“Older weight-loss medications such as Qsymia, Contrave and phentermine can be effective, and the cost is usually less than $100 per month,” he says. In some situations, “costs may be even lower” for patients with commercial insurance but no coverage, says Dr. Grunvald. Some private plans add drugs like Zepbound, others drop non-diabetes use. Members who qualify have access to weight-loss medications, including the latest GLP-1s, for much less than the list price — even without insurance coverage. Here’s what to know about navigating insurance coverage for anti-obesity medications, including appeals, cost-savings programs, and why cheaper so-called dupes might not be worth it. While many medications prescribed for chronic conditions are covered by insurance, weight-loss drugs are a different story. It’s best for people wanting straightforward, affordable access to GLP-1s who are comfortable managing their weight-loss journey without heavy hand-holding. Ro stands out for its insurance navigation tools, telehealth access, and a care model that includes physician oversight, dose titration, and habit-tracking tools. The insurance concierge is a highlight for those needing coverage help. Please note that compounded medications are sourced from licensed US pharmacies, but they are not FDA approved and may not be available in every state. Check with Medicare and your healthcare professional to get a better understanding of the rules. Medicare covers some bariatric surgical procedures, such as gastric bypass, when you meet certain conditions. You may be responsible for some or even a large portion of that cost, depending on your policy. Check your Medicaid plan for details. Sometimes, lifestyle and behavioral changes aren’t enough to help you lose 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. Weight-loss medications work in different ways. Your healthcare professional may consider prescribing you medication after discussing the risks and benefits with you. Find more top doctors on That’s not just a healthcare shift; it could also boost the economy. And when Medicare moves, other insurance programs like Medicaid may follow. As a result, many insurance policies may not fully reflect this new mindset. A 2025 JAMA Health Forum study estimated semaglutide’s cost per quality-adjusted life year (QALY) at over $450,000 (for reference, most insurers use a rough cutoff around $100,000 per QALY when judging value). They monitor shifts in GIP/GLP-1 access. Compounded versions through telehealth like Walgreens offer lower prices, around $149 initial months. Appeals often succeed with strong medical backing. Others like Mass General Brigham drop non-diabetes use. Initially approved for use in treating migraines and seizure disorders, it was shown to reduce weight in patients with a body mass index over 30, and subsequently became approved for that purpose when combined with another drug (phentermine).A winning letter is not a generic “please cover.” It is a structured argument tied to plan criteria.Even though the Medicare Plan Finder may identify Ozempic as covered, that doesn’t mean you will qualify for coverage.GLP-1 medications should always be used under the guidance of a licensed healthcare provider.Goldman Sachs estimates that by 2028, as many as 70 million people in the U.S. could be using these medications.Finally, there’s the ACA marketplace, where individuals or families purchase their own plans, often through HealthCare.gov.“If you are working with a qualified clinical team who is assessing your total nutrition (food and supplements), medications, lifestyle choices and will do so while you are on the medication, you may not need other services, so just getting the medication could be a win.” Even with these options, navigating cash-pay pricing (meaning, paying out of pocket without insurance) isn’t always straightforward. “For oral Wegovy, with cost savings cards or going through Novo Nordisk’s pharmacy, the price can range from $150–$300 per month, again depending on the dose,” Dr. Grunvald adds. “For injectable Wegovy, it can cost $200–$350 per month from Novo Nordisk’s pharmacy program or with a cost savings card,” he continues. “Most people pay out of pocket, and the price can easily exceed the cost of weight-loss surgery.” For those who don’t have Medicare, approval delays may happen because many weight-loss medications are still relatively new, particularly the GLP-1s. Although Medicare represents only those over age 65, it sets a tone for insurance companies about what should be covered. That means 65 million people in the U.S. who are on Medicare are not covered. However, requesting prior authorization from an insurance company can sometimes be helpful, since you’ll know it’s covered before the prescription is written, Seltzer says. Preventive cardiologist Martha Gulati, MD, even called out the Mayo Clinic’s coverage of weight loss drugs through its employee health plan in a recent Instagram post. On the flipside, a semaglutide medication that is approved for weight loss—Wegovy—might potentially be covered by insurance, despite the fact it's essentially the same medication as Ozempic. As more research shows that GLP-1s help not only with weight but also with heart health and diabetes, more employer-sponsored health plans are expected to offer coverage. Medicaid coverage for weight-loss medications varies depending on the state in which you reside.The medication must be FDA-approved, included in your plan’s formulary, and supported by thorough documentation from your provider.