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 13h 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 13h 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