Here’s When Experts Think Ozempic And Other Weight Loss Drugs Might Be Covered By Insurance

There’s been a massive shift in the conversation surrounding weight loss since GLP-1 agonist medications like Ozempic and Wegovy hit the mainstream in 2022. With help from these drugs, which suppress appetite and slow digestion, people struggling with obesity could lose up to 15 percent of their total body weight in just a few months.

But these buzzy drugs, which are meant to be “lifelong” drugs taken long term, aren’t cheap. And it’s currently pretty hard to get the cost covered by health insurance.

Some weight loss medications are covered by insurance right now, and others are expected to have coverage in the future, says Michael Russo, MD, a bariatric surgeon at MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, Calif. But not all insurance companies are covering these medications—and they’re generally very expensive without coverage, he notes.

“Accessibility is a huge issue—it’s very frustrating,” says Kunal Shah, MD, an assistant professor in the division of endocrinology at the Rutgers Robert Wood Johnson Medical School.

In fact, one in four people say obesity and weight loss is their biggest personal concern, while 65 percent say it’s important that medical weight loss is a covered medical benefit, a recent poll conducted by YouGov and healthcare company Included Health found.

Meet the experts: Kunal Shah, MD, is an assistant professor in the division of endocrinology at the Rutgers Robert Wood Johnson Medical Center. Michael Russo, MD, is a bariatric surgeon at MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, Calif. James Wantuck, MD, is the co-founder and chief medical officer of PlushCare and associate chief medical officer of Accolade. Jamie Alan, PhD, is an associate professor of pharmacology and toxicology at Michigan State University.

There’s a whole lot to wade through when it comes to health insurance and weight loss drugs. If you’re considering using medication to help you lose weight, it’s important to talk to your doctor about what this would look like for you, including health insurance coverage options.

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Are Ozempic and other weight loss drugs covered by health insurance?

Getting these medications covered is “complicated,” says James Wantuck, MD, co-founder and chief medical officer of PlushCare, a telemedicine platform, and associate chief medical officer of Accolade, a personalized healthcare and patient advocacy company. “Some insurers cover weight loss medications for anyone who is prescribed it, others cover it only if you meet certain requirements, and still others do not cover it under any circumstance,” he says.

Right now, some weight loss medications are not actually FDA-approved for that specific use, so they’re prescribed “off-label” by doctors. As a result, insurance companies won’t consider covering the cost, according to Jamie Alan, PhD, an associate professor of pharmacology and toxicology at Michigan State University.

Ozempic (with the active ingredient semaglutide) is a great example of this framework in action: The drug is technically only FDA-approved for insulin management in patients with type-2 diabetes. However, doctors have been prescribing Ozempic “off-label” for weight loss, says Dr. Russo. So, if you wanted to go on Ozempic to treat obesity and *don’t* have type-2 diabetes, there’s really no way your health insurance would cover it. (Mounjaro, with active ingredient tirzepatide, is similarly FDA-approved for treating type-2 diabetes, and yet is also prescribed off-label for weight loss.)

On the flipside, a semaglutide medication that is approved for weight loss—Wegovy—might potentially be covered by insurance, despite the fact it’s essentially the same medication as Ozempic. It simply has a different name, marketing, dosage size, and approved usage, explains Alan.

Still, even if you meet the insurance requirements, coverage can be spotty. “Most insurance companies do not cover GLP-1 agonists [Wegovy, Ozempic] or dual agonists [Zepbound, Mounjaro],” Alan says. “This is unfortunate, because weight loss has been shown to result in improved health outcomes for patients, which overall, reduces healthcare costs.”

Naturally, people are frustrated. Preventive cardiologist Martha Gulati, MD, even called out the Mayo Clinic’s coverage of weight loss drugs through its employee health plan in a recent Instagram post. (The company recently announced plans to put a two-year limit on weight loss medication coverage for employees.) “So disappointed in Mayo Clinic, who is a leader in medicine in so many ways,” she wrote. “Your employees’ health should be prioritized just like your patients.”

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How much do these weight loss medications cost without insurance?

While the sticker price varies by medication and dose, you can generally expect to pay about $1,000 a month out of pocket if you’re not able to apply your health insurance, Dr. Wantuck says. Since the drugs are meant to be used long-term, this can run up quite a bill.

“The sad truth is that these medications are very expensive,” Dr. Russo adds. “It’s hard to find a policy that covers them.”

Dr. Shah points out that the sticker price is “impossible for the vast majority of people to afford” but notes that these companies will often have a special coupon where you can get these medications for $25 a month for a limited time, even if your insurance doesn’t cover it.

“They coupons are usually good for up to a year,” he says. “The problem is, you have to make sure your insurance [continues to cover it] before the coupon runs out.”

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How much do they cost with insurance?

Even with insurance coverage, weight loss medication costs are still “highly variable.” But they typically cost the same as any other prescription medicine in your benefit plan, Dr. Wantuck says.

Dr. Russo adds that he’s seen some patients who pay $0 to under $100 a month for their medication when covered by insurance.

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When might these weight loss drugs be covered by insurance?

Unfortunately, there’s no clear, universal answer at the moment. The experts stress that it’s really in the hands of insurance companies right now—and levels of coverage vary based on your plan. To find out if your health insurance policy will cover a medication you’re interested in, Dr. Shah says you need to call the number on your health insurance card and ask.

Depending on the company and coverage plan, some medications, like Wegovy, are now covered for weight loss, but for people on Medicare, a 2003 law actually prevents weight loss medication coverage.

Dr. Russo thinks that over time, these medications will be covered more by insurance. Plus, there’s a lot of competition on the market—and that should eventually help drive the cost down,” he says.

Dr. Russo and Dr. Shah expect a newly FDA-approved tirzepatide weight loss medication, Zepbound, to be covered in about a year. (It often takes a few months to a year before insurance companies start covering the cost of brand new medications, Dr. Shah says.)

“Some [insurance plan] tiers will provide coverage and some won’t,” Dr. Shah explains. “Most commercial insurance plans should have one plan that provides some level of coverage.”

Coverage is not a guarantee. “Obesity is also looked at as ‘cosmetic’ and not like a chronic relapsing and remitting disease—which is an issue,” Alan says.

But this conversation is slowly changing. This summer, the U.S. legislature introduced a bill that would make Wegovy coverable through Medicare. And some employers have started to think about offering weight-management benefits. One woman in Washington sued the state agency in charge of purchasing health insurance for public employees after she was denied weight loss medication coverage.

How do I know if I qualify for Ozempic and other weight loss drugs?

The best way to know if you might qualify to have these medications covered by your insurance provider is to talk to your doctor, Dr. Shah says. Each medication has certain criteria for qualification, and it can be a lot to wade through.

Wegovy, for example, is designed for people who meet this criteria:

  • You have obesity (defined as a BMI of 30 or greater)
  • You are overweight (defined as a BMI of 27 or higher)
  • You have weight-related medical problems.

“Your insurer may have additional requirements, such as trying other medications or having done a diet and exercise program prior to covering the drug,” Dr. Wantuck adds.

The bottom line: If you’re interested in trying a weight loss medication like Ozempic, Wegovy, or Zepbound, it’s important to have an honest conversation with your doctor, and to check in with your health insurance company about coverage.