Ozempic and other GLP-1 medications have recently gained attention for their effectiveness in managing type 2 diabetes and weight loss. However, while their health benefits are well documented, one of the biggest questions patients face is whether these medications are covered by insurance.
Coverage can vary widely depending on your insurance provider, the reason for your prescription, and even the means through which you get insurance. Understanding how insurance companies determine eligibility can help you make more informed decisions about your treatment and costs. Here’s what you need to know about insurance coverage for Ozempic and similar GLP-1 drugs.
Key Takeaways
- GLP-1 medications, such as Ozempic, Wegovy, and Mounjaro, mimic natural hormones that help regulate blood sugar, promote fullness, and support weight loss.
- Insurance coverage varies widely depending on your provider, your plan, and the reason for your prescription.
- Most insurers only cover Ozempic for diabetes, not for off-label uses like weight loss or heart health.
- Without insurance, a month’s supply of GLP-1 medications can cost over $1,000, depending on the brand and dosage, but manufacturer savings programs and coupons can reduce costs.
What are GLP-1 Medications?
Glucagon-like peptide-1 receptor agonist (also known as GLP-1s or GLP-1 RAs) medications mimic natural GLP-1 hormones that your body creates every time you eat. These GLP-1 hormones, whether natural or synthetic, help your body in several ways, including helping you feel full after eating, signalling to your body to create and release insulin, and helping your body regulate its blood sugar.
Weight loss medications have become an important option for people seeking to manage their weight and improve their health, especially as obesity rates continue to rise. These medications are often used alongside lifestyle changes like healthy eating and regular exercise to support chronic weight management. With more FDA-approved medications available, including GLP-1s, patients now have more choices than ever before. However, insurance coverage for weight loss medications can be complicated, and not all insurance plans provide coverage for these treatments.
Understanding which medications are available, how they work, and what your insurance may cover is essential for anyone considering weight loss medication as part of their health journey. Whether you’re looking for help with chronic weight management or exploring new options for weight loss, knowing your coverage options can help you make informed decisions about your care.
Uses for GLP-1 Medications
GLP-1s have many uses. Their original use was to help treat diabetes, specifically type 2 diabetes, thanks to their ability to help regulate blood sugar levels. However, because they also promote satiety and make you less hungry, a common side effect of GLP-1 medications is weight loss.
In recent years, many of the different GLP-1 medications originally designed for diabetes have spawned alternative medications that use the same active ingredients but are fully intended to be used for weight loss. For example, Ozempic is a very popular GLP-1 medication for type 2 diabetes, and the manufacturer also produces another drug called Wegovy, which similarly uses semaglutide as its active ingredient but is FDA-approved for weight loss in certain adults who meet specific health criteria.
In addition to helping people lose weight or manage type 2 diabetes, GLP-1 medications have also been shown to promote heart health and reduce the risk of cardiovascular disease, heart attacks, and stroke. Other studies are currently looking into the effectiveness of GLP-1s and their connection to slowing the progression of kidney disease, but the results of these studies are not yet conclusive.
Types of GLP-1 Drugs
There are many different GLP-1s on the market, and they’re generally broken up in two different ways: by intended use or by active ingredient. The intended use will either be weight loss or type 2 diabetes, and the three most common active ingredients used in GLP-1s are semaglutide, liraglutide, and tirzepatide.
| Active Ingredient | Type 2 Diabetes | Weight Loss | |
|---|---|---|---|
| Ozempic | Semaglutide | ✓ | |
| Wegovy | Semaglutide | ✓ | |
| Rybelsus | Semaglutide | ✓ | |
| Mounjaro | Tirzepatide | ✓ | |
| Zepbound | Tirzepatide | ✓ | |
| Victoza | Liraglutide | ✓ | |
| Saxenda | Liraglutide | ✓ |
There are also other active ingredients that can be used for GLP-1 drugs, but these three are the most common. However, others can include duaglutide, which is used in Trulicity, and exenatide, which is used in Byetta. Both of which are FDA-approved medications for type 2 diabetes.
There are similar medications within the GLP-1 class that may be considered as alternatives depending on insurance coverage and patient needs.
Will Insurance Cover GLP-1 Drugs?
The question of whether your health insurance will cover your medications is a complicated one, as there are many factors that go into how insurance determines coverage. The type of health insurance you have—whether private, employer-sponsored, or government—can significantly impact what is included. Factors such as your specific health coverage, the reason behind the prescription, and your health history can all affect whether or not your insurance provider will cover the cost of the medication. Health coverage for GLP-1 medications can vary widely and is subject to ongoing policy changes. Some states and insurers are also considering expanded coverage for anti-obesity medications due to recent legislative developments.
