GLP-1 medications can cost $1,000-1,500 per month without insurance—a major barrier for many people. Understanding insurance coverage and alternatives can help you access these medications affordably.
Coverage Overview
- • Varies significantly by insurance plan
- • Often requires prior authorization
- • May require documented weight loss attempts
- • Diabetes indication usually covered better than weight loss
- • Medicare Part D now covers some GLP-1s for weight loss
Factors Affecting Coverage
Indication (Why It's Prescribed)
GLP-1s for diabetes (Ozempic, Mounjaro) are more commonly covered than those for weight loss (Wegovy, Zepbound). Your doctor may prescribe based on your specific situation.
BMI Requirements
Most insurers require BMI ≥30, or BMI ≥27 with a weight-related condition (high blood pressure, sleep apnea, etc.).
Prior Authorization
Your doctor usually needs to submit documentation showing you meet criteria. This may include previous weight loss attempts, lab work, and diagnoses.
Step Therapy
Some plans require you try cheaper medications first (like metformin or phentermine) before approving GLP-1s.
Options Without Insurance Coverage
Compounded Semaglutide
During brand-name shortages, compounding pharmacies can produce semaglutide at $200-400/month. Choose FDA-registered 503B compounding facilities.
Manufacturer Savings Programs
Novo Nordisk and Eli Lilly offer savings cards that can reduce costs significantly for those with commercial insurance (not Medicare/Medicaid).
Telehealth Providers
Online weight loss clinics often offer competitive cash-pay pricing and help navigate insurance appeals.
Official Summary
Insurance coverage for GLP-1s is improving but still inconsistent. Work with your doctor on prior authorization, explore manufacturer savings programs, and consider compounded alternatives if brand-name is unaffordable.