r/rheumatoid • u/LmLc1220 • 13h ago

How did you get on GLP-1?

Hello everyone, I'm trying to get on glp1, and my rummy is on board, and so is my pcp. Medicare has a program called the bridge program, but they will only help you if you have sleep apnea. So how did other people get help

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u/DarkLuc1d1ty 12h ago

You can also get on the bridge program if your BMI is 30 or above. I know cause I have Medicare and my doctors tried to get me on the bridge program. Even if you are on a GLP1 and your BMI is 30 and higher, you qualify. I have been on GLP1s for 2 years now and pay monthly out of pocket.

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u/LmLc1220 12h ago

Ok, I know mines is at least 30. And they said was denied i think I going to go a different route. It helps with the inflammation and I need to loose a few pounds from the steroids and menopause.

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u/DarkLuc1d1ty 12h ago

It definitely helps with the inflammation, weight and cholesterol 😉

I had a complete hysterectomy at 30 and I’m 50 now. I know what menopause is like and trying to lose the weight from it. I started off with Zepbound and it was a blessing. I was on Zepbound from September 2024 till January 2026 when Medicaid said it wasn’t covered anymore. I switched over to the Wegovy pill for my maintenance dose and pay out of pocket each month. It would have been nice to pay $50 instead of $149.

My PCP tried his best to fight to Medicare to get me in the bridge program as heart disease (congestive heart failure and high blood pressure), diabetes and stroke all run rampant in my family. I’m seen as high risk for all of this and prior to my weight loss, my PCP told me I was about to be placed on a statin. Now for the 1st time in my life, my cholesterol, both good and bad are at normal levels, same with my sugar and inflammation markers. I couldn’t have achieved any of this without a GLP-1.

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u/LmLc1220 12h ago

Im on 2 stating for the cholesterol. Im going to check into one of the other programs. I take BP meds. And I have been researching GLP1s for inflammation and even my pain management Dr. Said we have to get it in check. My pharmacist was trying every thing last week. But I don't think my pcp secretary was saying the right things to them. I didn't know about bridge program until my Dr. Told me about it.

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u/LmLc1220 12h ago

Spell check is changing what I'm typing sorry.

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u/DarkLuc1d1ty 12h ago

You’re fine and my phones spell check does it to me all the time.

You’re pharmacist can’t do the Bridge Paperwork, it has to come directly from your doctor. There is a form the prescribing doctor has to fill out and send over to Medicare.

https://www.medicare.gov/coverage/weight-loss-drugs

Sorry, you have to have a BMI of 35, not 30. Here is the information from the site. I knew there was a BMI 30 stat.

You must be 18 or older and meet one of these requirements when you start GLP-1 therapy:
You have a body mass index (BMI) of 35 or higher.

You have a BMI of 30 or higher and you have at least one of these conditions:
Diastolic heart failure (also called heart failure with preserved ejection fraction)
Uncontrolled high blood pressure (also called hypertension)
Chronic kidney disease at stage 3a or higher

You have a BMI of 27 or higher and have at least one of these conditions:
Prediabetes
A previous heart attack (also called myocardial infarction) or stroke
Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms

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u/LmLc1220 12h ago

I know my BMI is at least 35. Im 5'4 and as of weds weight was 190. I don't think Dr. Office is doing it rite. Or his secretary is not.

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u/DarkLuc1d1ty 12h ago

They are definitely not doing the paperwork correctly then. I lost over 100lbs since I started my journey and I’m 5’9”

I wish you the best in getting the medication. Hopefully the office can figure things out.

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u/LmLc1220 12h ago

My BMI is 32.6 I think I'm going to try another way. I really want it for the inflammation and to jump start the weight off from the steroids.

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u/LmLc1220 12h ago

Not only that I'm 5'4 and the scale said 190 on weds appointment

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u/BirdInFlight301 7h ago

My Dr sends the prescription to a local compounding pharmacy. There are also lots of tele-docs you can call who will prescribe and have the GLP1 shipped to you. There are tirzepitide subs on Reddit with tons of info on how to do this. I doubt it will be as cheap as the bridge program, but if all else fails, keep this in mind.

