Are Weight Loss Drugs Covered By Insurance?

Whether you’re on a weight loss journey of your own or not, you probably haven’t been able to avoid hearing about the sudden popularity of medications like Ozempic® — a diabetes drug that had major shortages when doctors discovered that it could be used as an effective obesity medicine and weight loss tool.

Some people’s first thoughts may have been about which celebrities are taking weight loss drugs, but if you’re struggling with weight gain or worried about cardiovascular health conditions, your first question may have been who would be footing the bill: you or your health insurance provider.

If you have a modest income, are struggling with your weight and eyeballing the health benefits of obesity medications, we have to be honest that the reality of how these drugs might affect your wallet is pretty grim. 

Below we’ve explained who might be able to get their medications covered by insurance, how to do so if you think you qualify and what to do if you can’t get coverage, but still want to stave off heart disease (or just love the way you look again).

The short version of the very long answer to this question is no, weight loss drugs are not typically covered by insurers — at least not for the purpose of weight loss alone.

There are several drugs used both on and off-label to treat obesity and promote weight loss, but very few, if any, of them are covered by the majority of insurance providers. 

The Affordable Care Act (ACA) did create some additional coverage for Americans with obesity or high body weight, along with related medical procedures like bariatric surgery. In general, elective weight loss is almost never covered by insurance, and when coverage is available, it’s only in circumstances where a person’s body mass index (BMI) is above certain levels. 

For example, the ACA changes did not include so-called obesity drugs like the Novo Nordisk® medication semaglutide — also known as Ozempic — which is only approved by the Food and Drug Administration for people with type 2 diabetes. But a drug like Wegovy®, which is FDA-approved for people with a BMI over 27, may be covered for weight loss (in some circumstances).

To find out if you’re going to have a chance at getting covered, start by looking at your policy. If you see indications that you may be covered, there are a few steps you’ll then need to follow to make sure you’re not stuck paying out-of-pocket later on.

To get your weight loss medication covered by your insurance in the United States, you’ll need to do a few things:

• Make sure your insurance policy covers the medication in the first place. Most providers will not offer coverage, but those who do may have strict requirements to approve yours.

• Talk to your healthcare provider about your needs. They may need to write a note seeking prior authorization to confirm your health insurance plan will cover it.

• When in doubt, appeal. If your coverage is unclear or your insurance company denies your request, you have the chance to appeal their decision. Often the appeal significantly increases your approval chances.

Even if you get your weight loss medication covered, you may need to pay a copay, so your cost still may not be zero.

Weight loss drugs look like the silver bullet for obesity and more moderate problems with weight, but they’re pretty new in general and even newer to being used exclusively for weight loss. There’s a lot of research that still needs to be done about their long-term effects on blood sugar, the digestive system and many other areas of health and well-being.

We understand if those risks keep you from pursuing an appeal after coverage for a weight loss drug was denied, or if they make you wary of weight loss medications in general. We also understand that even if you want to use a medication like Ozempic or Wegovy, it might just not be in your budget.

But if your weight is elevated, it can cause issues for your cholesterol, blood pressure, immune health and cardiovascular function — making it important to at least consider weight loss if you have obesity or are very overweight 

While they’re by no means as simple as an injection or a super pill, the National Institutes of Health (NIH) point to the following weight loss solutions for people dealing with obesity and extreme weight problems:

• Diet modification

• Behavioral intervention

• Exercise

• Surgery

For people with less severe weight issues, surgery is not often necessary, and lifestyle modifications (especially those to your diet) can help greatly.

Another option? Walking. While the 10,000 step-a-day number isn’t exactly the perfect number to lose weight and extend your life, a 2022 meta analysis found that adults under 60 can see a reduced risk for something called “all-cause mortality” for each step they take — up until the 8,000 or 10,000 mark, after which the benefits drop off.

A 2015 study also found that it takes an average of 300 minutes of exercise a week, alongside changes to their diet, for a person to initiate weight loss. More strenuous and higher-intensity exercise can reduce the number of minutes needed.

Prescription drugs for chronic weight management are on everyone’s radar right now — not just those with conditions like obesity. Unfortunately, most insurance plans don’t cover them, even though FDA-approved drugs like Ozempic may prevent high blood pressure and other health conditions down the road.

If you’re trying to get help with weight loss, keep the following in mind:

• Generally, most insurance companies and insurance plans will not cover weight loss drugs, even for people with weight-related conditions. You’ll have to pay for them yourself.

• If you have obesity, type 2 diabetes or a high BMI, a limited number of providers like Medicaid and Medicare may cover the costs of these medications.

• Some pharmaceutical companies offer coupons or other discounts for those who might not be able to afford weight loss medications, which may be enough to offset your out-of-pocket costs. There are also assistance programs you can reach out to for support.

• As a reminder, even FDA-approved medications come with side effects, and these drugs are no exception. In addition, these medications are relatively new in their use for weight loss and we can’t be quite sure about the long-term risks yet.

But if you want help working on your weight and wellness, learn more about safe and effective weight loss treatments.