Why doesn't insurance cover weight loss drugs?
Asked by: Miss Delta Murazik MD | Last update: October 21, 2025Score: 4.3/5 (2 votes)
Are weight loss drugs covered by insurance?
Unfortunately, most insurance contracts do not cover weight loss drugs. They cover GLP-1s for those with type 2 diabetes.
Why are insurance companies not covering Ozempic?
Although Ozempic was FDA-approved in 2017 to treat adults with type 2 diabetes, some physicians prescribe it to obese or overweight individuals for weight loss. But health insurance companies often deny Ozempic, in part because it is expensive.
How to get Ozempic for weight loss covered by insurance?
Often, when prescribed specifically for weight loss, Ozempic is not covered by insurance. However, it may be covered as a treatment for type 2 diabetes. On a case-by-case basis, a provider may appeal an insurance company's decision and make the case that Ozempic is medically necessary and should be covered.
How do you get approved for weight loss medication?
Criteria for Weight Loss Medication Prescriptions
Most medications are prescribed for someone with a BMI of 30 or greater, or a BMI of 27 or greater if the person has weight-related health conditions. Zepbound was approved in November 2023 for adults with a BMI of 30 or greater.
Obesity Medication & Why Your Insurance Won't Cover It
Can you really get Wegovy for $25?
Yes, you can really get Wegovy for $25 if you meet certain criteria. Offered by Novo Nordisk, the Wegovy Savings Card awards qualified individuals the opportunity to get the medication for $25 per month (i.e. 28-day supply).
Why won't my insurance cover Wegovy?
Health insurance coverage for Wegovy varies across insurers and disease types. The Affordable Care Act does not mandate health insurers to cover obesity-related surgeries or medications. And Wegovy is not approved to treat diabetes.
What is the strongest weight loss prescription pill?
Some of the strongest weight loss pills available today include: Naltrexone/bupropion (brand name Contrave) Phentermine/topiramate (brand name Qsymia) Orlistat (brand names Xenical, Alli)
How much is Ozempic at Walmart?
Walmart typically carries all available dosages of Ozempic, and prices can vary based on your location and whether you have insurance or use a discount card. If you're uninsured, the cost might range from $900 to $1,000 for a one-month supply.
What to do if insurance denies Ozempic?
- Step 1: Understand why your insurance denied Ozempic.
- Step 2: Gather Ozempic prior authorization evidence for your appeal.
- Step 3: Write your Ozempic appeal letter.
- Step 4: Submit your appeal.
How do I get Ozempic for $25 a month?
With the Ozempic® Savings Card, you may PAY AS LITTLE AS $25b for a 1-month, 2-month, or 3-month supply for up to 48 months. To receive offer, prescription must be for a 1-, 2-, or 3-month supply. Savings card offer applies to eligible commercially insured patients with coverage for Ozempic®.
Can I switch from Ozempic to Wegovy for weight loss?
Patients treated with semaglutide (OZEMPIC) subcutaneous injection 2.0 mg once weekly may be considered for conversion to semaglutide (WEGOVY) 2.4 mg once weekly, provided the patient has been receiving the 2.0 mg dose of semaglutide (OZEMPIC) for at least 4 weeks.
How to get insurance to pay for Wegovy?
Prior authorizations (PAs) are required by some prescription insurance plans to cover certain medications. Your health care provider will need to submit a form to your insurance company to seek approval for Wegovy®. You can reach out to your health care provider's office and request that they initiate a PA.
What makes me eligible for weight loss pills?
Your health care provider may suggest a weight-loss drug for you in some cases. These include if you haven't been able to lose weight through diet and exercise and your: Body mass index (BMI) is greater than 30. This means you're living with a condition that involves having too much body fat, called obesity.
What did Kelly Clarkson use to lose weight?
She combined diet changes, such as adopting a lectin-free diet, with regular exercise like walking. Clarkson's journey included using weight loss medication, although she emphasized a holistic approach. Wellness trends like infrared saunas and cold plunges played a role in her transformation.
Which is better, Wegovy or Ozempic?
Ozempic for weight loss: which is better? In a clinical trial that compared weekly use of semaglutide 1 mg and 2.4 mg, semaglutide 2.4 mg (the maximum dose of Wegovy) caused more weight loss than semaglutide 1 mg (the typical maintenance dose of Ozempic).
How to lose 20 pounds in a month?
Losing 20 pounds in 1 month may be easier than 2 weeks, but it's still unrealistic for most people. Once again, it comes down to your TDEE and simple math. To lose 20 pounds in 1 month, you'd need to create an average deficit of 2,500 calories per day for 4 weeks. This might be possible for larger men.
What to do if insurance won't cover weight loss medication?
Some recommendations for patients whose insurance won't cover weight loss medications are the same as for other treatments. One option is to consider generic versions of older drugs, such as bupropion, liraglutide, or orlistat. If a GLP-1 agonist is, in fact, the best option for a patient, they can comparison shop.
How do I pay for Ozempic if insurance doesn't cover it?
If you do not have insurance, Novo Nordisk may be able to offer patient financial assistance for Ozempic based on your income eligibility. Patient assistance programs provide free or lower-cost medications to people who cannot afford to buy their medicine.
How much is Wegovy without insurance?
The cost of Wegovy depends on your insurance coverage and pharmacy. A package of Wegovy contains four pens, each pre-filled with a single dose of Wegovy. Without insurance, the cost of Wegovy is $1,349.02 per month or 28-day package, which breaks down to $337.25 per week or $16,188.24 per year.
What is the closest OTC to Ozempic?
Are there any over-the-counter (OTC) Ozempic alternatives? Medications that work like Ozempic are only available with a prescription. But you may see OTC supplements, such as berberine, being promoted as natural Ozempic alternatives for weight loss.
Why is Mounjaro better than Ozempic?
While they are approved for diabetes, both Mounjaro and Ozempic also make people lose weight by helping you to feel full longer. Ozempic acts like a hormone your body makes. Mounjaro works similarly, but it acts like two hormones instead of one. Compared to Ozempic, Mounjaro might work even better for weight loss.