How confident are you in navigating insurance websites? Look for the section detailing prescription benefits. Exploring generic options might be a cost-effective alternative. It’s categorized into tiers, which affect your out-of-pocket costs. But if you take Ozempic for off-label uses such as weight loss, you’ll have to find alternative ways to pay for your medication. While the sticker price varies by medication and dose, you can generally expect to pay about $1,000 a month out of pocket if you're not able to apply your health insurance, Dr. Wantuck says. Still, even if you meet the insurance requirements, coverage can be spotty. The buzzy medications can run up a super high cost for some. Honest Care is not offering advice, recommending or endorsing any specific prescription drug, doctor or telehealth provider, or other information on the site. It can be used to complement other treatment approaches covered by Medicare and enhance the person’s success. This is despite the fact that these medications are increasingly recognized as an effective option for some people. These coverages may include gym memberships and subscriptions to fitness programs such as SilverSneakers® GO™—a fitness app designed for older adults. Through its Intensive Behavioral Therapy for Obesity initiative, beneficiaries with a BMI of 30 or higher can receive no-cost obesity screenings and behavioral counseling. The Medicare Part B program recently took a major step forward in encouraging doctors and patients to view obesity as a major health problem. Medicaid health insurance plans cover obesity medications with wide variation from state to state. Among 136 marketplace health insurance plans, 11% had some coverage for the specified drugs in only nine states. A formulary is the official list of all prescription drugs covered by a specific health insurance plan. Depending on the company and coverage plan, some medications, like Wegovy, are now covered for weight loss, but for people on Medicare, a 2003 law actually prevents weight loss medication coverage. Phentermine is approved for adolescents 16 and older. Zepbound is approved only for adults, but as of this writing, it is being studied for use in adolescents. Zepbound is approved for those with a BMI of 30 or greater. A decade ago, the American Medical Association ratified a resolution officially calling obesity a disease, a position that the OMA shares. A patient will need to check the details of their own plan. As of 2024, UnitedHealthcare is focusing on making GLP-1 drugs more affordable for its customers. Coverage hinges on several critical factors, including the patient's medical history, Body Mass Index (BMI), and the specific medication prescribed. Choosing medications in the lower tiers may save you money. Expert guides, proven workout plans and smart nutrition tips to help you achieve sustainable results. Always check your plan details before starting any medication. Like with Ozempic, some Medicaid programs require prior authorization before covering Mounjaro. Mounjaro is listed as a nonpreferred medication on various state Medicaid formularies, including the formularies for Delaware, North Carolina, and Wyoming. But it’s also been linked to significant body weight reduction. In fact, Medicare is prohibited by law from covering them. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. About the authorsTony Pugh is an award-winning writer and editor covering Medicare for AARP. This story, originally published Sept. 13, 2023, was updated to reflect the FDA’s recent approval of a pill form of Wegovy and CMS’s two-step plan to lower prices for Medicare Part D enrollees. You must itemize your deductions, and qualified medical expenses are deductible only if they’re more than 7.5 percent of your adjusted gross income. Another significant benefit of having health insurance coverage for weight loss medications is the broader range of health services that often come with it. This article will explore the weight loss drugs covered by UnitedHealthcare, the benefits of having coverage, and additional ways to save on these medications. Their health benefit plans are not allowed to exclude coverage of obesity medications. However, patient access to obesity medications through health insurance plan coverage is not the only barrier to the wide adoption of these medications. Whether Medicaid finances a health insurance plan with an FFS model or under an MCE, they both operate under the state’s approved prescription drug formulary and the state’s Preferred Drug List. We identified each state’s Preferred Drug List and their pharmacy and provider policy handbooks to formulate an accurate picture of the coverage offered by each state within their Medicaid health insurance plans. There is no single universal list of weight loss drugs covered by UnitedHealthcare. Some Medicare Advantage (Part C) plans provide enhanced coverage that can support your weight loss efforts. Weight-loss medications can cost hundreds of dollars per month, depending on insurance coverage and available savings options. Even with insurance coverage, weight loss medication costs are still "highly variable." But they typically cost the same as any other prescription medicine in your benefit plan, Dr. Wantuck says. Some UHC plans offer full or partial coverage, while others—particularly those tied to employer-sponsored programs—may exclude weight loss medications altogether. The answer isn’t always straightforward, as insurance coverage for weight loss drugs can vary based on plan type, employer decisions, and individual medical criteria. However, it's crucial to note that not all UnitedHealthcare plans cover Wegovy․ Some employers may choose to exclude weight loss medications from their plans, leading to limitations in coverage․ Let's take a closer look at two prominent weight loss medications, Wegovy and Ozempic, and their coverage under UnitedHealthcare