Most telehealth companies will not tell you whether you qualify until you have handed over your details and worked through an assessment. The criteria themselves are not secret. Here they are, so you can assess yourself before spending anything.
The standard clinical criteria
For GLP-1 medications prescribed for chronic weight management, the widely used thresholds are:
- A BMI of 30 or above, which meets the clinical definition of obesity; or
- A BMI of 27 or above with at least one weight-related condition — commonly high blood pressure, type 2 diabetes, high cholesterol, or obstructive sleep apnea
PlushCare publishes exactly this and adds type 2 diabetes as independently qualifying. It is the only provider in our review set that states its criteria publicly, which is worth knowing if you want to check your position before you start.
A note on BMI
BMI is a crude instrument. It does not distinguish muscle from fat, and it performs differently across ethnic groups and body compositions. It remains the gatekeeping number in almost every coverage policy and prescribing protocol, so it is worth knowing yours — but a clinician assessing you should be looking at considerably more than a single ratio.
Medicare uses its own criteria
Since July 1, 2026, Medicare has run the GLP-1 Bridge, a CMS demonstration giving eligible Part D beneficiaries covered GLP-1s at a flat $50 copay through December 31, 2027. Its criteria are separate from the commercial standard, and there are three routes rather than one:
- A BMI of 35 or higher, with no additional condition required
- A BMI of 30 or higher with diastolic heart failure, uncontrolled high blood pressure, or chronic kidney disease at stage 3a or higher
- A BMI of 27 or higher with prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease
Most coverage of this program describes it as simply “BMI 35,” which is only the first door. The lower routes reach a considerably wider group, and they are worth checking against your own diagnoses before assuming you do not qualify.
Medicare also excludes people who already get GLP-1s covered through their Part D plan, and those with type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease — noting in the latter case that Part D may cover them through the ordinary benefit instead. Our Medicare GLP-1 Bridge guide sets out the covered drug formats, the provider requirements, and the four limitations worth understanding before you rely on it.
Separately, several telehealth providers exclude government-insured patients entirely, for commercial rather than clinical reasons. We cover those workarounds in our insurance and HSA/FSA guide.
Who providers commonly exclude
These exclusions appear repeatedly across the providers we reviewed:
- Under 18. Near-universal for these programs.
- Pregnancy. GLP-1 medications are not used during pregnancy, and providers screen for it.
- Active eating disorder. PlushCare states it does not treat patients with symptoms of an active eating disorder, and Noom lists eating disorders among its exclusions. This is an appropriate safety screen, and a provider that does not perform it is telling you something.
- Underweight. Noom states you cannot use its service with a BMI below 18.5. PlushCare states it does not start weight-loss pharmacotherapy in new patients with a normal BMI.
Beyond these, your prescriber will screen for clinical contraindications. The labelling for GLP-1 receptor agonists in this class includes warnings relating to personal or family history of medullary thyroid carcinoma and multiple endocrine neoplasia syndrome type 2, and prescribers also assess history of pancreatitis, gallbladder disease, and severe gastrointestinal conditions. This is exactly the conversation to have with the clinician rather than a website.
The exclusion nobody expects: your insurance
This one is not clinical at all, and it disqualifies more people than any medical criterion.
LifeMD states that people with any form of government healthcare coverage — including Medicare, Medicaid, TRICARE, and Medicare Supplement plans, whether primary or secondary — are not eligible for its GLP-1 weight loss programs. Note the wording: holding the coverage disqualifies you, even if you never intend to use it for this.
Restrictions of this kind are common where manufacturer self-pay pricing is involved. If you have government coverage of any kind, check this before investing time anywhere.
If government coverage has locked you out
NovoCare Pharmacy explicitly permits people with government-funded plans to access its self-pay pricing by processing the purchase outside their insurance. Form Health states it is covered by national plans including Medicare, and Found quotes a $50/month Medicare Part D copay. Those are the three routes we found.
