Does Insurance Cover Weight-Loss Medications Such As Wegovy or Zepbound?
Key takeaways:
Coverage for weight-loss medications such as Wegovy (semaglutide) or Zepbound (tirzepatide) varies by insurance plan.
Many insurance providers may not cover prescription medications used strictly for weight loss.
If you have Type 2 diabetes, your insurance may cover FDA-approved medications such as Ozempic (semaglutide) and Mounjaro (tirzepatide) for treatment. Weight loss is often a side effect of these medications.
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Medications such as Wegovy (semaglutide), Zepbound (tirzepatide), and Ozempic (semaglutide) have become popular for helping with weight loss. But without insurance, they can cost over $1,000 a month.
Insurance coverage for these medications depends on why they’re prescribed. Some are FDA-approved for medical conditions such as Type 2 diabetes but are prescribed off label for weight loss. Coverage also depends on the type of insurance you have — such as Medicare, Medicaid, or employer-sponsored plans. It’s important to understand your insurance plan so you don’t get an unexpected bill.
Are weight-loss medications covered by insurance?
It depends on your insurance plan. While several prescription medications are FDA-approved for weight loss, coverage varies significantly between plans.
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A 2024 study found that 18% of large companies — those with 200 or more employees — covered GLP-1 agonists when prescribed primarily for weight loss or conditions related to their approved uses.
Among those companies, 28% of employers that have 5,000 or more workers and offer health benefits covered GLP-1 agonists for weight loss. For example, Wegovy, an injectable medication approved for chronic weight management, may be covered by certain Blue Cross Blue Shield plans if you meet specific criteria.
Health insurance may cover treatments for conditions where overweight or obesity is a related issue. For instance, if you have Type 2 diabetes, your insurance might cover medications such as Ozempic or Mounjaro (tirzepatide), since they are FDA-approved for Type 2 diabetes management. However, if you're prescribed these medications off-label for weight loss, coverage may be less likely.
What medications are commonly prescribed for weight loss?
Along with Wegovy and Zepbound, the following medications are FDA-approved for weight loss:
Saxenda (liraglutide)
Contrave (naltrexone / bupropion)
Qsymia (phentermine / topiramate ER)
Orlistat (Alli, Xenical)
Phentermine (Adipex-P, Lomaira)
Imcivree (setmelanotide)
Some medications, such as phentermine, phendimetrazine, and diethylpropion, are meant for short-term use. Many others can be used long-term.
Looking for ways to save? From patient assistance programs to GoodRx coupons, there are many ways to get help paying for your medications.
Medicare does not cover medications taken solely for weight loss. However, you may be eligible for coverage if you meet these requirements.
Medicaid coverage varies by state. Find out if Medicaid covers weight-loss medications in your state.
As mentioned earlier, medications such as Ozempic can be prescribed off-label for weight loss. Additional examples include:
Trulicity (dulaglutide)
Pramlintide (Symlin)
Topiramate (Topamax)
Bupropion (Wellbutrin SR, Wellbutrin XL)
Zonisamide (Zonegran)
To find out if your insurance covers specific medications, check your plan’s details. You may need to meet certain requirements, such as prior authorization or step therapy, to qualify for coverage.
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Does Medicare cover weight-loss medications?
Medicare is not allowed to cover weight-loss medications unless they are prescribed for other health reasons, such as reducing the risk of heart attack or stroke.
For example, Wegovy was FDA-approved in March 2024 to lower the risk of a life-threatening cardiovascular event in obese or overweight adults with a cardiovascular condition. That same month, the Centers for Medicare & Medicaid Services (CMS) issued a memo saying that anti-obesity medications (AOMs) that are FDA-approved for an additional medically accepted indication could be considered Part D medications for that specific use.
In the future, Medicare could begin covering weight-loss medications for obesity treatment more broadly if the Treat and Reduce Obesity Act is passed by Congress.
If you have Type 2 diabetes, your healthcare professional might prescribe Ozempic or Mounjaro These medications are approved to manage diabetes but can also lead to weight loss as a side effect. Since they are used to treat diabetes, Medicare Part D may cover them. However, you may need to provide proof of your diabetes diagnosis, and your plan could require you to try other treatments first. Check your Medicare Part D plan for coverage details and specific requirements.
Does Medicaid cover weight-loss medications?
Medicaid coverage for weight-loss medications depends on the state you live in. For example, some states list Wegovy as a preferred medication on their formularies, but you may need prior authorization before Medicaid will cover them. There may also be quantity limits on how much medication Medicaid will pay for within a certain time period.
If you are prescribed a Type 2 diabetes medication such as Ozempic or Mounjaro, Medicaid might cover it, but only if you meet certain conditions. These could include having a diabetes diagnosis, being a certain age, or trying other medications first. To find out what’s covered and the specific requirements, check your state Medicaid formulary.
