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For you to qualify for the Medicare GLP-1 Bridge, a provider must submit a prior authorization request that attests the beneficiary meets the following criteria: The beneficiary is prescribed the requested drug to reduce excess body weight and maintain weight reduction in combination with current and ongoing lifestyle modification including structured nutrition and physical activity consistent with the applicable FDA approved label, AND The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to thirty-five (35) at the time of initiation of GLP-1 therapy, or The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to thirty (30) at the time of initiating GLP-1 therapy with a diagnosis of one or more of the following: (A) heart failure with preserved ejection fraction, (B) uncontrolled hypertension (defined as systolic blood pressure above 140 mm Hg or diastolic blood pressure above 90 mm Hg, despite concurrent treatment with two antihypertensive medications), or (C) chronic kidney disease stage 3a or above, or The beneficiary is at least eighteen (18) years of age and has a BMI greater than or equal to twenty-seven (27) at the time of initiating GLP-1 therapy with a diagnosis of one or more of the following: (A) pre-diabetes (as defined by American Diabetes Association guidelines), (B) previous myocardial infarction, (C) previous stroke, or (D) symptomatic peripheral artery disease

Building on these results, a phase 1b trial in individuals with T2D further evaluated the safety, pharmacokinetics, and pharmacodynamics of once-weekly retatrutide over 12 weeks [43]

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