plans⁚ For example, in 2024, coverage for weight-loss medications increased to 44% among large employers with 500 or more employees. UnitedHealthcare’s Total Weight Support aims to address these challenges for employers and employees through a whole-person, evidence-based approach to weight loss that includes coverage with prior authorization for weight loss medication for eligible members, support, education and coaching. Employees who use weight loss medications may be more successful at achieving and maintaining their goals when supported by a comprehensive management program. Wegovy (semaglutide) is a popular GLP-1 medication for weight loss, and its coverage by UnitedHealthcare has been a subject of much discussion. It'simportant to discuss potential side effects with your healthcare professionalbefore starting any medication. Once you have a prescription, you can fill it at a participating pharmacy.It's important to check with your insurance provider to find out whichpharmacies are in-network and will accept your insurance. Choose a medication in a lower tier for your lowest cost options. Looking overseas, which some U.S. consumers do when it comes to high-priced drugs, is less likely to help out in this case, at least right now. Many will be forced to pay out of pocket, or lose out, said Brian O'Connell, an analyst who covers the insurance marketplace for InsuranceQuotes.com. How is a person diagnosed as overweight or obese? When we view obesity as a disease process affecting a person’s metabolic and hormonal homeostasis, we may begin to accept pharmacotherapy as a solution.5,26,27 One views obesity as a reflection of a person’s self-control or nutrition status, which prevents the adoption of pharmacotherapy. These were Alabama, North Dakota, South Carolina, South Dakota, Texas, Virginia, Wisconsin and Delaware, but they do require prior reauthorization and extensive medical evaluation for demonstration of treatment need. An alarming 39.8% of men and women in the United States suffer from obesity. Obesity requires an integrated approach to combat its public health threat. How to Use GoodRx Coupons on Brand-Name Medications: Wegovy, Farxiga, and More The service requires no copayment, coinsurance, or deductible when provided by Medicare-approved practitioners. Medicare Part B covers Intensive Behavioral Therapy (IBT) for obesity screening and counseling when beneficiaries have a BMI of 30 or higher. Documentation of treatment failure or contraindications to preferred medications supports approval requests. Initial approval is for 6 months; to continue, you'll need to show at least 5% weight loss. Always call UHC member services to verify your specific coverage. Check your specific coverage at optumrx.com or call the number on your UHC ID card. When UHC does cover Zepbound, prior authorization is always required. "My Appeal was approved the next day. Thank you Honest Care!" Coverage depends heavily on whether your employer specifically opted into weight management benefits. It’s about empowering the whole person—mind and body—to make sustainable changes that lead to better health. Yes, UnitedHealthcare often requires prior authorization for weight loss drugs. More weight loss drugs are being included. Healthcare coverage is adapting to new drugs. Researchers are developing innovative weight loss drugs. The future of weight loss drugs looks promising. Certain advocacy groups, such as the Obesity Action Coalition (OAC), are working on legislation to broaden access to treatment options for Medicare beneficiaries affected by obesity. Drug therapy is a key treatment component for certain groups of older adults living with obesity. Obesity puts older adults at risk for complications like high blood pressure, high cholesterol, heart disease, and type 2 diabetes—all of which can affect their well-being and lifespan. In 2013, the American Medical Association (AMA) officially recognized obesity as a disease. AOMs are especially suitable for people who carry significant excess weight and have not been able to lose weight through lifestyle and dietary changes alone. Concurrently, the Food and Drug Administration (FDA) approved several new drugs for the short and long-term treatment of obesity. First, they will determine if a weight loss medication is medically appropriate for you. This tool will tell you if the drug is covered by your plan. Many common weight loss interventions are not fully covered by Medicare. To find out if your insurance covers specific medications, check your plan’s details. Among those companies, 28% of employers that have 5,000 or more workers and offer health benefits covered GLP-1 agonists for weight loss. A 2024 study found that 18% of large companies — those with 200 or more employees — covered GLP-1 agonists when prescribed primarily for weight loss or conditions related to their approved uses. Some are FDA-approved for medical conditions such as Type 2 diabetes but are prescribed off label for weight loss. Mississippi Division of Medicaid universal preferred drug list. Minnesota fee-for-service and managed care Medicaid uniform preferred drug list. 2025 Delaware Medicaid preferred drug list (PDL). Weight loss medications are typically used as part of a comprehensive weightloss plan that includes a healthy diet and regular exercise. The specific medications coveredmay vary depending on your plan and individual circumstances. It's important to note that these are just a few examples of weight lossmedications that United Healthcare may cover. However, if the medications are approved for another purpose, such as Type 2 diabetes, then Medicare may cover them. Current law doesn’t allow Medicare to cover medications such as Ozempic, Wegovy, Mounjaro, and Zepbound, for weight loss. Without manufacturer discounts or insurance, weight-loss medications can cost thousands of dollars per year. Surgical options might