we cannot guarantee approval or coverage. 

If cost were equal, tirzepatide (Zepbound) is often a preferred starting option because:

• It is typically well tolerated
• It may be slightly more effective for some patients

Semaglutide (Wegovy) is also highly effective.  Some patients do very well on it, while others may switch to tirzepatide if results are limited. 

Available through Lilly Direct:

https://www.lilly.com/lillydirect/medicines/zepbound

Oral Pill: (Foundayo)

• Starting Dose: $149/month
• Mid doses: $199/month
• Higher Doses: $299/month 

Injection:

• Starting dose: ~$299/month
• Mid doses: ~$399/month
• Higher doses: ~$499/month

Note: some patients lose weight on lower doses, while others require higher doses. 

Available through NovoCare: 

https://www.novocare.com/pharmacy.html

Oral Pill: 

• Starting dose: ~$149/month
• Higher doses: up to ~$299/month

Injection: 

• Starting dose: ~$199/month
• Higher doses: up to ~$349/month

Note: many patients require higher doses for optimal results.

If affordability is your top priority:

Tirzepatide (compounded): 

• ~$449 for a 3-month starting supply 
• ~$299/month for higher doses 

Semaglutide (compounded): 

• ~$224 for a 3-month starting supply 
• ~$149/month for higher doses 

Many patients have had positive experiences with reputable compounding pharmacies such as orderlymeds.com

Most common side effect: nausea 

• Anti-nausea medication (like ondansetron/Zofran) can be prescribed if needed.

To reduce side effects: 

• Take a daily fiber supplement (e.g., fiber gummies or Citrucel) 
• Take a daily multivitamin

Doses are typically increased monthly if:

• Your are tolerating the medication well
• Your have not yet reached your goal weight

Once you reach your goal: 

• Gradually reduce the dose every 4 weeks 
• Avoid stopping suddenly to prevent weight regain

Important Note: If you stop the medication for several weeks, you will likely need to restart at a lower dose to avoid significant  nausea. 

Once you start treatment, check in regularly with your provider. Dose adjustments, side effect management, and long-term planning are key to success.