Insurance Coverage for GLP-1 Weight Loss Medications
Understanding insurance coverage, getting approval, and finding affordable alternatives when insurance doesn't cover.
The Bottom Line on Insurance Coverage
FOR DIABETES (Type 2):
Most insurance plans cover Ozempic and Mounjaro when prescribed for diabetes. Coverage is typically good with standard copays.
FOR WEIGHT LOSS:
Most insurance does NOT cover Wegovy, Zepbound, or off-label use of Ozempic/Mounjaro for weight loss. You'll likely pay out-of-pocket unless you have a specific rider or self-insured plan.
Without insurance: Brand-name medications cost $900-1,400/month. Compounded alternatives from telehealth providers cost $200-400/month.
Coverage by Medication
Semaglutide
Ozempic® (for diabetes)
Usually covered by insurance when prescribed for Type 2 diabetes
- • Typical copay: $25-$100/month
- • May require prior authorization
- • Step therapy sometimes required
Wegovy® (for weight loss)
Rarely covered by insurance
- • Full price: $1,300-1,500/month
- • Manufacturer savings card available
- • Some employers add coverage
Compounded Semaglutide
Never covered by insurance
- • Pay out-of-pocket: $200-350/month
- • Available through telehealth
- • More affordable than brand
Tirzepatide
Mounjaro® (for diabetes)
Usually covered by insurance for Type 2 diabetes
- • Typical copay: $25-$100/month
- • Savings card can reduce to $25
- • Often requires prior auth
Zepbound® (for weight loss)
Rarely covered by insurance
- • Full price: $1,000-1,200/month
- • Limited manufacturer assistance
- • Coverage expanding slowly
Compounded Tirzepatide
Never covered by insurance
- • Pay out-of-pocket: $300-450/month
- • Available through telehealth
- • More affordable than brand
Coverage by Insurance Type
Medicare
Limited CoverageFor Diabetes: Part D plans cover Ozempic and Mounjaro. Coverage varies by plan.
For Weight Loss: Medicare does NOT cover any weight loss medications, including Wegovy or Zepbound.
Exception: Medicare Advantage plans may offer limited coverage for weight loss drugs as an add-on benefit.
Medicaid
Varies by StateFor Diabetes: Most state Medicaid programs cover Ozempic and Mounjaro for diabetes.
For Weight Loss: Very few state Medicaid programs cover weight loss medications. Check your state's formulary.
Tip: Some states cover weight loss drugs for patients with BMI ≥35 and obesity-related conditions. Ask your doctor about documentation.
Private Insurance (Employer Plans)
Best CoverageFor Diabetes: Almost always covered with prior authorization.
For Weight Loss: Depends entirely on your employer's plan. Large employers and tech companies increasingly add coverage.
More Likely to Cover:
- • Self-insured large employers
- • Tech companies (Google, Meta, etc.)
- • Financial services companies
- • Plans with weight management programs
Rarely Cover:
- • Small business group plans
- • High-deductible health plans (HDHPs)
- • Budget HMO plans
- • Individual marketplace plans
How to Get Insurance Approval
Step 1: Check Your Coverage
Call your insurance and ask:
- • "Does my plan cover [medication name] for weight loss?"
- • "What is the prior authorization process?"
- • "Are there any step therapy requirements?"
- • "What documentation does my doctor need to provide?"
- • "What would my copay be if approved?"
Step 2: Work With Your Doctor
Your doctor needs to document:
Medical Necessity:
- • BMI ≥30 (or ≥27 with conditions)
- • Obesity-related health issues
- • Previous weight loss attempts
- • Why this medication is needed
Supporting Evidence:
- • Lab work (A1C, lipids, etc.)
- • Blood pressure readings
- • Weight history documentation
- • Failed diet/exercise records
Step 3: Submit Prior Authorization
Your doctor's office will submit paperwork including:
- Prescription with diagnosis codes
- Medical records documenting need
- Prior authorization form
- Supporting lab work and vitals
Timeline: Prior authorization typically takes 3-14 days. Your doctor can request "urgent" review if needed.
Step 4: If Denied, Appeal
Most denials can be appealed. Your options:
Peer-to-Peer Review
Your doctor speaks directly with insurance medical director
Formal Appeal
Submit additional documentation and letters of medical necessity
External Review
Independent review by third party (if first appeal fails)
If Insurance Doesn't Cover: Affordable Alternatives
Manufacturer Savings
If you have commercial insurance (not Medicare):
- • Wegovy Savings Card: Pay as low as $0-500/month
- • Mounjaro Savings Card: Pay $25/month for up to 2 years
- • Ozempic Savings: Pay as low as $25/month
Check manufacturer websites for eligibility
Compounded GLP-1s
Same active ingredients, lower cost:
- • Semaglutide: $200-350/month
- • Tirzepatide: $300-450/month
- • Available through telehealth
- • No insurance needed
Patient Assistance
For low-income patients:
- • Novo Nordisk PAP: Free Wegovy/Ozempic if eligible
- • Lilly Cares: Free Mounjaro/Zepbound
- • Income limits apply
- • Must have no insurance
Applications through doctor's office
Need Affordable GLP-1 Medications?
Compare telehealth providers offering compounded semaglutide and tirzepatide at a fraction of brand-name costs.
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