If you’re living with obesity, medications like semaglutide (Wegovy), liraglutide (Saxenda), and tirzepatide (Zepbound) may be an important part of your treatment plan. These glucagon-like peptide-1 (GLP-1) receptor agonists — a type of medicine to help regulate appetite and blood sugar — have shown promising results in helping people manage their weight and improve their health. However, getting insurance coverage for these medications can sometimes be a challenge.

This article will walk you through the process and share five practical tips to improve your chances of getting your medication covered by insurance — even if you run into some bumps along the way.

1. Know the Insurance Criteria for GLP-1 Coverage

Insurance companies have specific rules about which medications they’ll cover. Understanding these rules can help improve your chances of getting your GLP-1 medication approved. Although the details may vary by insurer and plan, here are some common requirements.

BMI Requirements

Insurance may cover GLP-1 medications for people diagnosed with obesity, which is usually defined as a body mass index (BMI) of 30 or higher. Some plans may also cover these drugs for people with a BMI of 27 or higher if they also have other weight-related health conditions such as type 2 diabetes, high blood pressure, or high cholesterol. Note that the BMI is a measure based on height and weight and is unrelated to any specific body type or size.

Diagnosis of Obesity-Related Health Conditions

Coverage for GLP-1 medications can vary a lot between insurance plans. For example, the U.S. Food and Drug Administration (FDA) approved semaglutide sold under the brand name Ozempic mainly for treating type 2 diabetes, so it’s more likely to be covered when prescribed for that reason. Wegovy, another brand that contains the same active ingredient, is specifically approved for managing obesity, but not all insurance plans cover it. So even if you qualify medically, your plan might still say no to Wegovy.

Prior Authorization

Most insurance companies require prior authorization for GLP-1 drugs. This means your doctor has to send in paperwork showing that the medication is necessary for you. Without this step, the insurance company may automatically deny coverage.

2. Get a Letter of Medical Necessity

One of the most important steps to getting GLP-1 medication covered involves asking your doctor for a Letter of Medical Necessity. This letter explains why the medication is needed for your health and how it fits with current clinical guidelines for treating obesity. The letter should include:

• Your medical history — Your doctor should provide a clear explanation of your diagnosis of obesity, any related health conditions (such as type 2 diabetes or high blood pressure), and details about your overall health.
• Your past weight-loss efforts — The letter should describe the steps you’ve already taken to manage your weight (such as lifestyle changes, past medications, or other treatments) and why they didn’t work well enough.
• The reasons you need GLP-1 medications — Your doctor should explain why a GLP-1 medication is the medically appropriate next step to improve your overall health and manage your health conditions.

Generally, the more complete and specific this letter is, the better your chances of approval for insurance coverage.

3. Document Previous Weight-Loss Attempts

Most insurance companies want to see proof that you've tried to lose weight before they’ll approve coverage for GLP-1 drugs. Keeping a record of your past efforts can help support your case. These attempts might include:

• Participating in medically supervised weight-loss programs
• Following diet plans, exercise routines, or using other weight-loss medications or treatments
• Taking steps to eat healthier and be more physically active

This documentation shows that you’ve made consistent efforts to manage your weight, but these approaches didn’t work well enough, so GLP-1 medications are the next medically appropriate step.

4. Check if Your Insurance Covers GLP-1 Drugs

Not all insurance plans cover GLP-1 drugs, so it’s important to find out what your plan does — before starting treatment. Here are some easy ways to check:

• Ask your doctor — Some doctors can check coverage using their electronic medical record (EMR) system. This can give you an idea but may not be the final answer.
• Go onto your insurance company’s website or app — Many insurance companies let you search online to see if specific medications are covered. If you’re looking into semaglutide, make sure to ask if it’s covered specifically for weight loss, not just for type 2 diabetes.
• Call your insurance company directly — Ask if GLP-1 drugs are listed on your plan’s formulary (the list of drugs your plan covers). Also ask about any requirements, like prior authorization, or if coverage is limited to certain medical conditions.

If the medication is listed but has restrictions, you may need to complete extra steps — or file an appeal — to get it approved.

5. Understand the Appeal Process

If your insurance company denies coverage for GLP-1 medications, you have the right to appeal the decision. Here’s how to get started:

• Read the denial letter carefully — Make sure you understand why your insurance company denied your request.
• Ask your doctor for more documentation — Explain why your claim was rejected, and request extra paperwork or an updated Letter of Medical Necessity with more details that support your case.
• Submit your appeal — After gathering all the necessary documents, submit your appeal to the insurance company. In many cases, adding more information or clarification from your doctor can help get the decision reversed.

Financial Assistance if Insurance Won’t Cover GLP-1 Drugs

If your insurance doesn’t cover GLP-1 drugs, you still have options to help lower the cost of these medications.

Manufacturer Savings Programs

Drug companies such as Novo Nordisk, which makes semaglutide medications (Ozempic and Wegovy), offer savings cards to help reduce out-of-pocket costs for people who qualify. Visit the manufacturers’ websites or speak with your doctor to learn how to apply for these programs.

Patient Assistance Foundations

Nonprofit organizations such as the PAN Foundation and NeedyMeds may offer grants, discounts, or other resources for people who need assistance paying for medications. Some for-profit companies, like GoodRx, can also help you compare prices and find discounts on prescription medications.

State Medicaid Programs

Medicaid coverage for GLP-1 drugs varies depending on the state. In some (but not all) states, Wegovy may be covered for managing obesity. Ozempic is more often covered when prescribed for type 2 diabetes, but less commonly for weight loss. To find what’s covered where you live, contact your local Medicaid office.

Consider Other Options if Insurance Won’t Cover GLP-1 Drugs

If your insurance doesn’t cover GLP-1 medications, don’t give up — there are still other paths to consider.

Ask About Other Weight-Loss Medications

Semaglutide sold as Wegovy is currently the most commonly prescribed GLP-1 medication for managing obesity. But if it’s not covered by your plan, ask your doctor about other options. Liraglutide and tirzepatide are also FDA-approved for weight loss and may be covered by your insurance.

Explore Other Coverage Options

Consider speaking with a patient advocate or using tools like the Health Insurance Marketplace. These resources may help you compare plans that provide better access to medications for weight management.

Focus on a Healthy Lifestyle

Remember, medication is just one part of a treatment plan for managing obesity. Eating nutritious food, staying active, and making behavior changes provide the foundation of long-term health. GLP-1 drugs can support these efforts, but they’re not a replacement for healthy habits.

Talk With Others Who Understand

On MyObesityTeam, the social network and online support group for people with obesity and their loved ones, more than 56,000 members come together to share experiences, seek advice, and offer support.

Have you been prescribed a GLP-1 medication for weight management? What steps have you taken to get insurance coverage for your medication? Share your thoughts in a comment below, or start a conversation by posting on your Activities page.