Who Qualifies for GLP-1 Medications? The Clinical Criteria Explained (2026)

GLP-1 medications have become one of the most talked-about treatments in weight management. But not everyone who wants one will qualify, and the criteria exist for good reason: these are prescription medications with real clinical effects and real contraindications. Understanding what providers look for can help you know where you stand before you start the process.

*Compounded semaglutide and tirzepatide are not FDA-approved. This article is for informational purposes only and does not constitute medical advice. Individual results vary. Consult a licensed healthcare provider before starting any medication.*

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The Foundation: What GLP-1 Medications Are Approved For

GLP-1 receptor agonists like semaglutide and tirzepatide were originally developed for type 2 diabetes management. Their approval for chronic weight management came after large clinical trials demonstrated significant and sustained weight loss in people with obesity or overweight.

The landmark STEP 1 trial, published in the *New England Journal of Medicine*, found that adults with a BMI of 30 or higher (or 27 or higher with a weight-related condition) lost an average of 14.9% of their body weight on once-weekly semaglutide 2.4 mg over 68 weeks, compared to 2.4% on placebo. The SURMOUNT-1 trial showed even larger effects for tirzepatide, with participants at the 15 mg weekly dose losing approximately 20.9% of body weight at 72 weeks (treatment-regimen estimand).

These outcomes established the clinical basis for the eligibility criteria that providers use today.

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The Core Eligibility Criteria

Most providers, whether in-person or online, follow the criteria established through the FDA approval process for GLP-1 medications used in weight management. The two main thresholds are:

BMI of 30 or higher

A body mass index at or above 30 places a person in the obesity category. At this threshold, you may qualify for GLP-1 treatment based on BMI alone, without needing a specific diagnosis of a related health condition.

BMI of 27 to 29.9 with at least one weight-related health condition

If your BMI falls in the overweight range (27 to 29.9), providers will look for at least one comorbidity directly connected to your weight. This is where a lot of people who assume they do not qualify actually do.

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Conditions That Qualify You at a Lower BMI

The list of weight-related conditions recognized by clinical guidelines is broader than most people realize. If your BMI is between 27 and 30, any of the following may qualify you for treatment:

• Type 2 diabetes or prediabetes
• High blood pressure (hypertension)
• High cholesterol or abnormal lipids (dyslipidemia)
• Obstructive sleep apnea
• Non-alcoholic fatty liver disease (NAFLD)
• Cardiovascular disease (including prior heart attack, stroke, or coronary artery disease)
• Polycystic ovary syndrome (PCOS)
• Osteoarthritis related to excess weight
• Metabolic syndrome

You do not need to have been formally diagnosed with one of these conditions before starting the evaluation. If you have a history of any of them or have symptoms that suggest an undiagnosed condition, your provider will factor that into their assessment.

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Who Does Not Qualify: Contraindications

GLP-1 medications are not appropriate for everyone. Providers will screen for the following conditions and history before issuing a prescription.

Thyroid Cancer History

The most widely cited contraindication is a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Animal studies showed thyroid C-cell tumors with GLP-1 agonists at high doses, and while this effect has not been confirmed in humans, the precautionary guidance remains in place.

If you or a close family member has this history, GLP-1 medications are not recommended for you.

Hypersensitivity to GLP-1 Agonists

If you have had a serious allergic reaction to a GLP-1 receptor agonist in the past, this disqualifies you from treatment with the same class of medications.

Pregnancy and Breastfeeding

GLP-1 medications are not prescribed during pregnancy or when planning to become pregnant in the near term. If you are breastfeeding, most providers will not prescribe GLP-1 medications during that period. If you are on GLP-1 treatment and become pregnant, your provider will advise discontinuing the medication.

Pancreatitis History

A personal history of pancreatitis is considered a relative contraindication. Providers evaluate this on a case-by-case basis, considering the cause and severity of prior episodes.

Severe Gastrointestinal Conditions

Conditions like gastroparesis (delayed stomach emptying) can complicate GLP-1 therapy, since these medications further slow gastric motility. If you have a significant GI history, your provider will review it carefully.

Severe Renal or Hepatic Impairment

Certain GLP-1 formulations require dose adjustments or caution in people with significantly reduced kidney or liver function. This is something a provider reviews as part of intake.

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What Providers Do NOT Require

It is worth clearing up a few common misconceptions about the process.

You do not need a prior diagnosis to apply. Many people who qualify have never been formally told they have a qualifying condition. Your intake and health history are enough for a provider to make that determination.

You do not need a referral. Telehealth platforms allow you to connect directly with a licensed provider without going through your primary care clinician first.

You do not need recent lab work. Most telehealth providers can evaluate you based on your health history alone, though having recent labs available (thyroid panel, metabolic panel, lipid panel) can give your provider more to work with and may strengthen your case if your BMI is near the lower threshold.

You do not need to have failed other weight loss methods first. While some insurance plans historically required documented prior attempts, telehealth GLP-1 programs generally do not have this requirement.

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How the Evaluation Actually Works

Understanding the criteria is one thing. Understanding what the evaluation process looks like in practice is another.