be suitable for those needing significant weight loss. It’s important to consult with a healthcare provider before starting any medication. Coverage may include medications like Saxenda, Contrave, and Qsymia. This step confirms that the medication aligns with your health needs. During this meeting, discuss your weight loss goals. Doctors prescribe certain weight loss drugs. Imagine finally achieving your weight loss goals with the support of your insurance plan. The drug list may change over time and may not be covered by your specific plan. If your plan has one of these lists, your insurance benefit may be applied before you meet your deductible for the listed preventive medications. These could include having a diabetes diagnosis, being a certain age, or trying other medications first. If you are prescribed a Type 2 diabetes medication such as Ozempic or Mounjaro, Medicaid might cover it, but only if you meet certain conditions. Check your Medicare Part D plan for coverage details and specific requirements. Coverage also depends on the type of insurance you have — such as Medicare, Medicaid, or employer-sponsored plans. Here’s a closer look at some of the top weight loss drugs covered and what makes them stand out.Minnesota fee-for-service and managed care Medicaid uniform preferred drug list.Download your free coupon on the GoodRx app or at by searching for the medication and then texting, printing, or emailing your coupon.California, for example, has started to cover weight-loss medications on their Medicaid preferred drug lists.Whether Medicaid finances a health insurance plan with an FFS model or under an MCE, they both operate under the state’s approved prescription drug formulary and the state’s Preferred Drug List.Pharmaceuticals like GLP-1s offer one option for treating obesity and have long been approved for treating type 2 diabetes.We identified health plans for individuals and families and assessed the four silver plans we mentioned above. Assuming coverage exists without verification can lead to unexpected costs. Weight loss can significantly improve health outcomes for individuals with obesity, improving quality of life and potentially reducing healthcare costs in the long run. This involves submitting detailed medical documentation to the insurance company for review and approval before the prescription can be filled. This is because insurance companies evaluate the clinical evidence supporting the drug's effectiveness and safety for the intended use within the context of the patient's overall health profile. Can Zepbound Cause Insomnia? Maximizing the benefits of weight loss drugs covered by UnitedHealthcare helps you get better results. UnitedHealthcare may limit coverage on some weight loss drugs. UnitedHealthcare covers several weight loss drugs listed in their plan. UnitedHealthcare offers different levels of coverage for weight loss drugs. Understanding coverage details and costs helps you plan your weight loss treatment better. And some employers have started to think about offering weight-management benefits.The key document you are looking for is your plan's formulary.Bariatric surgery is a weight-loss option for people with BMIs of 40 and higher.They provide resources to help manage weight effectively.Other health risks like diabetes may also qualify you.The specific medications coveredmay vary depending on your plan and individual circumstances.Some are diabetes treatments prescribed off-label, and, in some cases, manufacturers have rebranded and gained FDA approval specifically to treat obesity.This discussion helps tailor a plan that fits your needs. If you are a member of one of these groups (Eligible Organizations), UnitedHealthcare is required to cover certain birth control products and services at no cost to you. This drug list shows which drugs can be dispensed in quantities up to a 90-day or 100-day supply. If the prior authorization request is approved, you will pay a $0 cost share, not subject to a deductible. Preparing comprehensive medical documentation is crucial for prior authorization․ This includes records of your BMI, relevant comorbidities, attempts at lifestyle modifications, and previous treatments․ The more complete and well-documented your application, the better your chances of approval․ This documentation demonstrates a commitment to a holistic approach to weight management, strengthening the justification for prescription medication․ Weight loss medications can be an eligible expense if your doctor prescribes them, even if your Part D plan doesn’t cover them. Its approval for sleep apnea and obesity allowed Medicare Part D plans to cover it for those reasons. Before late 2024, Medicare had not been covering Zepbound because the FDA has approved it for weight loss only. Medicare Part D plans can cover Wegovy for adults who have cardiovascular disease or the liver disease MASH and are also overweight. While some older weight loss medications have available generics, making them more affordable, the newer drugs can come with a hefty price tag. The field of weight management is constantly evolving․ New medications, technological advancements, and a deeper understanding of obesity's complexities are shaping how insurers approach coverage․ The focus is shifting from solely relying on BMI to a more holistic assessment considering comorbidities, lifestyle factors, and long-term health outcomes․ This evolution reflects a move towards a more personalized and comprehensive approach to weight management․ A thorough consultation with your physician is the first and most important step․ Your doctor can assess your health status, evaluate your eligibility for weight loss medication, and guide you through the process of obtaining prior authorization․ They play a crucial role in documenting the medical necessity for the medication, thereby increasing the likelihood of successful coverage approval․ A