“Most people pay out of pocket, and the price can easily exceed the cost of weight-loss surgery.”The cost of weight loss drugs can be substantial, but many insurance providers now offer coverage for these medications.That means if they are prescribed Wegovy, Zepbound, or Saxenda, their insurance will not cover it.Among the largest employers (20,000 or more employees), coverage rose to 64%, up from 56% in 2023.Unfortunately, coverage for weight-loss medications here is rare. Weight-loss medications work in various ways to help you lose weight and maintain weight loss long term. Improving access and affordability to high-cost weight management drugs. GoodRx also offers programs that can help people access these medications. Your healthcare professional must also provide counseling in a primary care setting, such as a doctor’s office. MNT focuses on using nutrition to manage specific health issues and minimize the risk of complications. Examples include nutrition counseling and therapy, medication, and surgery. WebMD does not provide medical advice, diagnosis or treatment. On average, the trendy GLP-1 medications have helped people lose 12 percent of their total weight. These medications also can help with weight loss because they make you feel fuller faster. Novo Nordisk calls it part of a pilot program to add obesity to the list of covered medical conditions and expects that most Part D beneficiaries would be covered. However, doctors have been prescribing Ozempic “off-label” for weight loss, says Dr. Russo.The medical community generally defines having obesity and being overweight in adults by body mass index.To improve your chances of getting coverage for weight-loss medications, review your policy, gather medical documentation, and be prepared to advocate for coverage through letters or appeals.If you’re considering using medication to help you lose weight, it’s important to talk to your doctor about what this would look like for you, including health insurance coverage options.He likes looking trimmer, but his recent blood work shows that the drug is about way more than physical appearance.Many people meet clinical eligibility yet still get denied because the barrier is not “Does this work?Weight-loss medications work in various ways to help you lose weight and maintain weight loss long term.So why doesn’t insurance routinely cover these medications? 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. Affordable and personalized virtual care for opioid addiction, hormone therapy, weight loss, and urgent health needs. And even when coverage is available, the out-of-pocket costs can still be a stretch. There are no hidden fees, no long waits for insurance approval, and no complicated paperwork loops. That’s why some people turn to services like QuickMD. Especially those dealing with joint pain, mobility issues, or emotional burnout tied to chronic health concerns. ”—it is “Does this match the plan’s benefit design and the insurer’s prior authorization checklist? Many people meet clinical eligibility yet still get denied because the barrier is not “Does this work? This article on Epainassist.com has been reviewed by a medical professional, as well as checked for facts, to assure the readers the best possible accuracy. Dive into our musings and share in our discoveries! Because we're fascinated by the concept of weight in all its forms. See what’s possible with GLP-1s “The sad truth is that these medications are very expensive,” Dr. Russo adds.It helps prevent inappropriate use and controls costs.Novo Nordisk offers access to a health coach for diet and exercise to help people taking Wegovy.If you have Medicare and a qualifying comorbidity, you may gain access.Insurers have responded by creating structured pathways to evaluate when medication use is appropriate, balancing access with safety and cost-effectiveness.Even with perfect documentation, some plans will not cover weight loss medications.If insurance isn’t an option (or the process is taking too long), QuickMD offers a direct-access alternative. Without approval, out-of-pocket costs can range from $200 to over $1,000 per month. In this approach, your healthcare provider initiates the prior approval request on your behalf, submitting clinical data and rationale directly to the insurer. This is not an automatic benefit and requires meeting defined medical and administrative criteria set by the insurer. The field of weight management is evolving–and fast. How are prescription drug prices determined? If you don’t use tax-free money from an HSA, weight loss medication prescribed for a medical condition, such as diabetes or obesity, can be a tax-deductible medical expense, says Barbara Weltman, author of J.K. Data reflect the average share of commercial and health exchange covered lives with insurance coverage across all available forms and dosages of each medication. Altogether, 8.5% of people with commercial insurance — over 16 million people — lack coverage for any of the GIP and GLP-1 agonists prescribed for weight loss in 2026. Despite the growing list of medical benefits for GIP and GLP-1 agonists, including weight loss, commercial insurance coverage has yet to catch up to demand. Prescription drug coverage determines how much people pay out of pocket for their medications. Programs that cover weight-loss medications may require prior authorizations and impose quantity restrictions. Medicare may expand weight-loss medication coverage if the Treat and Reduce Obesity Act is passed by Congress. Check your insurance plan to see what’s covered and the requirements. Many insurance plans cover nutrition counseling by a registered dietitian or licensed nutritionist. Some insurance plans may cover additional services. “If the prescriber cannot or will not attempt those steps, the patient can consider seeing a healthcare professional who focuses on weight management. Even when coverage exists, a denial isn’t uncommon, especially at the outset. For example, Zepbound is covered for moderate to severe obstructive sleep apnea; Wegovy is covered for certain heart disease conditions or advanced fatty liver disease. 