Eligibility is not one number. There is the label criteria a medication is approved against, there is what a drug plan will pay for, and there is whether a clinician thinks it is right for you. Those three are different, and they do not always agree.
The usual starting point is a BMI of 30 or above. Below that, a BMI of 27 and above can qualify when a weight-related condition is documented: prediabetes, type 2 diabetes, high blood pressure, high cholesterol or sleep apnea are the ones that come up most.
Meeting the threshold is not the same as being approved by an insurer. Drug plans frequently want prior authorisation, documented weight history and evidence of previous attempts, and some workplace plans exclude weight-management drugs entirely.
And separately from both: there are histories where a GLP-1 is not appropriate regardless of BMI. That is a clinical judgement, and it is the reason the assessment happens before anything else. BMI requirements, Qualifying health conditions and Who should not take it go further into it.
Three tests
The check
How GLP-1 eligibility is decided, step by step
Measurements
Height and weight give the BMI. It is a blunt number and it is only the first gate, not the decision.
Conditions
Any weight-related diagnosis matters, both for whether you qualify at a lower BMI and for how the plan is built.
History and medications
Personal and family history, and everything you already take. This is where a GLP-1 gets ruled out if it is going to be.
A clear answer
Either you are a candidate and the plan is explained, or you are not and you are told why, along with what else is reasonable.
Eligibility
Everything that decides GLP-1 weight loss eligibility
The thresholds, the conditions that lower them, the histories that rule it out, and where to start.
Thresholds, conditions, insurance and what happens if you do not qualify.
Generally 30 or above, or 27 and above with a documented weight-related condition such as prediabetes, type 2 diabetes, high blood pressure, high cholesterol or sleep apnea. A clinician confirms it against your records.
Not automatically. Label eligibility, insurance eligibility and clinical appropriateness are three separate things. Your history and current medications can make a GLP-1 unsuitable even at a qualifying BMI.
GLP-1 medication for weight management is not indicated below that range, and a clinician should tell you so rather than prescribe around it. There is still useful ground to cover on nutrition and monitoring.
Your insurer decides whether it pays, not whether treatment is appropriate. Plenty of people qualify clinically and still pay privately because their plan excludes weight-management drugs.
The free check is a screening step, not a diagnosis. It tells you whether booking a consultation makes sense. The clinical decision happens in the consultation itself, with a licensed clinician.
Austin patients
What Austin patients say about the eligibility check
The check covers BMI, conditions and what you already take. It costs nothing, needs no card, and a clinician reviews the answers before anyone calls you.