strong doctor-patient relationship is essential in advocating for the best possible outcome․ But that definitely does not mean it will be covered by your plan as a weight loss medication, even if it’s covered for diabetes” or sleep apnea, Cubanski says. However, if you have Type 2 diabetes or another health condition, your insurance might cover medications that are approved to treat it. The difference among states for coverage of weight loss medications may be logical if the health insurance plans with coverage existed among the states with the highest prevalence of obesity. UnitedHealthcare, a leading health insurance provider, offers a variety of plans with varying levels of coverage for weight loss medications. We set out to investigate the coverage of Food and Drug Administration-approved medications for obesity within Medicare, Medicaid and ACA-established marketplace health insurance plans. Historically, Medicare is barred by statute from covering weight loss drugs, but as part of the 2026 proposed rule for Medicare Part D prescription plans, the Biden Administration planned to allow coverage of these drugs to all people with obesity on Medicare or Medicaid. Understanding Your Plan For those who might not be eligible for certain medications or find them too costly, even with insurance, exploring alternative treatments can be beneficial. Like Wegovy, Zepbound is often part of a comprehensive weight loss plan that includes dietary changes, exercise, and regular consultations with healthcare providers. For patients who do have weight regain after achieving a healthier body mass index or with inadequate weight loss, pharmacotherapy may be an option for postoperative patients to achieve a healthy weight.30 These results were after a 56-week study, and more data with longer-term use are needed to evaluate cardiovascular end points with phentermine/topiramate, in addition to the other obesity medications. While medication can be a valuable tool, it's essential to remember that it's most effective when combined with lifestyle changes, including diet and exercise. The PDL is organized by cost levels, known as tiers. Keep learning and stay proactive about your health journey. Staying informed helps you manage weight safely and effectively. However, it's important to note that coverage may varydepending on your specific plan and individual circumstances. UnitedHealthcare is one of the largest healthcare providers in the United States,offering a wide range of coverage options. Many people turn to medicationas a tool to help them achieve their weight loss goals, and it's important toknow what options are available to you. Of the 34 States’ Medicaid prescription drug policies reviewed, eight states have some form of possible coverage for obesity medications for beneficiaries (Table 5). When reviewing their preferred drug lists and their policy handbooks, if it included none of the FDA-approved obesity medications, the state received a score of ‘0’, ‘1’ if it included some coverage and ‘− 1’ if information was mentioned that excluded any of the obesity medications. MCE receive a pre-determined amount of money for caring for a Medicaid beneficiary from the government, which it then uses to cover the costs of certain medical services, mental health services and/or prescription drugs. We investigated each plan’s formularies to determine coverage for the FDA-approved obesity medications listed in Table 1. Since Medicare is barred from covering medications for weight loss, coverage can be limited. Medicare, the federal health insurance program primarily for people aged 65 and older, is currently prohibited from covering medications solely for weight-loss purposes. Dr. Russo and Dr. Shah expect a newly FDA-approved tirzepatide weight loss medication, Zepbound, to be covered in about a year. “Today’s announcement builds upon our … goal of democratizing access to weight-loss medication, which has been out of reach for so many in need,” says Dr. Mehmet Oz, CMS administrator. And because the program is a test, coverage will end in December 2031 unless the program is extended. AARP’s Medicare experts share tips and updates to help manage your health care costs. Your healthcare professional must also provide counseling in a primary care setting, such as a doctor’s office.The U.S. Congress has pushed for Medicare to cover weight loss medications, most recently with the Treat and Reduce Obesity Act of 2023 (H.R. 4818 and S. 2407).Enter your medication name to see if it’s covered.Prescription medications not covered by your health insurance plan are included in the IRS list of eligible HSA/FSA expenses.Finding out whether your preferred medication is covered might seem daunting.Companies may not consider the treatment medically necessary. Are you curious about the weight loss drugs that UnitedHealthcare covers? The below lists contain preventive medications that may be covered under your plan. For non-contraceptive preventive care prescription drug lists, refer to the Standard Zero-cost preventive care medications (PPACA) dropdown. Lists may change over time and some medications listed may not be covered by your specific plan. If your insurance doesn’t cover weight-loss medications, there are other ways to save money on out-of-pocket costs. However, if you're prescribed these medications off-label for weight loss, coverage may be less likely. For instance, if you have Type 2 diabetes, your insurance might cover medications such as Ozempic or Mounjaro (tirzepatide), since they are FDA-approved for Type 2 diabetes management. Examples include nutrition counseling and therapy, medication, and surgery. WeightWatchers for Business offers behavioral weight management, both virtually and in person. Eligible employers who offer UnitedHealthcare’s Total Weight Support can provide employees with access to one of two weight management vendor options. Medicaid coverage for