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). Many insurers and employers who sponsor health coverage consider weight loss a cosmetic need rather than a medical one. Payers tend not to cover weight loss medications. High costs leave patients asking, does insurance cover weight loss medication? While some older weight loss medications have available generics, making them more affordable, the newer drugs can come with a hefty price tag. And without insurance coverage, a cost of $1,000 to $1,600 a month puts these drugs out of reach for the great majority of Americans. KFF’s 2025 employer survey findings reflect that larger employers are more likely to cover these medications, but many say coverage has a significant impact on prescription drug spending. Medicaid coverage for obesity medications is not uniform. As awareness grows about the role of obesity in chronic disease development, more individuals are exploring all available tools for sustainable weight management 1. The goal is to ensure that medication use aligns with evidence-based practices and is reserved for individuals who could experience meaningful health improvements from its use. They may be well versed in what’s covered and what’s required to get approval. (This coverage request letter template may be a good starting place for your provider.) Once submitted, the process moves pretty quickly. The decision to take GLP-1 medications for weight loss should be made together with a licensed healthcare provider. GLP-1s are a class of medications used for weight loss and to treat Type 2 diabetes. Ozempic, which the FDA first approved for diabetes and then for kidney disease, is popular for weight loss, but Medicare has been covering it only when it’s prescribed for diabetes or kidney disease. In March 2024, the FDA approved Wegovy’s use for adults with cardiovascular disease who are also overweight, which opened the door for Medicare Part D plans to cover it. How Are Insurance Policies Changing for My GLP‑1 Medication in 2026? Check your TRICARE plan for details on coverage and criteria. 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. As a result, programs like FEP Blue now offer not only medication coverage pathways but also complementary resources such as virtual nutritional counseling and fitness discounts 1. Insurers have responded by creating structured pathways to evaluate when medication use is appropriate, balancing access with safety and cost-effectiveness. It involves coordination between you and your healthcare provider to submit necessary documentation, demonstrate medical necessity, and comply with plan-specific rules such as step therapy or formulary restrictions. This process typically applies to FDA-approved medications used as part of a comprehensive approach that includes lifestyle modifications like nutrition and physical activity 2. When a treatment has the potential to improve your health and quality of life, cost shouldn’t be a barrier. Whether you’re navigating Medicare, employer insurance, or looking for alternatives, this guide helps you understand your options and how to access care Being overweight or obese has serious implications for your health. Significant weight loss is usually required. Whether you’re considering GLP-1 medications for yourself or supporting someone who is, understanding how coverage works is an important aspect of accessing care. You’ll learn which plans are most likely to help, why coverage is still so limited, and what to do if you’re facing high out-of-pocket costs. Insurance providers may not cover prescription medications used exclusively for weight loss. Medicaid coverage for weight-loss medications varies depending on the state in which you reside. Goldman Sachs estimates that by 2028, as many as 70 million people in the U.S. could be using these medications. Insurers want to be sure these medications go to people who genuinely need them, not just those hoping to drop a few pounds for appearance. Without coverage, the cost is staggering. For those considering GLP-1 medications like Wegovy or Mounjaro, insurance can be the difference between getting help and going without. Many plans require prior authorization, documented health conditions, or participation in a workplace wellness program. It simply has a different name, marketing, dosage size, and approved usage, explains Alan. But these buzzy drugs, which are meant to be "lifelong" drugs taken long term, aren't cheap. Losing weight and keeping it off is hard. You’ll need to share documentation of your type 2 diagnosis with your Part D plan. 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. Outside of Medicare, typical requirements include a BMI of 30 or higher or 27 or higher when combined with another health condition. Novo Nordisk’s Ozempic and Wegovy have the same underlying product, but they come in slightly different dosages and are approved for different reasons. In January 2025, CMS selected Ozempic, Rybelsus and Wegovy, all GLP-1s manufactured by Novo Nordisk, for its second round of Medicare drug price negotiations. Get effective, FDA-approved treatment While several prescription medications are FDA-approved for weight loss, coverage varies significantly between plans.Zepbound is approved for those with a BMI of 30 or greater.But you’ll have to research cost-savings programs for each individual drug your healthcare provider is considering to prescribe for weight management.But if the drug truly works, it will usually make its way to the mainstream, he says.Bronder, 57, of San Jose, CA, had struggled with his weight for most of his adult life.People often notice reduced appetite quickly after starting GLP-1 medications like Wegovy or Zepbound—within days to weeks.Yes, if your plan denies, cards like from NovoCare cap costs low.Plus, "there’s a lot of competition on the market—and that should eventually help drive the cost down," he says. But figuring out how to access them (especially through insurance) can feel confusing and, honestly, a little overwhelming. While the insurance landscape evolves, many people can’t afford to wait. With more people feeling healthier and working more, experts think U.S. Goldman Sachs predicts that employer coverage could jump from about 50% today to 90% by 2030, especially as more companies enter the market and prices start to drop. Without bringing prices down, covering these drugs widely could be financially overwhelming. If insurance isn’t an option (or the process is taking too long), QuickMD offers a direct-access alternative. Most people don’t think much about their insurance until they’re faced with a treatment they need (and maybe can’t afford). Finally, there’s the ACA marketplace, where individuals or families purchase their own plans, often through HealthCare.gov. Insurance may not cover prescription medications that are used solely for weight loss, because they may not always be seen as medically necessary. 