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What are common medical and BMI eligibility criteria telehealth providers use for prescribing tirzepatide?
Executive summary
Telehealth prescribers generally mirror trial and FDA label criteria: tirzepatide (Mounjaro for diabetes; Zepbound for weight) is intended for adults with type 2 diabetes or for chronic weight management in adults with BMI ≥30 kg/m2, or BMI ≥27 kg/m2 with at least one weight‑related condition; many telehealth services therefore require documentation of diagnosis, BMI thresholds, and basic safety screening before prescribing [1] [2] [3]. Clinical-trial eligibility and manufacturer guidance also shape safety exclusions (e.g., personal/family history of medullary thyroid carcinoma, pancreatitis concerns) that telehealth clinicians typically evaluate during intake [4] [2].
1. What the FDA label and trials set as the baseline
The FDA approved Zepbound for chronic weight management in adults with obesity (BMI ≥30 kg/m2) or overweight (BMI ≥27 kg/m2) plus a weight‑related condition, and the SURMOUNT trial enrolled adults meeting those BMI cutoffs (or BMI ≥27 with a complication), which establishes the core medical/BMI criteria many clinicians and telehealth services use when deciding on eligibility [1] [2].
2. How telehealth platforms translate those criteria into practice
Telehealth clinics and online programs generally require an initial medical history, self‑reported or documented height/weight to calculate BMI, and confirmation of either a type 2 diabetes diagnosis (for Mounjaro) or the BMI/weight‑related comorbidity (for Zepbound); many webpages and services state they follow the same BMI thresholds cited in trials and labels (BMI ≥30, or ≥27 with comorbidity) when assessing candidacy [3] [5] [6].
3. Safety screening and exclusions telehealth clinicians typically check
Besides BMI and diagnosis, telehealth providers commonly screen for contraindications and safety signals highlighted in product information and trials — examples include history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, prior pancreatitis or severe gastrointestinal disease, and severe hypersensitivity — and these exclusions are commonly asked about during remote consultations [4] [2].
4. Lab work, prior treatments, and evidence telehealth may request
Telehealth services often ask for prior labs or medical records to verify diabetes status or relevant comorbidities and may inquire about prior GLP‑1 therapy; VA criteria note consideration of prior GLP‑1 intolerance and sequencing among agents, and telehealth platforms similarly may require documentation or a trial of alternative agents depending on clinical history [7] [2].
5. Weight‑related comorbidities that commonly qualify patients
The FDA label and telehealth guidance list common qualifying weight‑related conditions such as hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea and cardiovascular disease risk — platforms typically accept those same conditions when applying the BMI ≥27 threshold [1] [6].
6. Differences between diabetes (Mounjaro) and weight‑loss (Zepbound) prescriptions
Mounjaro is FDA‑approved for type 2 diabetes and may be prescribed based chiefly on diabetes diagnosis and glycemic goals, while Zepbound is the brand approved specifically for chronic weight management with explicit BMI thresholds; telehealth providers make this distinction when determining which indication a patient meets and which documentation is needed [1] [8].
7. The role and limits of telehealth: monitoring and follow‑up
Telehealth clinics promote convenience but also emphasize ongoing monitoring (dose titration, side‑effect management, and coordination with diet/exercise support). Manufacturer and trial guidance call for lifestyle intervention alongside drug therapy; telehealth providers often incorporate scheduled follow‑ups or referrals to dietitians to meet those expectations [4] [2].
8. Red flags, off‑label use and compounded products
Some telehealth or direct‑to‑consumer sites have promoted compounded tirzepatide or looser BMI cutoffs; however, regulatory and safety updates since the shortage changed compounding rules mean compounded products and nonstandard prescribing carry additional risks, and many established telehealth services emphasize FDA‑approved brands and indicated BMI criteria [9] [10] [11]. Available sources do not mention specific telehealth platforms’ current internal policies beyond what public pages state.
9. What remains inconsistent across providers
While BMI cutoffs and major safety exclusions are consistent with FDA/trial guidance, differences remain in telehealth practices about required documentation (self‑reported vs. verified records), whether prior GLP‑1 trials are needed, and whether providers will consider borderline BMI cases on a case‑by‑case basis; online services and brick‑and‑mortar clinics present competing approaches in their public materials [3] [12] [13].
10. Practical takeaways for patients seeking tirzepatide via telehealth
Expect to give height/weight to establish BMI, document a type 2 diabetes diagnosis or a qualifying weight‑related comorbidity for Zepbound, complete safety screening for thyroid, pancreatic and GI history, and engage in follow‑up for titration and side‑effect monitoring; if you encounter offers that sidestep FDA‑approved brands or BMI thresholds, those are flagged in published guidance and regulatory notices as higher‑risk or nonstandard approaches [1] [2] [9].
Limitations: reporting here relies on FDA labels, clinical trial eligibility and public telehealth/clinic materials in the provided sources; individual telehealth providers’ internal protocols and state‑by‑state regulatory nuances are not exhaustively covered in these sources (not found in current reporting).