weight-loss medications varies depending on the state in which you reside. Medicare is prohibited from covering weight-loss medications unless they are prescribed for other health reasons. Health plans may also cover medical nutrition therapy (MNT) for certain conditions, such as diabetes and chronic kidney disease. After establishment of the ACA and increased focus on obesity as a public health concern, we observed an increase in the coverage for bariatric surgery.9,29 However, a patient must meet strict guidelines to qualify for bariatric surgery, such as having a body mass index ⩾ 40, or body mass index ⩾ 35 with comorbidities which include hypertension, diabetes or sleep apnea. Of these 13 states, 6 are among the states with the highest prevalence of obesity.25 Conversely, 6 of the 21 states with no coverage for obesity medications are among the states with the highest prevalence of obesity. States with at least one Silver plan with obesity medication coverage and their corresponding type of coverage The other 25 states had no drug coverage provided within the four silver plans investigated. This ensures the medication is medically necessary. Coverage depends on your plan type and medical necessity approval. Sleep well and manage stress to support weight loss. Some pharmacies offer special pricing or savings on certain drugs. They contain the same active ingredients as brand-name drugs. But the largest companies in the U.S. are generally self-insured, so they're the ones calling the shots when it comes to coverage — and for them, cost is a major issue. Still, many benefits experts say it's a matter of when, not if, more employers will cover GLP-1 drugs. In addition to high costs, companies don't have long-term data on effectiveness and potential side effects to support coverage, and some are just biding their time until more of this information exists. Payers tend not to cover weight loss medications. High costs leave patients asking, does insurance cover weight loss medication? With weight loss medications proliferating and attracting ample media attention, more patients are asking about their costs. Successfully navigating UnitedHealthcare's weight loss drug coverage involves proactive steps and careful planning․ This section offers practical advice and strategies to improve your chances of obtaining coverage․ Several key factors determine whether UnitedHealthcare will cover weight loss medications․ Understanding these factors empowers individuals to navigate the process effectively․ We'll analyze these factors through a critical lens, considering potential biases and limitations․ Then, insurers generally cover care for both the excess weight and the co-morbid condition. The average weight loss for people who had gastric band surgery was about 15% of their starting weight. Prior authorization, step therapy, or specific FDA approval for weight loss may be required. Some medications may help you feel less hungry or feel full sooner. Drug availability, indications, and insurance coverage can change over time. UHC Medicare Advantage does not cover Zepbound for weight loss — see our Medicare guide for details. OptumRx is UnitedHealthcare's pharmacy benefit manager (PBM), so "OptumRx coverage" depends entirely on your UHC plan. Brand-name weight loss medications may have higher co-pays.Plans like UnitedHealthcare typically include several different drugs in their formulary, increasing the likelihood that you’ll find an effective treatment.Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) can be used to pay for qualifying weight loss medications with pre-tax dollars.But these medications, which are intended for long-term use, can cost over $1,000 per month without insurance.Eligible employers who offer UnitedHealthcare’s Total Weight Support can provide employees with access to one of two weight management vendor options.Depending on the company and coverage plan, some medications, like Wegovy, are now covered for weight loss, but for people on Medicare, a 2003 law actually prevents weight loss medication coverage.Understanding the prescription process for weight loss drugs can be crucial.Health plans also play a pivotal role in expanding access to various weight loss medications. Obesity is a treatable chronic disease Medicaid coverage for weight-loss medications depends on the state you live in. In the future, Medicare could begin covering weight-loss medications for obesity treatment more broadly if the Treat and Reduce Obesity Act is passed by Congress. Medicare is not allowed to cover weight-loss medications unless they are prescribed for other health reasons, such as reducing the risk of heart attack or stroke. What does a Part D plan cost? If you have Medicare, you’re probably wondering if your weight-loss medications will be covered. The best way to know if you might qualify to have these medications covered by your insurance provider is to talk to your doctor, Dr. Shah says. “Some insurance plan tiers will provide coverage and some won’t," Dr. Shah explains. "Most commercial insurance plans should have one plan that provides some level of coverage.” (It often takes a few months to a year before insurance companies start covering the cost of brand new medications, Dr. Shah says.) Dr. Russo thinks that over time, these medications will be covered more by insurance. Understanding these drugs helps in making informed choices. Dive in and discover the possibilities that await you with UnitedHealthcare’s coverage. They include certain vital use drugs such as preferred insulins. Contact your insurance provider to clarify benefits. Simple steps improve your chances of success and keep your health on track. Always consult your doctor before switching to a generic drug. Choosing generics can reduce out-of-pocket costs significantly. Rising Costs Lead Insurers to Drop Weight Loss Drug Coverage, Further Increasing Patient Burden The average cost of bariatric surgery is between $7,400 and $33,000 before insurance coverage. Check with your private or employer insurance provider to find out the details of your plan’s coverage. Programs that cover weight-loss medications may require prior authorizations and impose quantity restrictions. Plan recommendations are based on the information that you provide regarding your health coverage needs. 