Insurance Plans
Just having insurance isn’t enough to guarantee coverage for GLP-1 medications. If you get insurance coverage through your job via an employer-sponsored health plan, it’s possible that your employer chose to exclude GLP-1 drugs from the plan due to costs.
The Reason for the Prescription
All drugs have an intended use behind them. For something like Ozempic, the intended use is to manage type 2 diabetes symptoms, and that is what the drug is FDA-approved for. However, it’s possible to use a drug off-label, which means using a drug for an unintended other effect that it may cover but isn’t necessarily approved for. In the case of Ozempic, an off-label use could be as a weight loss medication or for heart health, both things that the drug can technically do but aren’t the intended use. Most insurance plans do not cover weight loss as an indication for Ozempic.
Insurance companies will typically reject any off-label drug use and expect you to cover the costs out of pocket. However, on the other hand, if you have type 2 diabetes and your doctor prescribes you Ozempic to manage your type 2 diabetes symptoms, your insurance provider will be far more likely to pay for either in part or the full cost of the prescription. Some insurance plans may cover weight loss medications like Wegovy or Zepbound, but coverage varies widely depending on the insurer and policy. Patients interested in Zepbound should check if their insurance plan will cover Zepbound specifically, as coverage for weight loss medications can differ significantly.
Medicaid and GLP-1 Drug Coverage
If you are enrolled in your state’s Medicaid program, the individual state Medicaid programs will determine if GLP-1 medications are covered drugs or not. Coverage for GLP-1 medications can depend on whether your state uses a Medicaid fee for service model or a managed care plan, as policies and availability may vary between these models. As of August 2024, 13 states cover GLP-1 medications for both type 2 diabetes and obesity treatment, and four states will only cover the drugs for type 2 diabetes.
States that cover GLP-1 medications for both include:
- Delaware
- California
- Kansas
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- New Hampshire
- North Carolina
- Pennsylvania
- Rhode Island
- Virginia
- Wisconsin
States that only cover GLP-1s for type 2 diabetes include:
- Louisiana
- North Dakota
- South Carolina
- Texas
However, starting in 2026, Medicaid will no longer cover GLP-1 medications used as weight loss drugs.
Medicare and GLP-1 Drug Coverage
Previously, Medicare Part D did cover GLP-1s for both type 2 diabetes and treating obesity and weight management. However, starting in 2026, Medicare Part D will only cover GLP-1s used for type 2 diabetes management. Medicare only covers GLP-1s as prescription drugs for diabetes, not for weight loss, because these medications are classified as prescription drugs and are excluded from coverage for weight management under current Medicare rules.
Medicare Advantage plans may have different coverage for GLP-1 prescription drugs, but they must follow Medicare Part D rules regarding which drugs are covered and for what indications.
If you’ve already been using GLP-1s for type 2 diabetes through your Medicare plan, you shouldn’t see any difference going forward. However, people using GLP-1s for weight loss will need to either pay out-of-pocket costs for their medications going forward or talk to their doctors about trying other medications.
GLP-1 Drug Costs Without Insurance Coverage
If you don’t have insurance coverage or a particular plan that will cover GLP-1 medications, you will be expected to pay out of pocket if you still want to use the medications. But how much can GLP-1 medications cost? The answer will vary depending on the medication you’re trying to get. Here are the most common GLP-1 medications and unmodified prices listed by their manufacturers for a one-month supply.
- Ozempic: $1,177
- Wegovy: $1,349
- Rybelsus: $997
- Mounjaro: $1,079
- Zepbound: $1,060
- Victoza: $1,162
- Saxenda: $1,350
It’s important to note that stopping GLP-1 medications can result in an increase in body weight, so ongoing treatment may be necessary to maintain weight loss results.
How to Save Money Without Insurance Coverage
There are a few different ways you can potentially save money on GLP-1 medications, even if you don’t have insurance coverage.
Use Coupons
Many drug manufacturers partner with big pharmaceutical websites such as GoodRx to offer coupons for popular medications, and you may be able to find coupons for the GLP-1 medications you need. These coupons typically aren’t as good as if you have insurance, but they will still save you money, so it’s a good idea to see what’s available if you need a prescription filled.
Manufacturer Savings Programs
Some manufacturers have savings programs on their websites that you can choose to sign up for. For example, Novo Nordisk, the manufacturer behind Ozempic and Wegovy, has NovoCare and a Patient Assistance Program that can help you get the medications you need more affordably.
Similarly, Eli Lilly, the manufacturer behind Mounjaro and Zepbound, offers a savings card for certain medications that offer similar benefits to other manufacturers like Novo Nordisk.
