Alyssa Lane
Weight loss medications can be expensive, often exceeding $1,000 per month, and insurance companies often do not cover the cost. This is because obesity is often considered a cosmetic issue rather than a chronic disease. Medicare is barred from covering weight loss medication by law due to past safety concerns, and private insurance companies often follow the federal program's lead. However, there are some options for patients whose insurance won't cover weight loss medications. These include considering generic versions of older drugs, comparison shopping to find the best prices, and seeking help through programs like Medicare Part D Extra Help.
How to get my insurance to cover weight loss medication
| Characteristics | Values |
|---|---|
| Cost of weight loss medication | High, often exceeding $1,000 for a month's supply |
| Insurance coverage | Often does not cover weight loss medication due to the perception that obesity is a cosmetic issue rather than a medical one |
| Medicare coverage | Barred from covering weight loss medication by law due to past safety concerns |
| Private insurance companies | May take cues from federal programs like Medicare, which does not cover weight loss medication |
| GLP-1 agonist medications | May be covered by insurance if prescribed for type 2 diabetes, but not typically for obesity |
| Alternative options | Generic versions of older drugs, such as bupropion, liraglutide, or orlistat, which may be more affordable |
| Comparison shopping | Patients can use tools like GoodRx to compare prices across pharmacies and look for coupons |
| Medicare Part D Extra Help program | Patients on Medicare with limited resources may be eligible for assistance through this program |
| Clinical trials | Ongoing to prove health benefits beyond weight loss, which may increase insurance coverage |
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What You'll Learn
Medicare and Medicaid do not cover weight loss medication
Medicare and Medicaid do not cover weight-loss drugs that are used only for weight loss. This is due to past safety concerns, specifically the fallout from fen-phen in the 1990s, a combination of fenfluramine and phentermine that was found to cause heart valve damage. As a result, the federal government disallowed Medicare from covering drugs viewed as having risks that outweighed their benefits, namely cosmetic benefits.
However, Medicare does cover weight-loss drugs for patients with diabetes, and for a much smaller subset of people who are obese and also have heart problems or sleep apnea. If a weight-loss medication is also approved by the FDA for added health benefits, like treating Type 2 diabetes or cardiovascular disease, it may be covered under Medicare Part D. Medicare Advantage plans may include additional benefits that can help with weight loss, like fitness programs.
In November 2024, the Biden administration proposed a new rule that would allow the coverage of these medications by Medicare and Medicaid specifically to treat obesity. The proposal argued that the drugs would be allowed to treat the disease of obesity and its related conditions. However, the Trump administration rejected this proposal in April 2025. The Centers for Medicare and Medicaid Services stated that they believed that expanding coverage “is not appropriate at this time” but that they had not ruled out coverage and “may consider future policy options”.
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Private insurance companies may follow federal guidance
Private insurance companies often take cues from federal programs about what to cover. Medicare is prohibited by law from covering weight loss medication, and many private insurance companies follow suit. This is due to the high cost of these medications, which can exceed $1,000 for a month's supply, and the perception that obesity is a cosmetic issue rather than a chronic disease. However, there are some indications that insurers and lawmakers may be coming around to the idea of covering weight loss drugs. In 2021, House lawmakers introduced the Treat and Reduce Obesity Act, which would have allowed the federal government to expand Medicare Part D coverage to include weight loss medications.
Additionally, clinical trials are underway to prove that weight loss drugs have health benefits beyond weight loss, such as reducing the risk of heart attack, stroke, and kidney disease. If successful, this could make it easier for patients to get insurance coverage for these medications. While some older weight loss medications have generic versions available, making them more affordable, the newer drugs can be very expensive. Payers, including commercial insurers, Medicare, and Medicaid, tend not to cover weight loss medications.
Some insurance plans may cover weight loss injectables, such as Wegovy, Ozempic, and Saxenda, but only if the patient has an obesity-related medical problem, such as high cholesterol or high blood pressure. It is up to each insurer and its chief medical officer to decide whether these medications will be covered. Patients can contact their insurer to find out if weight loss medications are excluded from their coverage.
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Weight loss injectables are rarely covered by insurance
However, some select Medigap and Medicare Advantage plans for retirees do cover weight loss medication. If you have one of these plans, check with its administrator. The VA will also cover obesity management. See your local Veterans Administration provider to discuss obesity medication options.