1 You will pay a maximum of $35 for each 1-month supply of Part D covered insulin drug through all drug payment stages except the Catastrophic Coverage stage, where you pay $0. Many plans offer cost savings if you use a preferred pharmacy. Standalone Part D plans charge a monthly premium and may also have an annual deductible, copays and coinsurance. You can avoid this penalty if you can show that you have "credible coverage" equal to or better than a Part D plan. FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweight. Use your health savings account (HSA) or flexible spending account (FSA) to pay for qualified medical expenses. There are also plans for conditions including cancer, stroke, or kidney failure. TRICARE is the federal health insurance for U.S. military members and their families. To find out what’s covered and the specific requirements, check your state Medicaid formulary. Childhood obesity facts. Consult with your healthcare professional to document your BMI. There are effective treatments available today, including counseling, medication, and surgery. Companies may not consider the treatment medically necessary. The CDC reports that around 1 in 5 children and adolescents in the U.S. have obesity, as well. It's always agood idea to check with your insurance provider to confirm coverage beforestarting any medication. "There's a lot of evidence that they help people lose weight and prevent really serious illnesses like stroke and heart attack. It's going to be harder and harder not to cover these drugs because the benefits seem to be so great." Meanwhile, benefits consultants expect the coverage problem will eventually resolve itself, given the need and long-term benefits these drugs may be able to provide. Since the drugs are meant to be used long-term, this can run up quite a bill. “Most insurance companies do not cover GLP-1 agonists Wegovy, Ozempic or dual agonists Zepbound, Mounjaro,” Alan says. However, doctors have been prescribing Ozempic “off-label” for weight loss, says Dr. Russo. But these buzzy drugs, which are meant to be "lifelong" drugs taken long term, aren't cheap. Always seek the advice of your physician or other qualified healthcare professional regarding any medical condition or treatment. "It's certainly a big step forward, compared to no coverage at all," she says. The American Medical Association’s 2013 declaration of obesity as a disease provides medical foundation for these policy changes. These programs typically require income verification and may offer free or reduced-price medications for eligible patients. Medicare covers Medical Nutrition Therapy (MNT) for beneficiaries with diabetes or kidney disease when referred by a physician. Connecticut plans Some are diabetes treatments prescribed off-label, and, in some cases, manufacturers have rebranded and gained FDA approval specifically to treat obesity. Several newer medications, mainly GLP-1 receptor agonists, have been introduced. Weight-loss counseling and surgery can be covered He has also covered Medicare for Bloomberg Law and as a national correspondent for Knight Ridder/McClatchy Newspapers.Kimberly Lankford is a contributing writer who covers Medicare and personal finance. Medicare doesn't cover weight-loss medications, with the exception of patients with Type 2 diabetes.They determine if medication is a suitable option.Use your health savings account (HSA) or flexible spending account (FSA) to pay for qualified medical expenses.The patients in this study had their medications covered by insurance, so cost may not have been a factor.As part of Health Care Reform, health plans must cover certain Preventive Care Medications at no cost to you.In other words, the injections, which can cost well over $1,000 a month out of pocket, will not be covered for enrollees only seeking to lose weight.The information on this page is for educational and informational purposes only and is not intended as medical advice.UnitedHealthcare often covers FDA-approved weight loss medications. Understanding your plan ensures you know which medications are covered.You can find out whether your Medicaid program covers Ozempic by checking your state’s preferred drug list, or formulary.We investigated the drug formularies of four ‘silver’ plans with the lowest, second lowest, median and highest premiums.Your prescriber may have to fill out prior authorization and medical necessity forms as part of the review process.Besides those risks, there are also risks of going off the medications.Remember, this information is for educational purposes and should not be considered medical advice. You may be responsible for some or even a large portion of that cost, depending on your policy. Bariatric surgery is a weight-loss option for people with BMIs of 40 and higher. Check your Medicaid plan for details. Sometimes, lifestyle and behavioral changes aren’t enough to help you lose weight. The medical community generally defines having obesity and being overweight in adults by body mass index. Forty-nine out of 51 state Medicaid programs include coverage for one or more surgical procedures to treat obesity. Weight-loss medication coverage may come with restrictions. The Affordable Care Act requires most health insurers to cover obesity screening and counseling. By providing tools and resources for sustainable weight loss, employers can help foster a healthier, happier workforce. See our complete OSA coverage guide → As of January 2025, UHC offers automated prior authorization