Getting insurance to cover GLP-1 medications for weight loss is challenging but not impossible. Here's everything you need to know about insurance coverage, prior authorization, appeals, and what to do if your claim is denied.
Insurance Coverage: The Reality
The Hard Truth
- For diabetes: Most insurance plans cover Ozempic and Mounjaro
- For weight loss only: Most plans DO NOT cover Wegovy or Zepbound
- Employer plans: Only ~25% of employer plans cover weight loss GLP-1s
- Medicare: Federal law prohibits coverage of weight loss medications
- Medicaid: Varies by state, most don't cover for weight loss alone
This is why most people turn to telehealth providers offering compounded GLP-1 at $99-$450/month—significantly cheaper than paying $1,000-$1,500/month for brand-name medications out of pocket.
Which Insurance Plans Cover GLP-1?
Commercial Insurance (Employer Plans)
Coverage varies dramatically by employer and plan. Some large employers (particularly in tech and healthcare) have started covering GLP-1s for weight loss, but most still exclude them.
How to check: Call your insurance company or check your plan's formulary (list of covered medications). Ask specifically about Wegovy or Zepbound for "obesity treatment" or "weight management."
Medicare
Federal law (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) explicitly prohibits Medicare from covering medications for weight loss. This includes Wegovy and Zepbound.
Exception: Medicare covers Ozempic and Mounjaro if prescribed for Type 2 diabetes, but not for weight loss alone.
Medicaid
Coverage varies by state. Some states (like North Carolina and Louisiana) have recently added coverage for weight loss GLP-1s, but most states exclude them from formularies.
Coverage Requirements
If your plan does cover GLP-1 for weight loss, you'll typically need to meet these criteria:
Common Requirements
- BMI ≥30 (obese), OR
- BMI ≥27 with weight-related comorbidity (diabetes, hypertension, high cholesterol, sleep apnea)
- Failed previous weight loss attempts (documentation of diet and exercise programs)
- No contraindications (personal/family history of thyroid cancer, etc.)
- Prior authorization from insurance company
- Prescription from licensed healthcare provider
Prior Authorization Process
Most insurance plans require prior authorization (PA) before covering GLP-1 medications. Here's how the process works:
Step-by-Step PA Process
- Doctor writes prescription: Your provider submits a prescription to your pharmacy
- Pharmacy contacts insurance: Pharmacy requests coverage and is told PA is required
- Doctor submits PA: Your provider fills out extensive paperwork documenting:
- Your BMI and weight history
- Any weight-related health conditions
- Previous weight loss attempts and results
- Medical necessity justification
- Insurance reviews: Typically takes 3-7 business days
- Decision: Approved, denied, or request for more information
Timeline: The entire process usually takes 1-2 weeks, sometimes longer if additional information is requested.
How to Appeal a Denial
If your insurance denies coverage, don't give up. Many initial denials are overturned on appeal. Here's how to appeal effectively:
Appeal Strategy
- Request denial in writing: Get the specific reason for denial
- Review your plan documents: Check if weight loss medications are explicitly excluded
- Gather supporting documentation:
- Medical records showing obesity-related health issues
- Documentation of failed weight loss attempts
- Clinical studies showing GLP-1 effectiveness
- Letter from doctor explaining medical necessity
- Submit formal appeal: Write a detailed letter (or have your doctor write it) explaining why the medication is medically necessary
- Emphasize health complications: Focus on how obesity is affecting your health (diabetes risk, joint pain, hypertension, etc.)
- Reference clinical guidelines: Cite medical society recommendations for obesity treatment
- Request peer-to-peer review: Ask your doctor to speak directly with the insurance company's medical director
Sample Appeal Letter Points
- "I have a BMI of [X] and suffer from [obesity-related conditions]"
- "I have tried [list previous weight loss attempts] without long-term success"
- "My doctor has determined that GLP-1 medication is medically necessary to prevent progression to Type 2 diabetes/cardiovascular disease"
- "Clinical trials show GLP-1 medications produce average weight loss of 12-22%, far exceeding other interventions"
- "The cost of this medication is significantly less than future costs of obesity-related complications"
Success rate: About 30-40% of appeals are successful, especially when weight-related comorbidities are documented.
Medicare & Medicaid Coverage
Medicare
Medicare does not cover weight loss medications by federal law. There's ongoing advocacy to change this law, but as of February 2026, coverage is still prohibited.
Workarounds: Some Medicare recipients get coverage for Ozempic or Mounjaro if they have Type 2 diabetes, even if weight loss is a secondary benefit.
Medicaid
State Medicaid programs have the option to cover weight loss medications. Some states that currently cover GLP-1s include:
- North Carolina (added coverage in 2023)
- Louisiana (select cases)
- Several others on a case-by-case basis
Check with your state's Medicaid program to see if coverage is available.
Alternatives If Insurance Doesn't Cover
If your insurance denies coverage and your appeal fails, you have several options:
1. Manufacturer Savings Programs (Limited)
Novo Nordisk and Eli Lilly offer savings cards that can reduce costs—but these typically require commercial insurance and exclude cash-paying patients.
- Wegovy Savings Card: Up to $500/month off for commercially insured
- Zepbound Savings Card: Pay as little as $25/month for 13 fills
Major limitation: Not available for Medicare, Medicaid, or uninsured patients.
2. Telehealth Compounded GLP-1 (Best Option)
This is the most affordable option for most people. Telehealth providers offer compounded semaglutide and tirzepatide at a fraction of brand-name costs:
- CoreAge Rx: $99/month for semaglutide (cheapest option)
- Super Healthy Rx: $279/month with premium service
- FuturHealth: $299/month with excellent app
- Tirzepatide options: $249-$450/month
Savings: At $99/month, you save $1,250-$1,400/month compared to brand-name Wegovy ($1,349/month). See our complete cost breakdown.
3. Health Savings Account (HSA) / Flexible Spending Account (FSA)
If you have an HSA or FSA, you can use pre-tax dollars to pay for GLP-1 medications prescribed for obesity treatment. This provides some tax savings even without insurance coverage.
The Bottom Line
Insurance coverage for GLP-1 weight loss medications is limited and difficult to obtain. Most plans don't cover these medications for weight loss alone, and Medicare is prohibited by law from covering them.
The good news: Compounded GLP-1 through telehealth providers is affordable ($99-$450/month) and accessible to everyone, regardless of insurance status. For most people, this is actually cheaper than insurance copays would be anyway. Check out our complete provider rankings to find the best option for your budget.
Start GLP-1 Without Insurance Hassle
Skip the insurance paperwork and denials. CoreAge Rx offers compounded semaglutide starting at $99/month with fast consultations and no prior authorization required.