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. Some are FDA-approved for medical conditions such as Type 2 diabetes but are prescribed off label for weight loss.Check your Medicaid plan for details.Altogether, 8.5% of people with commercial insurance — over 16 million people — lack coverage for any of the GIP and GLP-1 agonists prescribed for weight loss in 2026.“Ozempic is a medication for diabetes,” Levy said before its approval for kidney disease.BMI is a measure based on height and weight.The U.S. is doing better than it was 20 years ago when it comes to helping people lose weight and fight obesity. The table highlights drug-specific trends, emphasizing diabetes ease over weight. Gather medical records showing why you need the medication, like BMI readings or diabetes diagnoses. Log into your insurer’s portal or call customer service for the latest on covered drugs. Hims and Hers both offer convenient access to brand-name and compounded GLP-1 medications without requiring insurance. Ro Body offers a fully integrated telehealth experience for GLP-1 weight-loss treatment, blending medical care, insurance navigation, and lifestyle support. Consumers are often shocked to find that GLP-1 medications like semaglutide (Ozempic®, Wegovy®) and tirzepatide (Mounjaro®, Zepbound®) can cost over $1,000 a month without insurance. For plans like FEP Blue, this typically means having a Body Mass Index (BMI) of 30 or higher, or a BMI between 27–30 with a weight-related health condition such as type 2 diabetes or hypertension 1. Just remember that weight-management medication should be one part of a larger medical weight-management treatment plan that's made in collaboration with your healthcare provider. Unfortunately, “weight-loss medication is often not covered at all,” says Dr. Robert Kushner, M.D., a professor of medicine and medical education at Northwestern University’s Feinberg School of Medicine in Chicago. Some supplemental health insurance plans also help pay for costs related to an illness or injury. Medicaid coverage for weight-loss medications depends on the state you live in. Formularies list what’s included, often tiered by cost-sharing levels. Always discuss with a doctor to see if they fit your health profile. They’re FDA-approved for specific uses, influencing how insurers view them. But getting insurance to pick up the tab often requires some legwork and know-how. You can also explore the manufacturer’s direct‑to‑consumer program for cash‑pay options, though the cost may still be prohibitive. Affordable Care Act Websites: HealthCare.gov vs. State Marketplaces We’ll cover checking eligibility, appealing decisions, and alternatives if coverage falls short.Tax-deductible medical expense.Investigators measured the effects on weight, as well as blood sugar levels, blood pressure, cholesterol levels, and C-reactive protein, which may indicate heart disease risk.Take a look at our advocacy Toolkit for talking points and advice on contacting policymakers about supporting coverage for weight loss medications.Insurance coverage for GLP-1s like Wegovy and Zepbound for weight loss varies.A licensed QuickMD provider will review your health history to determine if a GLP-1 suits you.Affordable and personalized virtual care for opioid addiction, hormone therapy, weight loss, and urgent health needs. For obesity, it’s spotty—requiring BMI 30+ or comorbidities. Pilots starting this year aim to broaden access. In 2026, pilots expand for obesity in beneficiaries. This step ensures appropriate use per plan guidelines. Renewals require progress proof like weight logs. For example, Zepbound (tirzepatide) costs $1,087 per month and Wegovy (semaglutide) costs $1349. Weight-loss medication is no different, and out-of-pocket prices often exceed $1,000 per month, particularly for the newer GLP-1s. That’s good news for the more than 40% of adults in the U.S. living with obesity. Here’s how to figure out what your insurance will pay — if anything — and what you’ll be responsible for. Despite growing clinical evidence, Medicare still excludes weight loss medications from coverage. While the process may seem complex, the potential benefits of covered weight loss medications can make the effort worthwhile. 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. Another argument for coverage is obesity's link to cardiovascular and other related diseases. For example, in November 2023, the FDA approved Zepbound, a brand name for the drug tripeptide, already sold as Mounjaro, to treat diabetes. The medication must be FDA-approved and deemed medically necessary. All medications must be FDA-approved and prescribed within professional standards. Some plans waive copays entirely for members enrolled in approved wellness programs. Pilots starting this year aim to broaden access.On average, the trendy GLP-1 medications have helped people lose 12 percent of their total weight.A s a result, the federal government disallowed Medicare from covering drugs viewed as having the risks outweigh the benefits, namely cosmetic benefits.