Does the VA cover weight-loss medications?
TRICARE is the federal health insurance for U.S. military members and their families. Wegovy and Zepbound may be covered by TRICARE if you meet the following prior authorization criteria:
You have a body mass index (BMI) of 30 or higher or a BMI of 27 or higher with a weight-related health issue.
You’ve tried and failed to lose weight with (or can’t take) other oral weight-loss medications, such as Qsymia or Contrave.
You’ve attempted to lose weight through diet and exercise for at least 6 months with no success.
You pledge to maintain lifestyle changes, such as exercising and eating nutritious foods, while using Wegovy or Zepbound.
TRICARE may cover Ozempic or Mounjaro if you have Type 2 diabetes, want to lose weight, and can’t take metformin for a medical reason. Your prescriber may have to fill out prior authorization and medical necessity forms as part of the review process. Check your TRICARE plan for details on coverage and criteria.
Can supplemental insurance help you pay for weight-loss medications?
Supplemental health insurance plans help pay for medical costs not covered by your health insurance plan. These expenses include copays, coinsurance, and deductibles. Some supplemental health insurance plans also help pay for costs related to an illness or injury.
Types of supplemental health insurance plans include vision, dental, and long-term care. There are also plans for conditions including cancer, stroke, or kidney failure. It’s unlikely that a supplemental health insurance plan would cover weight-loss medications, but it depends on the policy.
How to get insurance to cover weight-loss medication
Here are steps you can take to increase your chances of getting coverage for weight-loss medications:
Read your policy. Review the details of your health insurance plan. Are weight-loss medications included or excluded? Are there preferred and nonpreferred weight-loss medications? What criteria do you have to meet to get weight-loss medication coverage?
Gather information from your healthcare professionals. Weight-loss medication coverage may depend on your BMI information and medical condition documentation. You may also need to enroll in a physician-supervised weight-loss program.
Get prior authorization. Your insurance provider may require approval of coverage for weight-loss medications that aren’t listed in its formulary. Your prescriber may need to prove that the medication is medically necessary.
Write a letter advocating for coverage. If you don’t have weight-loss medication coverage, write a letter with your prescriber to your insurance provider. You can describe your weight-related health problems, including difficulty walking or doing other activities.
Write an appeal if you’re denied coverage. The clock starts ticking on your appeal rights when you receive a denial. So it’s in your best interest to file quickly if you’re denied weight-loss medication coverage. You will likely need to request a letter from your prescriber.
Ways to save on weight-loss medications
If your insurance doesn’t cover weight-loss medications, there are other ways to save money on out-of-pocket costs.
1. Use a GoodRx coupon
GoodRx has coupons for a variety of weight-loss medications. Download your free coupon on the GoodRx app or at www.goodrx.com by searching for the medication and then texting, printing, or emailing your coupon.
2. Use a manufacturer copay card
A manufacturer copay card may help you save money on weight-loss medications even if you don’t have insurance. To qualify for the maximum savings, you typically need to have commercial insurance that covers your prescription, as well as meeting other eligibility requirements. Take the Wegovy savings card, for example. You can pay as low as $0 for a 28-day supply of the medication (for up to 13 fills), if you meet the qualification, or $650 per month without insurance.
3. Use your HSA or FSA
Use your health savings account (HSA) or flexible spending account (FSA) to pay for qualified medical expenses. Prescription medications not covered by your health insurance plan are included in the IRS list of eligible HSA/FSA expenses.
The bottom line
Insurance may not cover prescription medications that are used solely for weight loss, because they may not always be seen as medically necessary. These medications may also be costly. However, if you have Type 2 diabetes or another health condition, your insurance might cover medications that are approved to treat it. And some of these medications can also lead to weight loss as a side effect.
To improve your chances of getting coverage for weight-loss medications, review your policy, gather medical documentation, and be prepared to advocate for coverage through letters or appeals. If coverage is still denied, you can explore other ways to reduce costs, such as using a GoodRx coupon or applying for a patient assistance program.
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References
BlueCross BlueShield of North Carolina. (2021). Saxenda & Wegovy – NC standard.
Centers for Medicare & Medicaid Services. (2024). HPMS memos for WK 4 March 18-22.
Claxton, G., et al. (2024). Health benefits in 2024: Higher premiums persist, employer strategies for GLP-1 coverage and family-building benefits. Health Affairs.
IRS. (2023). Publication 502 (2023), medical and dental expenses.
National Cancer Institute. (n.d.). Supplemental health insurance.
Obesity Action Coalition. (n.d.). Reviewing your insurance policy or employer sponsored medical benefits plan.
U.S. Food and Drug Administration. (2024). FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweight.
Wenstrup, B. R. (2023). H.R.4818 - Treat and Reduce Obesity Act of 2023. Congress.gov.