for select GLP-1 medications. Always check your plan's drug list at uhc.com or by calling member services. All the UHC coverage rules, prior authorization requirements, and appeal processes described on this page apply to OptumRx. If you have UnitedHealthcare insurance, OptumRx handles your medication formulary and prior authorizations. BCBS Michigan is not the first insurer to drop coverage of GLP-1 drugs for weight loss. Effective January 1, 2025, coverage for these drugs will end for fully insured large group commercial members, with coverage ending on the renewal date for plans renewing after January 1. For example, if one of the drugs receives FDA approval to treat diabetes or prevent cardiovascular disease, Medicare part D plans may cover it for that use. The Centers for Medicare & Medicaid Services is testing pilot programs that could allow Medicare Part D plans to cover GLP-1 drugs specifically for weight management. Before reaching the cap, beneficiaries typically pay 25% coinsurance for covered drugs after meeting their plan’s deductible. Weight-loss medications work in different ways. Your healthcare professional may consider prescribing you medication after discussing the risks and benefits with you. Contact your local Medicaid office or visit your state’s Medicaid website to learn about covered services. We must embrace an integrated obesity treatment framework which incorporates changes in the way we think of obesity as a disease and provides measures on how we will begin to destigmatize obesity. The use of anti-obesity pharmacotherapy will not solve the obesity epidemic in the USA, but they do serve as part of the solution. In addition, since more and more patients with obesity are undergoing bariatric surgery, patients still need to manage their obesity, although it may be in remission. Another barrier to the use of pharmacotherapy for the treatment of obesity may be due to the increased knowledge and established efficacy of bariatric surgery for the treatment of obesity. Plans like UnitedHealthcare typically include several different drugs in their formulary, increasing the likelihood that you’ll find an effective treatment. Ironically, federal government employees, with 2.7 million beneficiaries, have benefitted from the recognition of obesity as a complex disease. The integrated framework may also create useful strategies that will provide a meaningful investment in the future of our citizens by preventing and controlling obesity in ways supported by scientific evidence. Prescription drugs often suit individuals with specific needs. These medications require professional guidance. Weight loss drugs come in different types. There may also be quantity limits on how much medication Medicaid will pay for within a certain time period. While this information is intended to be helpful, it is not a substitute for professional medical advice. Remember that proactive communication with your physician and insurance provider is essential throughout the entire process. As part of Health Care Reform, health plans must cover certain Preventive Care Medications at no cost to you. These cards are typically available directly from the drug manufacturer and can be used with insurance coverage to reduce costs further. Similar to coupons, manufacturer savings cards can offer substantial discounts on weight loss medications. Medications are placed into tiers that represent the cost you pay out-of-pocket. Amin added that as more manufacturers enter the GLP-1 market, manufacturers may be offering competing discounts to try to get patients to pick their drug. Consumers with commercial insurance may be able to get assistance through the manufacturer if they are eligible for savings programs. Employers are "really struggling to determine the cost versus benefit," Stich said. The discounts also would apply to purchases made via a new direct-to-consumer portal, TrumpRx, scheduled to launch in early 2026 to link users to manufacturers’ websites to buy the prescriptions. You can pay as low as $25 for a 1-month supply of the medication, if you meet the qualification. Download your free coupon on the GoodRx app or at by searching for the medication and then texting, printing, or emailing your coupon. These expenses include copays, coinsurance, and deductibles. Your prescriber may have to fill out prior authorization and medical necessity forms as part of the review process. When deciding what medication to prescribe, Shauna Levy, M.D., medical director of the Tulane Bariatric and Weight Loss Center in New Orleans, says insurance is her number one limiting factor. Though some GLP-1s have been FDA-approved for weight loss, others have not. On average, the trendy GLP-1 medications have helped people lose 12 percent of their total weight. Real Appeal Rx® provides whole-person support addressing medication adherence, nutrition, physical activity and the emotional and social experiences of the GLP-1 weight loss medication journey. “Many adults say will-power alone is not enough for successful weight loss, yet employers are looking for ways on how to offer support,” said Dr. Rhonda Randall, chief medical officer for UnitedHealthcare’s commercial business. While these medications show promise for treating obesity, experts agree that, in accordance with the FDA’s label, they should be used in combination with a reduced calorie diet and increased physical activity.6 Pharmaceuticals like GLP-1s offer one option for treating obesity and have long been approved for treating type 2 diabetes. These challenges may also increase health care costs for employers and consumers, with obesity alone costing the U.S. health care system nearly $173 billion a year.5 Understanding the prescription process for weight loss drugs can be crucial. The formulary is a list of medications your insurance plan covers. These drugs have been proven effective for many, but coverage