“With obesity, every insurance and every employer follow their own plan,” she says.However, insurance coverage has yet to catch up.That’s why some people turn to services like QuickMD.The drug mimics a naturally occurring hormone called GLP-1 that lessens cravings, increases satiation, and slows digestion so that you feel full for longer.In addition to helping with weight loss, GLP-1s, or glucagon-like peptide-1 receptor agonists, have been found to improve heart and liver health and treat sleep apnea in overweight adults.With the introduction of generic liraglutide, commercial insurance coverage has also worsened for brand-name Victoza and Saxenda in 2026. Mochi Health offers a well-rounded GLP-1 program with insurance integration, making it a solid pick if your plan covers brand-name meds. While compounded medications have faced scrutiny, the company now emphasizes FDA-approved treatments with clear disclaimers where applicable. With flexible online care and brand-name medications, it’s a strong option for those seeking reliable weight-loss support. GobyMeds provides compounded GLP-1 medications through a streamlined online process that includes telehealth visits and home delivery. Hims & Hers scores well on transparency, access, and flexibility. Public reviews on Reddit and GLP-1 forums praise GobyMeds for its ease of access and fast shipping. If you’re looking for a budget-friendly, no-insurance-needed GLP-1 program, MEDVi is worth considering. Eli Lilly has a Mounjaro savings program available to adults with an on-label prescription for type 2 diabetes, but you’ll need proof of your condition to enroll in the savings program. Pharmaceutical assistance programs are usually limited to FDA-approved use. 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. Medicare Part D plans can cover Wegovy for adults who have cardiovascular disease or the liver disease MASH and are also overweight. Some plans require you to try other medications first. “People call their insurance and ask if Ozempic is covered, and they say it is, but if you don’t have diabetes, it’s not covered.” If your doctor prescribes Ozempic for type 2 diabetes or kidney disease rather than weight loss, Medicare Part D can cover it. When a new medicine for obesity is first released, insurers may restrict access only to patients who have a very high BMI or who have tried other medications unsuccessfully. Some people were able to get it covered by their insurance, others weren’t. Ironically, the very drug that could have helped prevent his prediabetes would likely not have been covered until he actually developed the condition. As of January 2026, analysis from KFF reported that 13 state Medicaid programs cover glucagon-like peptide-1 medications for obesity treatment under fee-for-service, often with prior authorization controls. It helps prevent inappropriate use and controls costs. Yes, a licensed provider must assess your health, write a prescription, and submit documentation to support the prior approval request. For those who qualify, this path offers structured support within a broader weight management strategy that includes nutrition, physical activity, and behavioral change. Insurers follow federal and state regulations regarding patient privacy and equitable access, and members have the right to appeal decisions they believe are incorrect. With successful prior approval, copays may be reduced to $25–$75 monthly, depending on your plan’s pharmacy benefits. “In some cases, a drug is used off-label for a time and then is approved for that purpose, making it on-label.” And that’s because everyone’s insurance carrier and specific plan is different. We’re living in a golden age of weight-loss drug innovation. A manufacturer copay card may help you save money on weight-loss medications even if you don’t have insurance. Types of supplemental health insurance plans include vision, dental, and long-term care. TRICARE may cover Ozempic or Mounjaro if you have Type 2 diabetes, want to lose weight, and can’t take metformin for a medical reason. As mentioned earlier, medications such as Ozempic can be prescribed off-label for weight loss. Health insurance may cover treatments for conditions where overweight or obesity is a related issue. It’s a strong choice if you want access to Zepbound and personalized coaching all through one platform. Shed offers one of the easiest and most flexible ways to start GLP-1 treatment online, with fast access, multiple formats, and fair pricing at lower doses. Support is provided via text or email, with no real-time chat or phone access. While Shed does provide licensed care and clear cost breakdowns, limited clinical monitoring and slow support may leave some patients needing more hands-on guidance. Support is limited to email, but it remains a solid pick for price-conscious beginners who want to start quickly without labs or insurance hassles. 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. Today, more than 2 in 5 adults in America have obesity, according to the Centers for Disease Control and Prevention. Since 1990, worldwide adult obesity has more than doubled, and adolescent obesity has quadrupled. Those who live in rural areas or prefer a remote connection might try a virtual visit with a healthcare professional. In 2010, the Affordable Care Act expanded coverage by government and commercial insurers to defray the costs of interventions like bariatric surgery to treat obesity. Medicare is barred from covering weight loss medication by law due to past safety concerns. Whether any given payer covers these medications can vary from one plan to another. Then Bronder ran across some research about a weight loss drug called semaglutide (Wegovy). For many health plans, after internal appeals you can request an independent external review, and insurers must accept the external reviewer’s decision. Some policies require at least a specific percentage reduction from baseline weight to continue coverage. Are you struggling with weight management and considering medication as part of your weight loss journey? Remember to stay informed about your coverage