What providers actually publish
| Provider | Published criteria | Stated exclusions |
|---|---|---|
| PlushCare | BMI 30+, or 27+ with a comorbidity, or type 2 diabetes | Active eating disorder; new patients with normal BMI |
| LifeMD | BMI 30 without a comorbidity; BMI 25+ for non-GLP-1 pack | Any government healthcare coverage |
| Noom | Not published | Under 18, pregnancy, eating disorder, BMI below 18.5 |
| Henry Meds | 18+, “demonstrated medical need”, supported state | Not otherwise published |
| Mochi Health | Not published | Not published |
| Found | Not published | No insurance plans in California |
What to have ready before you apply
Whichever provider you choose, the assessment will ask for most of this. Having it accurate speeds things up and makes the clinical review more useful:
- Your current height and weight, so your BMI is right
- Any weight-related diagnoses — hypertension, type 2 diabetes, prediabetes, high cholesterol, sleep apnea, fatty liver disease
- A full list of current medications and supplements
- Personal and family history relevant to the class warnings, particularly thyroid cancer and endocrine conditions
- Any history of pancreatitis, gallbladder disease, or significant GI problems
- Previous weight-loss medications you have tried and how you responded
- Recent lab results, if you have them
If you do not qualify
A GLP-1 is not the only pharmacological option, and not qualifying for one is not a verdict on you. Several providers offer alternatives at lower thresholds — LifeMD states that anyone with a BMI of 25 or greater may be eligible for its combination of metformin, bupropion, and topiramate, and Found lists non-GLP-1 plans from $49/month.
It is also worth saying plainly: a provider that declines to prescribe is often doing its job. A platform willing to write a GLP-1 prescription for anyone who asks is not being generous with you.
Frequently Asked Questions
What BMI do I need for a GLP-1 prescription?+
The standard clinical criteria used for weight-management GLP-1s are a BMI of 30 or above, or a BMI of 27 or above with at least one weight-related condition such as high blood pressure, type 2 diabetes, high cholesterol, or obstructive sleep apnea. PlushCare publishes exactly these thresholds and also accepts type 2 diabetes as qualifying on its own.
Does Medicare use the same BMI threshold?+
Medicare uses its own criteria under the GLP-1 Bridge demonstration, with three routes rather than one: BMI 35 or higher; BMI 30 or higher with diastolic heart failure, uncontrolled high blood pressure, or chronic kidney disease at stage 3a or higher; or BMI 27 or higher with prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease. The widely-quoted BMI 35 figure is only the first of the three.
Who cannot take GLP-1 medications?+
Providers commonly exclude people under 18, people who are pregnant, people with an active eating disorder, and people who are underweight. Noom states specifically that you cannot use its service if you are under 18, pregnant, have an eating disorder, or have a BMI below 18.5. There are also clinical contraindications your prescriber will screen for, including personal or family history of medullary thyroid carcinoma and multiple endocrine neoplasia syndrome type 2.
Can I be disqualified for having the wrong insurance?+
Yes, and this catches people out. LifeMD states that people with any form of government healthcare coverage — Medicare, Medicaid, TRICARE, or Medicare Supplement plans, whether primary or secondary — are not eligible for its GLP-1 weight loss programs. This is a commercial restriction rather than a clinical one, and it is unrelated to whether the medication is appropriate for you.
Do I need lab work to qualify?+
It varies widely. LifeMD includes comprehensive metabolic testing in its membership if you have not been tested in the past 12 months. Most compounded-focused telehealth providers do not state any lab requirement at all. Baseline labs are clinically useful regardless of whether a provider mandates them.
Why do so few providers publish their eligibility criteria?+
It is a conversion decision. Publishing thresholds lets people disqualify themselves before entering the funnel. Of the providers we reviewed, PlushCare is the notable exception — it publishes its criteria and states what it will not treat. Most others describe an assessment without saying what it screens for.
What if I do not meet the BMI threshold?+
A prescriber may still have options. Some providers offer non-GLP-1 medications at lower BMI thresholds — LifeMD states that anyone with a BMI of 25 or greater may be eligible for its combination pack of metformin, bupropion, and topiramate. PlushCare states it will not start weight-loss pharmacotherapy in new patients with a normal BMI, which is a reasonable clinical position rather than an obstacle.
🇺🇸Medical Disclaimer
Your health, your doctor. This article describes criteria providers and payers publish. It is not medical advice and it cannot tell you whether a GLP-1 medication is appropriate for you — only a clinician who has assessed your full history can do that. Meeting a BMI threshold is not the same as being a good candidate. Provider criteria verified August 5, 2026 and subject to change.