Request Generic or Compounded Medications
Generic medications are always cheaper than brand-name medications, and they are strictly regulated to ensure they use the same active ingredients as the official drug. This means, when you get a generic version of Ozempic, which uses semaglutide, the medication you receive from your pharmacy will also use semaglutide in the same ratios. However, other ingredients, such as preservatives or flavorings (if applicable), may be different.
For example, the official recommended retail price of Ozempic is $1,177. Using a discount website like GoodRx, you can get it for $499. Generic semaglutide, however, can potentially cost as little as $129 per month, though this will vary depending on your pharmacy.
Patient Assistance Programs
Patient assistance programs (PAPs) are a valuable resource for people who need help affording their weight loss medications. Many pharmaceutical companies offer these programs to reduce pocket costs, providing discounts, coupons, or even free medication to eligible patients. For example, the Obesity Action Coalition offers support and resources to help patients access the weight loss medications they need. Some insurance providers also partner with drug manufacturers to offer additional savings or special programs for their members. If you’re struggling with the cost of your medication, it’s a good idea to check with your insurance provider directly to see if they offer any patient assistance programs or discounts for weight loss medications. These programs can make a significant difference in your ability to start and maintain treatment, ensuring you get the support you need for your weight loss journey.
Be Aware of Your Options When Using GLP-1s
Navigating insurance coverage for Ozempic and other GLP-1 medications can be complicated, but understanding your options can make a big difference in both your health and your wallet. Whether you’re managing type 2 diabetes or exploring weight loss treatments, it’s important to know what’s covered, what isn’t, and how to access the support you need.
If medications are not covered, nutritional counseling and other treatments may be available to help manage weight. Working with a healthcare provider can help you explore all available options to manage weight, including medications, nutritional counseling, and other treatments.
If you want to get the most out of your GLP-1 medications, a registered dietitian can help you develop a personalized plan that fits your health goals and budget. Sign up today to talk with a registered dietitian at no cost to you!
Frequently Asked Questions About Insurance and GLP-1s
Why Do Some Insurance Plans Not Cover GLP-1 Drugs?
Coverage decisions often come down to cost and plan design. Some employer-sponsored or marketplace plans exclude GLP-1 drugs for weight loss because of their high price tag. Others may only cover them if you meet specific medical criteria, like a type 2 diabetes diagnosis or a BMI above a certain threshold.
How Do I Know Which GLP-1 is Right for Me?
While semaglutide, liraglutide, and tirzepatide are all used for GLP-1 medications, they have some key differences that make them better for certain people. Talk to your healthcare provider about starting a GLP-1, and together, you can go over your health history and needs to choose the right medication for your situation.
Does Insurance Cover Ozempic for Weight Loss?
In most cases, insurance companies will only cover GLP-1 medications for their intended use, and because Ozempic is intended for type 2 diabetes treatment, it’s unlikely that they will cover the cost if you intend to use it to treat obesity.
If you want to use Ozempic for weight loss but still want to have the costs covered by your insurance company, you may want to talk to your doctor about Wegovy, which is intended for weight loss and uses the same active ingredient.
Can My Doctor Help Me Get Insurance Approval For GLP-1s?
Your doctor can submit documentation to justify medical necessity, such as a diagnosis of type 2 diabetes, obesity, or a related condition. This process, known as a prior authorization, can improve your chances of coverage approval.
Can a Dietitian Prescribe GLP-1s?
Dietitians cannot prescribe drugs of any kind or diagnose any health conditions. Only doctors, nurse practitioners, and certain specific medical professionals can prescribe medications to patients.
Next Steps for Patients
If you’re thinking about starting a weight loss medication, the first step is to talk with your doctor about your health goals and medical history. Your doctor can help you decide which weight loss medications are best suited for you and explain how they are used for weight loss or to reduce cardiovascular risk. Once you have a prescription, contact your insurance company or insurance provider directly to ask about coverage options, prior authorization requirements, and potential pocket costs. It’s also helpful to research common medications like GLP-1 drugs, including Wegovy and Ozempic, to understand how they work and whether they are covered by your insurance plan. If you run into challenges with coverage, ask your doctor about submitting a prior authorization or explore alternative medications that may be covered. Taking these steps can help you navigate the insurance process and find the best solution for your weight management needs.
Conclusion
Weight loss medications can play a key role in helping people manage their weight and improve their overall health, but insurance coverage for these medications is often complex and varies by plan. By learning how insurance coverage works and exploring all available options, you can make more informed decisions about your treatment. Work closely with your doctor and insurance provider to determine the best medication for your needs, and don’t hesitate to ask about patient assistance programs or discounts that can help lower your costs. Always check with your insurance provider directly to confirm coverage and pricing for any medication, including Zepbound, and to find out about any available support programs. With the right information and support, you can take control of your weight loss journey and achieve your health goals.
