Weight Loss Drugs Covered By Insurance

Weight loss medications have become increasingly popular as more people look for effective ways to tackle obesity. The World Health Organization classifying obesity as a chronic complex disease—one that can be treated with medication

Weight loss medications are now viewed not just as a short-term solution but as part of a comprehensive treatment plan for managing this complex health issue. Despite their efficacy, many potential users find themselves priced out of options that could significantly improve their health.

Understanding which weight loss drugs are covered by insurance can help individuals access the treatments they need to achieve their weight loss goals and improve their overall health.

Why do you need weight loss medications covered by insurance?

The steep cost of weight loss medications keeps many individuals from accessing these effective treatment options. With some medications priced at over $1,000 per month, the financial burden can quickly become overwhelming.

These are meant to be long-term treatments, leaving individuals paying five figures a year for one medication without insurance coverage.

Weight loss medications covered by insurance

When it comes to weight loss, having access to medications covered by insurance can make a world of difference. However, there’s no guarantee that insurance will cover these treatments, as insurers are not currently required to provide coverage for weight loss medications.

That said, some medications are more likely to be covered than others, particularly those that have received FDA approval specifically for weight management.

Will insurance cover Wegovy for weight loss?

When it comes to getting weight loss medications covered by insurance, Wegovy is often your best bet. This is a well established medication which gained FDA-approval for weight loss in 2021.

Given its status as an FDA-approved weight loss medication, patients may find that their insurance providers are willing to cover part or all of the costs associated with Wegovy. However, coverage can still vary by plan, and some insurers may require prior authorization before approving the medication.

Will insurance cover Zepbound for weight loss?

While Zepbound is also FDA-approved for weight loss, it only gained approval in November 2021, after being fast-tracked by the FDA. While clinical trials have demonstrated its efficacy in promoting weight loss, many insurance providers may not have Zepbound included in their formularies—yet.

As a relatively new medication, it might take time for insurers to evaluate its cost-effectiveness and establish coverage policies. As a result, individuals interested in Zepbound should check with their insurance providers to confirm its availability and coverage status.

Will insurance cover Ozempic for weight loss?

There is a good chance that Ozempic will be included on insurance formularies, but coverage may only be guaranteed for diabetes management, as this is the medication’s FDA-approved use.

While Ozempic has gained popularity for weight loss, insurance companies are generally less likely to cover medications prescribed for off-label use. Patients interested in using Ozempic for weight loss should check with their insurance providers to clarify the specifics of their coverage.

Will insurance cover Mounjaro for weight loss?

Similar to Ozempic, Mounjaro is only FDA-approved for diabetes management. While clinical studies have demonstrated its effectiveness for weight loss, insurance coverage for off-label prescriptions like Mounjaro is less certain.

Insurance providers typically prefer to cover treatments that align with FDA-approved indications. So, many insurance companies may not cover medications used off-label. This means that individuals seeking Mounjaro for weight loss could face higher out-of-pocket costs.

Insurance companies that pay for weight loss medications

Coverage for medications can vary greatly with the individual insurance plan determining costs and inclusions. While there are some health insurance companies more likely to provide coverage—Blue Cross Blue Shield, Aetna, Cigna, and UnitedHealthcare—your plan may not.

Most employer health plans do not offer coverage for weight loss medications. A recent survey found that only about one-quarter cover these under their insurance. This may be changing soon, but in 2024 it means coverage under an employer health plan is rare.

The International Foundation of Employee Benefits Plans found 76% provide coverage for GLP-1 medications (like Ozempic and Mounjaro) for diabetes, but only 27% provide coverage for weight loss. But, 13% were considering weight loss coverage.

Unfortunately, the answer is dependent on your current health plan. So, be sure to review your coverage and your plan’s formulary to determine what medications can be covered by your insurance provider.

Weight loss programs covered by insurance

Insurance companies are required to provide obesity screening and counseling under the Affordable Care Act—at no extra cost to the insured. Beyond this, coverage varies greatly by both insurance plan and employer.

Some insurance plans may offer coverage for specific programs or treatments, but others may not. Coverage provided may also be uneven. For instance, it may cover aftercare for bariatric surgery but not the surgery itself.

Some employers offer wellness programs which can give employees access to discounts and programs that may not be available elsewhere. Aetna lists the programs they can offer through employers.

Some insurance providers may also have their own programs, like UnitedHealthcare’s Real Appeal.

Through these programs, you may have coverage for weight loss related programs, but they are unlikely to provide coverage or discounts for the actual medications.

How to get insurance to cover weight loss medication

In order to even attempt to get a weight loss medication covered by insurance, it will need to be included on your plan’s formulary—the list of medications covered. If it is included, here are some requirements that will likely need to be met:

You must meet the medication’s requirements. For weight loss medications, this means you must have a BMI (body mass index) of 30 or higher, or a BMI of 27 or higher and at least one weight-related condition. These can include:
- Heart disease
- High blood pressure
- Sleep apnea
- Type 2 diabetes—with this diagnosis, you will likely be able to get Ozempic and Mounjaro covered without proving further medical necessity
You will need to prove medical necessity. Weight loss medications can be considered preventative medicine. If you can prove there is a medical need for you to lose weight, then you have a higher chance of coverage by insurance.

Even if you meet the requirements and prove medical necessity, you will have a much higher chance of approval if you are seeking a medication that is FDA-approved for weight loss.

Wegovy is your most likely option if you’re hoping for insurance coverage.

What options do you have when insurance won’t cover weight loss medications?

If your insurance doesn’t cover weight loss medications, there are still several options to help you save on out-of-pocket costs. Many pharmaceutical companies offer discount programs or patient assistance programs designed to reduce medication expenses for eligible individuals.

There are also subscription plans, like those offered through Heally, that provide a convenient way to access medications at a reduced price. Heally’s services can help you find affordable options for weight loss medications without the hassle of navigating insurance coverage.

Take the first step by registering with Heally today.