Insurance Coverage (GLP-1)
The patchwork reality of getting weight medication covered — commercial plans, Medicare, and the self-pay alternative.
Coverage is the least standardized fact in weight medicine: many commercial plans cover Wegovy or Zepbound for BMI 30+ (or 27+ with conditions) behind prior authorization; many others exclude weight medication categorically as a plan-sponsor choice. Medicare historically excluded weight-loss drugs, with coverage expanding only through non-weight indications — semaglutide for cardiovascular risk post-SELECT, tirzepatide for sleep apnea — and policy continuing to evolve. Medicaid varies by state.
The decision tree is short: check your formulary, ask about prior auth criteria, use manufacturer savings cards if commercially insured, and price the self-pay lane against your copay math. Diagnosis coding matters too — coverage sometimes exists under diabetes or cardiovascular indications where pure weight-management coverage doesn't.
This glossary entry is general information, not medical advice, and is written to be consistent with FDA prescribing information and primary trial publications as of its last review. Always consult a licensed healthcare provider for personal medical decisions.
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