options, maintain required documentation, and utilize available savings programs to maximize your benefits. The investigators concluded that "ongoing treatment is required to maintain improvements in weight and health." Besides those risks, there are also risks of going off the medications. There are concerns about a heightened risk of complications with anesthesia for people using these drugs. These steps help insurers control costs and make sure the medications are going to the people who really need them. If Congress passes the Treat and Reduce Obesity Act or if new government rules come into play, Medicare could start covering GLP-1 weight loss drugs. It’s no wonder so many people feel frustrated when they watch some patients gain access to GLP-1 medications while others are left struggling ot get the same care. Without insurance, access is often limited to those with the financial means to cover steep out-of-pocket costs. Manufacturer savings programs for weight loss medications like Wegovy and Ozempic are usually for in-person pharmacies and require commercial insurance, not Medicare or Medicaid. If your insurance plan denies coverage for medications like Wegovy or Mounjaro, you still have options. Medicare Part D excludes medications used for weight loss, even though some of these same drugs are now FDA-approved to reduce heart disease risk. Medicare, which serves people over 65, currently denies coverage for weight loss drugs like Wegovy or Zepbound. Speak with a QuickMD provider today to explore affordable GLP-1 weight loss medications without the long-term commitments or monthly costs starting at $1,000. What insurers look for before approving weight loss medications Off-label prescriptions can get tricky with insurance because, just like on-label usage, coverage varies. Initially approved for use in treating migraines and seizure disorders, it was shown to reduce weight in patients with a body mass index over 30, and subsequently became approved for that purpose when combined with another drug (phentermine). Healthcare providers consider various factors, including cost, in determining whether to prescribe an off-label medication, says Dr. Charlie Seltzer, M.D., an obesity specialist based in Philadelphia. 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. Coverage may be less likely when these medications are used for weight loss alone. Insurance coverage for GLP-1s like Wegovy and Zepbound for weight loss varies. With weight loss medications proliferating and attracting ample media attention, more patients are asking about their costs. There are several routes through which individuals seek insurance coverage for weight loss medication, each varying in complexity and success rate. Since many of these medications are relatively new and obesity wasn’t recognized as a disease until recently, not all health insurance companies cover them. Your out-of-pocket cost decreases for coinsurance and uncovered medications when you choose the pharmacy with the lowest price. If the federal government begins allowing Medicare coverage for weight-loss drugs, odds are that private health insurance companies will follow suit, says Pepin. If you’ve heard about Mounjaro® for weight loss, you might be wondering... These often include having a BMI over 30, or over 27 with a weight-related condition like diabetes or high blood pressure. During the appointment, you’ll talk about your health history, what you’ve tried, and whether a GLP-1 medication makes sense for you. The medication must be FDA-approved, included in your plan’s formulary, and supported by thorough documentation from your provider. Health insurance is part of the eligibility criteria, but many times people who have state or federal health insurance like TRICARE, Medicaid, or Medicare aren’t eligible—and the criteria and savings can change without notice. Advocate for yourself.If your insurance company has denied coverage, reach out. One way to possibly pay less for weight-loss medications is to join WeightWatchers. Today, more than 2 in 5 adults in America have obesity, according to the Centers for Disease Control and Prevention.Each medication has certain criteria for qualification, and it can be a lot to wade through.However, some confusion has arisen around medication purchase rules, specifically that brand-name meds must be run through insurance, not as cash through Mochi.These often include having a BMI over 30, or over 27 with a weight-related condition like diabetes or high blood pressure.Obesity and overweight.Bronder seemed like a perfect candidate for the drug.Many complications from obesity can be reversed or improved with diet and exercise, weight loss, and medical treatment.Dr. Russo and Dr. Shah expect a newly FDA-approved tirzepatide weight loss medication, Zepbound, to be covered in about a year. For Medicaid enrollees, unless their state program covers obesity drugs, they are unlikely to afford even the reduced cash prices. Your next step should be to verify your specific plan's coverage. Medicare is preparing to cover these drugs for obesity for the first time for some beneficiaries. Bronder seemed like a perfect candidate for the drug. The drug mimics a naturally occurring hormone called GLP-1 that lessens cravings, increases satiation, and slows digestion so that you feel full for longer. He had tried lots of diets including keto and intermittent fasting, but even when he managed to lose some weight, he gained it all back. His job in artificial intelligence took him all over the world, but the long hours and constant travel led to steady weight gain. Several newer medications, mainly GLP-1 receptor agonists, have been introduced. Prior approval (or prior authorization) is a review process that ensures a medication is medically necessary and aligns with safety and quality standards. Prior approval is not a one-time event—it often requires periodic renewal to continue coverage 3. A BMI of 30 or higher falls into one