can vary based on your plan type. UnitedHealthcare provides a range of insurance plans, each with different coverage options. This information is typically available online or through your plan's customer service department. Carefully reviewing your plan's formulary and benefit details is essential. Lack of clarity on this front can lead to unnecessary frustration and delays in accessing needed medication. This article will delve into these complexities, exploring the issue from various perspectives to provide a comprehensive and nuanced understanding for both beginners and experienced healthcare navigators. If you have not used Optum Home Delivery Pharmacy, you must approve the first prescription order sent directly from your doctor before it can be filled. Novo Nordisk offers access to a health coach for diet and exercise to help people taking Wegovy. Some employer insurance. You can pay out-of-pocket, taking advantage of the lower prices expected to be available on drug manufacturers’ websites linked to from TrumpRx. You’ll need to share documentation of your type 2 diagnosis with your Part D plan. Drug availability, indications, and insurance coverage can change over time.Many insurance plans cover nutrition counseling by a registered dietitian or licensed nutritionist.The company encourages combining medication with lifestyle changes.Plans may have different coverage levels, premiums, deductibles and copayments.Below are a few popular medications that are used for weight loss and more information about cost and coverage.Commercial health plans may cover the cost of prescription weight-loss medications.It's always agood idea to check with your insurance provider to confirm coverage beforestarting any medication.Medicare spent $2.6 billion on Ozempic in 2021 and $4.6 billion in 2022, making it one of the 10 drugs it spends the most on. In some cases, Medicaid programs also require enrollees to meet certain criteria before covering Ozempic. For example, the medication is listed as a preferred agent in North Carolina, but it’s listed as nonpreferred in Arizona and Wyoming. Without insurance, the retail price of Ozempic ranges from $1,000 to $1,200 or more for 1 pen. It follows, then, that they consider weight loss drugs a medical treatment. However, it did not address weight loss medications. Fen-phen, a combination of fenfluramine and phentermine, led to rapid weight loss and received comprehensive media coverage as a "miracle" drug. This affordability can encourage more people to seek help rather than avoid treatment due to cost concerns. If your UHC plan categorically excludes weight loss medications, an appeal for medical necessity likely won't succeed. This could open an alternative pathway to Zepbound coverage even if your plan excludes weight loss drugs—but note the criteria are stringent. Navigating the process of obtaining coverage for weight loss medications can feel daunting, but understanding the steps involved can make it more manageable․ Here's a breakdown of the key steps⁚ Some recommendations for patients whose insurance won't cover weight loss medications are the same as for other treatments. Take a look at our advocacy Toolkit for talking points and advice on contacting policymakers about supporting coverage for weight loss medications. Unlike CVS Caremark (which removed Zepbound in July 2025), OptumRx is maintaining Zepbound on 2026 formularies for plans that cover obesity medications. If your plan excludes weight loss medications, you may still qualify for Zepbound through the sleep apnea pathway. Starting July 1, 2025, UHC's sleep apnea policy (P ) may cover Zepbound even if your plan excludes weight loss drugs. These choices often offer similar benefits at a lower cost or with better support. Finding alternatives helps maintain your health goals without overspending. Always review your policy’s drug list and restrictions carefully. Without prior authorization, you may pay full cost. It's crucial to review your specific UnitedHealthcare plan documents and consult with your insurance provider to understand your financial responsibility before starting medication-assisted weight loss. UnitedHealthcare covers several weight loss drugs that may help you. Some drugs may be fully covered, while others require copayments or coinsurance. Know which medications are covered and any cost updates. Coverage may be restricted to certain weight loss medications only. Some Part D plans, called MAPD, are bundled with Medicare Advantage plans. This complex issue of affordability and coverage is further highlighted by broader budgetary concerns. The disparity in drug prices—Wegovy costs $1350 per month in the US compared to $190 to $330 per month in Germany—illustrates the difficulty in managing cost and access. It also allows the government’s Medicare Plan Finder to include the information as potential enrollees shop for standalone Part D prescription plans and Medicare Advantage coverage. The long lead time for Part D participation allows plans to include GLP-1s in their drug coverage lists, update their computer systems and fine-tune their marketing before next year’s open enrollment Oct. 15 to Dec. 7. Some supplemental health insurance plans also help pay for costs related to an illness or injury. Broader coverage of pharmacotherapy can make a significant contribution to fighting this complex and chronic disease. They can discuss the potential benefits and the serious risks and side effects of these powerful drugs. You should never start a prescription medication without a thorough consultation with a doctor. These medications may also be costly. To qualify for the maximum savings, you typically need to have commercial insurance that covers your prescription, as well as meeting other eligibility requirements. GoodRx has coupons for a variety of weight-loss medications. Check your TRICARE plan for details on coverage and criteria.