The FDA has recently approved GLP-1 medications, including Wegovy (semaglutide), Saxenda (liraglutide), and Zepbound (tirzepatide), for chronic weight management. These prescriptions are meant to be used alongside a reduced-calorie diet and exercise to manage weight and reduce the risk of obesity-related conditions. However, your health insurer may not cover these drugs unless you have an obesity-related medical problem, such as high cholesterol or high blood pressure.
If your doctor has prescribed medication that your insurer has denied coverage for, you have the right to appeal your health plan's denial of benefits. There are two kinds of appeals: internal appeal and external review.
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GLP-1 drugs are often excluded from employer-sponsored health plans
GLP-1 drugs are a new class of weight-loss medications that have gained popularity for their effectiveness in treating obesity. These drugs are expensive, with a month's supply costing around $1,000 to $1,500. The high cost of GLP-1 drugs is straining employer healthcare budgets, and as a result, GLP-1 drugs are often excluded from employer-sponsored health plans.
Employers are facing challenges due to the increasing use of GLP-1 drugs for weight loss, as the drugs were initially developed to treat type 2 diabetes. The demand for these drugs as a weight-loss aid, along with their potential health benefits, has led to a rise in employer coverage. A recent survey found that one-third of companies now offer GLP-1 drug coverage for both diabetes management and weight loss. However, the high cost of these drugs continues to be a concern for employers, and they are considering various coverage and management strategies.
Some employers are planning to restrict access or withdraw coverage for GLP-1 drugs due to the financial impact on their health plans. They may implement strategies such as prior authorization, limiting coverage to certain individuals, or setting higher cost-sharing requirements. For example, employers may require documentation to ensure that the drugs are being used for their intended purpose and are not being taken off-label for weight loss. This helps manage costs and ensures a sufficient supply of the drug for those treating diabetes.
Additionally, employers may explore other cost-management approaches such as step therapy and eligibility requirements. They may also consider limiting coverage to individuals with higher body mass indexes (BMIs) who are expected to benefit the most from the treatment. Other strategies include requiring members to participate in weight management programs or try less expensive alternative weight-loss drugs before GLP-1 medications.
While GLP-1 drugs are often excluded from employer-sponsored health plans due to their cost, it is worth noting that the landscape is changing. More employers are covering these drugs, and even more are considering adding coverage. This shift may be attributed to the increasing demand for GLP-1 drugs as a weight-loss aid and their potential health benefits. However, employers are navigating the challenge of balancing employee needs with the financial constraints posed by these expensive medications.
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Generic versions of older drugs are more affordable
Weight loss drugs can be expensive, with a month's supply of Wegovy (semaglutide) costing $1,300 as of October 2022. Medicare is prohibited by law from covering weight loss drugs, and Medicaid coverage varies by state. Commercial insurers also tend not to cover weight loss medications, as they are often considered a cosmetic need rather than a medical one.
Given the high costs of many weight loss medications, insurance often does not cover them. If your insurance does not cover weight loss medication, one option is to consider generic versions of older drugs, which are more affordable. For example, GoodRx lists phentermine for as little as $10. Other generic options include bupropion, liraglutide, or orlistat.
It is important to note that generic drugs may not be as effective as newer, brand-name drugs. However, they can be a more affordable option for those who cannot afford the newer medications. Additionally, generic drugs may have different side effects or interactions than their brand-name counterparts, so it is important to speak with a healthcare professional before starting any new medication.
It is also worth noting that some weight loss drugs, such as GLP-1 agonists, are currently in short supply, which can make them difficult to access even with insurance coverage. In response to the shortage, semaglutide and tirzepatide were added to the FDA Drug Shortages Database, allowing compounding pharmacies to produce generic versions. This has led to telehealth companies selling these drugs at significantly lower prices than brand-name GLP-1s. However, there are concerns about a lack of meaningful medical supervision for patients prescribed GLP-1s through telehealth companies.
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Frequently asked questions
Contact your insurer to find out if they cover weight loss medication. If they do not, you may be able to switch to an insurer that does.
Payers tend not to cover weight loss medications because they consider weight loss a cosmetic need rather than a medical one. Medicare is barred from covering weight loss medication by law due to past safety concerns.
You can consider generic versions of older drugs, such as bupropion, liraglutide, or orlistat. Patients on Medicare with limited resources may be able to get help through the Medicare Part D Extra Help program.
Some popular weight loss medications include Wegovy, Ozempic, and Mounjaro. These medications are typically used to treat type 2 diabetes but are sometimes prescribed off-label for weight loss.
