How do I get my insurance to approve weight loss medication?


Editorial team Published on

To get health insurance to cover weight loss medication, you must verify your plan's formulary and secure a formal prior authorization from your doctor proving medical necessity.

1. Check Your Plan and Formulary

  • Call your insurer: Look at the number on the back of your insurance card and ask specifically if anti-obesity medications (like Wegovy or Zepbound) are included or explicitly excluded in your employer or individual package.
  • Review the drug tier: Find out if the medication requires prior authorization (approval before filling), step therapy (trying cheaper drugs first), or has quantity limits.

2. Meet Medical Criteria

Insurers typically approve coverage only if you meet strict clinical thresholds:

  • BMI requirements: A Body Mass Index (BMI) of 30 or higher, or a BMI of 27+ combined with a weight-related health condition.
  • Comorbidities: Documented medical problems like high blood pressure, type 2 diabetes, high cholesterol, sleep apnea, or cardiovascular disease.
  • Documented history: Proof that you tried supervised lifestyle changes, diet programs, or alternative medications first.

3. Work with Your Doctor on Prior Authorization

  • Ask your prescribing physician or an obesity medicine specialist to submit a thorough prior authorization request.
  • Ensure your medical chart explicitly details your weight history, BMI records over time, and how the medication directly treats your weight-related health risks.
  • If your initial request is denied, work with your doctor's office to file a formal appeal backed by a strong letter of medical necessity.