of three obesity categories. A BMI between 25 and 30 is in the overweight category. BMI is a measure based on height and weight. Some weight-loss surgeries are performed using minimally invasive techniques. Shed offers low-cost GLP-1s in injectable and lozenge forms, including Wegovy and Zepbound, along with optional coaching and a 10% weight-loss guarantee. The only bad thing is they don’t have brand name medications (Ozempic, Wegovy, etc) so if that’s what you’re looking for, I’d check out Ro.co. The goal is to find a telehealth clinic that offers GLP-1s at an affordable price while also being legitimate and trustworthy with real doctors reviewing and prescribing your medication. That means if they are prescribed Wegovy, Zepbound, or Saxenda, their insurance will not cover it. Since drugs like tirzepatide and semaglutide are meant to be taken indefinitely, starting one is a financial commitment. This content is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. This typically involves submitting additional medical information or requesting an exception based on clinical justification. Reviewing your insurance policy or employer sponsored medical benefits plan. If coverage is still denied, you can explore other ways to reduce costs, such as using a GoodRx coupon or applying for a patient assistance program. These medications may also be costly. GoodRx has coupons for a variety of weight-loss medications. If you’re paying out of pocket, these approaches can help reduce your costs. A Forbes analysis notes that 54% of GLP‑1 users struggle to afford their medication. If you have Medicare and a qualifying comorbidity, you may gain access. The plan’s pharmacy benefit design excludes weight loss medications. The patients in this study had their medications covered by insurance, so cost may not have been a factor. Some medications are approved for people with obesity, while some are also approved for people classified as having overweight but not obesity. With obesity rates higher than ever, it's estimated that nearly half the U.S. population is eligible for weight loss medications. Commercial insurance coverage for Ozempic, the most-filled GLP-1 agonist, has remained largely the same, with nearly 5 million people who lack coverage. An additional 19,000 people with commercial insurance have lost coverage for Mounjaro, leaving over 680,000 without coverage. Telehealth platforms (virtual care services that prescribe medications online), have made GLP-1s feel more accessible, often touting low monthly prices and easy sign-ups. Yes, you want a low monthly cost, but you also want to keep safety and legitimacy in mind. These options provide different ways to help you achieve your weight-loss goals. “Some patients do very well at lower doses of drugs,” notes Dr. Grunvald. Dose, too, can influence monthly costs more than many patients expect. “Confirming their local pharmacy is also aware of the cost-saving options so mistakes are not made in securing the best price.” Some GLP-1 medications also act like a second hormone called glucose-dependent insulinotropic polypeptide (GIP) for additive effects. A 72-week study of adults without diabetes and a BMI of 30 or greater, or a BMI of 27 or greater with a weight-related condition, lost on average 20% with tirzepatide and 14% with semaglutide. This calculation applies a universal 20% weight loss factor. If you have Medicaid or a commercial plan, you may lose coverage for weight‑loss use, though drugs prescribed for type 2 diabetes generally remain covered. One woman in Washington sued the state agency in charge of purchasing health insurance for public employees after she was denied weight loss medication coverage. (The company recently announced plans to put a two-year limit on weight loss medication coverage for employees.) “So disappointed in Mayo Clinic, who is a leader in medicine in so many ways,” she wrote. Wouldn’t it be easier – and cheaper – to treat obesity before it leads to more serious conditions like diabetes, heart disease, and high blood pressure? The problem with Sovaldi wasn’t the cost of the drug so much as the market size, says Joyce. Social media message boards and chat groups were filled with stories of frustration, many of which ended in denied coverage. After one year, both groups regained at least some weight. Investigators measured the effects on weight, as well as blood sugar levels, blood pressure, cholesterol levels, and C-reactive protein, which may indicate heart disease risk. This extension of a clinical trial study of 1,961 people followed 327 of them for an additional year. The American Society of Anesthesiologists recommends forgoing medication doses for a day to a week before undergoing anesthesia, depending on dosing frequency. Other options may be available for children with certain rare genetic diseases that cause obesity. For decades, Medicare was prohibited from covering drugs prescribed solely for weight loss. At the same time, many state Medicaid programs and commercial insurers are dropping or restricting coverage for weight loss. Insurance coverage for GLP‑1 medications is changing significantly in 2026. “Your insurer may have additional requirements, such as trying other medications or having done a diet and exercise program prior to covering the drug,” Dr. Wantuck adds. To find out if your health insurance policy will cover a medication you’re interested in, Dr. Shah says you need to call the number on your health insurance card and ask. AARP offers savings and planning resources for all. Always consult your healthcare provider before starting any new treatment. Shed is the best overall choice if you want fast, affordable access to compounded semaglutide or tirzepatide, as well as brand-name options like Wegovy and Zepbound. Refunds are not typically offered, and GLP‑1 medication purchases are handled separately by insurers or cash for Zepbound. The medical community generally defines having obesity and being overweight in adults by body mass index. The average weight loss for people who had gastric band surgery was about 15% of their starting weight. 