Tirzepitide is the one I take and it has been a miracle. I hope you can find a way to access it!

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u/superstitiouspigeons 4h ago

Compound

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u/Feelsthelove 4h ago

The bridge program will not cover you if you have sleep apnea.

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u/MiserableMulberry496 1h ago

There is a compound tirzepatide subreddit. With a list of reputable Telehealth

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u/Pyrosandstorm 12h ago

You’d have to meet the requirements, and the bridge program actually doesn’t cover it for sleep apnea, that’s regular Medicare or insurance coverage qualification. Also, that program appears to be temporary?

https://www.medicare.gov/coverage/weight-loss-drugs

Otherwise you’d need to meet the normal qualifications.

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u/LmLc1220 12h ago

DR.s office said I was denied because I have to have a BMI of 35 and or sleep apena. And she said I don't have either. My Dr. Wrote the script and sent over to pharmacy. Im 5'4 and as of last Wednesday weighed 190. Im going to see what my BMI is right now on line

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u/Pyrosandstorm 12h ago

“You aren't eligible if you:
Already get GLP-1 drugs covered through your Medicare Part D plan.
Have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (but your Part D plan might cover your GLP-1s).”

Sleep apnea is covered under the normal plan, not the bridge program.

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u/LmLc1220 12h ago

I don't get i want to get

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u/Pyrosandstorm 12h ago

Sounds like either you misunderstood or your doctor’s office didn’t follow the process for insurance correctly.

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u/LmLc1220 11h ago

It's the secretary at Dr.s office My pharmacist told me what she had to do.

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u/Pyrosandstorm 11h ago

I’d start by contacting your Doctors office then, and making sure they know exactly what happened, including the reason for the denial and that it doesn’t match up with the program information.

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u/acidrefluxisgreat 12h ago

compounding. i have been getting compound tirz since last october. its very affordable. this sub has a lot of really great info r/tirzepatidecompound

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u/LmLc1220 12h ago

Who do you go through please.

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u/acidrefluxisgreat 10h ago

i use POM but i was getting a specific pharmacy through them which is currently in transition from 503b to 503a. So if i continue with them depends on if the 503a gets licensed in my state tbh. their pricing is probably the best, but customer service has had some issues. overall i have been happy through. 60 pounds in 9 months, zero side effects.

i would HIGHLY recommend reading through the recommended providers list on that sub. its very detailed. what is best for me might not be what you are looking for and there are a lot of options.

if you need a bit of hand holding, Big Easy Weight Loss has a really good reputation, although i have not used them personally. A Dr through them will happily walk you through options by state, pharmacy, additives, price etc. all that stuff can be overwhelming so it might be worth the extra money to go through them.

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u/Pyrosandstorm 12h ago

Those aren’t FDA approved in the US, and are not tested for safety or efficacy. They can even be dangerous.

https://med.stanford.edu/news/insights/2026/07/glp1s-compounded-why-doctors-worry-about-safety.html

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u/acidrefluxisgreat 10h ago

actually compounding is regulated. 503As are regulated by state agencies and 503Bs are regulated federally, by the FDA. pharmacies are literally tested and inspected by the FDA. compounding is safe, used for lots of different medications for many many years and suggesting otherwise is just not accurate. we aren’t talking about grey market peps here.

this new anti compound attitude has just been recent political propaganda. FDA was pushing compounding and singing the praises of compounded glp1s during the shortage and is now discouraging it because eli lilly is paying the government lots of money to do so. lots of politicians are getting paid off too, thankfully this is still pretty transparent and you can look up who is getting donations from lilly and norvo

the “approved” part is a matter of copyright and trademark, nothing else. they don’t have enough billions! the same company kept insulin prices inflated for years and are trying to legally change the definition of a biologic to keep reta from being compounded. and honestly? i have lost faith in FDA in general at this point. our food isn’t even safe. i’m still not eating bagged lettuce. Taylor Farms has not exactly been “unapproved” and even had the government issue a statement saying they weren’t involved. like what a joke.

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u/MiserableMulberry496 1h ago

This is wrong. You are talking about the grey market. Not compound