When you apply through a telehealth platform, the process typically follows these steps:

Health intake form: You answer detailed questions about your height, weight, health history, current medications, diagnoses, and family history. This is not a generic questionnaire. A thorough intake covers everything a provider needs to make a safe, informed clinical decision.

Provider review: A licensed clinician or nurse practitioner reviews your intake personally. They are not rubber-stamping approvals. They are evaluating whether treatment is appropriate for you specifically and whether any factors in your history require additional attention or follow-up questions.

Prescription or denial: If the provider determines treatment is appropriate, they issue a prescription. If they have concerns or need more information, they may request clarification or decline to prescribe. Not everyone who applies qualifies, and that is by design.

Ongoing monitoring: Qualification is not a one-time evaluation. Responsible programs include follow-up check-ins to monitor your response to treatment, adjust doses as needed, and address any side effects that arise.

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A Note on Age

GLP-1 medications for weight management are approved for adults. Most telehealth programs set a minimum age of 18. Semaglutide (Wegovy) is FDA-approved for chronic weight management in adolescents aged 12 and older with a BMI at or above the 95th percentile, but tirzepatide (Zepbound) remains approved for adults only for weight management as of 2026. Adolescent treatment varies by platform and requires additional clinical consideration.

There is no upper age cutoff based on FDA criteria alone, but providers will factor in overall health, other medications, and age-related considerations when evaluating older adults.

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Frequently Asked Questions

My BMI is 26. Can I still qualify?

The standard FDA-approved threshold is a BMI of 27 with a qualifying condition. At a BMI of 26, most programs will not prescribe GLP-1 medications. If you have specific metabolic conditions your provider believes warrant treatment, they may evaluate your case individually, but this is not common through standard telehealth programs.

I have high blood pressure but my BMI is 28. Do I qualify?

Very likely yes. A BMI of 28 combined with a diagnosis of hypertension meets the criteria (BMI of 27 or higher with at least one weight-related condition). This is one of the more common eligibility pathways for people in the overweight BMI range.

Does my doctor's office prescribe GLP-1s the same way?

The clinical criteria are the same whether your prescription comes from a telehealth platform or a traditional in-person practice. The main differences are speed, access, and cost. Telehealth programs typically move faster, do not require in-person visits, and offer transparent pricing for compounded formulations.

Will I need to do blood work before I can start?

Some providers require baseline labs; others do not. Platforms that operate without mandatory labs rely on your health history intake. If you have recent lab results, uploading them is always a good idea. If your provider determines that labs are necessary before prescribing, they will tell you.

What if I'm on other medications?

Your provider will review all current medications as part of the intake. The most important interactions involve other glucose-lowering medications, particularly insulin, since combining them with GLP-1 agonists can increase the risk of hypoglycemia. Inform your provider of everything you are taking and do not adjust your current medications without guidance.

What happens if I qualify but the medication doesn't work for me?

Treatment can be adjusted. Your provider can modify your dose, switch you to a different medication within the class (for example, from semaglutide to tirzepatide), or help you explore other options. Not everyone responds the same way, and ongoing monitoring is specifically designed to catch and address that.

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Getting Started

If you are unsure whether you qualify, the most direct way to find out is to complete a health assessment with a licensed provider. Self-screening against general criteria can give you a rough sense of where you stand, but only a provider can make a clinical determination for your specific situation.

Licensed healthcare providers connected through Prescriva's platform review your intake within 24 hours. If you qualify, your medication ships within a few business days. The monthly price includes your consultation, medication, and shipping as a single bundled charge.

You can [start your assessment at Prescriva](/assessment) to get a clinical evaluation and find out whether GLP-1 treatment is right for you.

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Sources

1. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. *N Engl J Med*. 2021;384(11):989-1002. [PMID: 33567185](https://pubmed.ncbi.nlm.nih.gov/33567185)

1. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. *N Engl J Med*. 2022;387(3):205-216. [PMID: 35658024](https://pubmed.ncbi.nlm.nih.gov/35658024)

1. Ryan DH, Lingvay I, Colhoun HM, et al. Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity (SELECT) rationale and design. *Am Heart J*. 2020;229:61-70. [PMID: 32916609](https://pubmed.ncbi.nlm.nih.gov/32916609)

1. Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. *Endocr Pract*. 2016;22(suppl 3):1-203. [PMID: 27219496](https://pubmed.ncbi.nlm.nih.gov/27219496)

1. FDA. [Wegovy (semaglutide) prescribing information](https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=215256). Novo Nordisk. 2023.

1. FDA. [Zepbound (tirzepatide) prescribing information](https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=217806). Eli Lilly. 2023.

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*This article is for educational purposes only. Compounded semaglutide and tirzepatide are not FDA-approved and are not equivalent to branded formulations. This content does not constitute medical advice. Consult a licensed healthcare provider before starting any medication. Individual results vary.*

*All medical services, including prescribing, are provided by independently licensed healthcare providers. Blue Oak Services LLC dba Prescriva is a management services organization and does not practice medicine or make clinical decisions.*

*Ozempic and Wegovy are registered trademarks of Novo Nordisk A/S. Mounjaro and Zepbound are registered trademarks of Eli Lilly and Company. Prescriva is not affiliated with, endorsed by, or sponsored by Novo Nordisk or Eli Lilly.*