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. So far in 2026, Zepbound has already seen notable shifts in commercial insurance coverage. Some people have a separate deductible that applies only to prescription medications. Keep in mind that insurance coverage doesn’t account for deductibles, which have become increasingly common. Check your insurance coverage before you try any treatment. People with medical issues, wounds, or excessive skin that hinders daily activities after bariatric surgery may also be covered. Insurers may cover the cost of body contouring surgery for people who have had bariatric surgery. Geoffrey Joyce, PhD, director of health policy, University of Southern California Schaeffer Center for Health Policy and Economics. He likes looking trimmer, but his recent blood work shows that the drug is about way more than physical appearance. But if the drug truly works, it will usually make its way to the mainstream, he says. If you get insurance through your employer, you can also talk to your HR department about the issue. Your personal clinician will be able to go over your options and the cost before ever writing you a prescription. Experts interviewed for this piece also note there’s likely weight bias at play. An example is a drug called topiramate, he adds. “This is common, and is likely in up to 20 percent of prescriptions–not just for obesity but for numerous conditions,” Seltzer says. ACA marketplace plans rarely cover them for obesity, though they may cover Ozempic if prescribed for diabetes. Seemingly, most insurers focus on short-to medium-term cost-effectiveness, but a shift toward valuing future health system savings could easily reshape the debate over covering these medications. Covering GLP-1 medications might reduce costs in the long run by lowering rates of chronic diseases tied to obesity, like type 2 diabetes, heart disease, and even some cancers. A review found that fewer than 1% of these plans included Wegovy, while over 80% covered Ozempic, but only for diabetes. Unfortunately, coverage for weight-loss medications here is rare. Many drug makers offer patient assistance programs that include discounted pricing. One option is to consider generic versions of older drugs, such as bupropion, liraglutide, or orlistat. The semaglutide group, initially losing an average of 17.3% of their body weight, returned to 5.6% below their starting weight. Does Medicaid cover weight-loss medications? 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. For example, in 2024, coverage for weight-loss medications increased to 44% among large employers with 500 or more employees. 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. Tax-deductible medical expense. You can’t contribute to a health savings account after you enroll in Medicare, but if you’ve already accumulated money in an account, you can withdraw it tax-free at any time for eligible expenses. No listed prices for brand-name meds and limited availability make it less ideal for those outside the insurance system. It pairs medical care with lifestyle coaching, and the Wellness Plus perks are a nice bonus. It’s tailored for patients aiming to leverage insurance for comprehensive care. Dr. Russo thinks that over time, these medications will be covered more by insurance. There's a whole lot to wade through when it comes to health insurance and weight loss drugs. But not all insurance companies are covering these medications—and they’re generally very expensive without coverage, he notes. And it's currently pretty hard to get the cost covered by health insurance. This means your access and cost are in flux. “The problem is, you have to make sure your insurance continues to cover it before the coupon runs out.” “The sad truth is that these medications are very expensive,” Dr. Russo adds. “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. It raises the risk of developing diabetes, heart disease, sleep apnea, joint deterioration, and several types of cancer. The outlook may be a bit better if you get insurance through your job, especially at a larger company. Medicaid, which is a joint federal and state program designed for people with low incomes, offers a bit more variation. They’re about improving heart health, blood sugar, reducing joint pain, and the ability to move through daily life with greater ease. Though some GLP-1s have been FDA-approved for weight loss, others have not. GLP-1 is a class of medications created to treat type 2 diabetes by helping the pancreas release the right amount of insulin when blood sugar levels are high. Drugs prescribed for weight gain, cosmetic purposes, fertility, hair growth and treatment of sexual or erectile dysfunction also aren’t allowed to be covered. If you can’t get coverage at first, keep asking questions. It is now approved to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease who are either overweight or obese. The good news about its effectiveness is still filtering down to health care providers and insurance companies. Wegovy is a relatively new medication, approved by the FDA in June 2021. In the short term, it may be impossible to suddenly cover a market of 100 million people or more without going out of business. 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. But unless you’re overweight and have another ailment, such as diabetes, Medicare won’t cover any of the popular weight loss drugs like Ozempic and Wegovy until at least July 2026. Embracing the pros and cons of the new weight loss medications (semaglutide, tirzepatide, etc.). As a result, more people need to jump through extra hoops to access these medications, despite having insurance. Restrictions continue to limit the vast majority of commercial insurance coverage for GIP and GLP-1 agonists prescribed specifically for weight loss.