Are Weight Loss Drugs Covered By Insurance?

If you’re considering using medication to reach a healthy body weight, your first question might be: Are weight loss drugs covered by insurance? The short answer: Sometimes, but not always.

Coverage for GLP-1s (that’s glucagon-like peptide-1 receptor agonists) and other weight management medications is still somewhat limited. In most cases, insurance companies only cover these meds when prescribed for type 2 diabetes. That said, a small number of plans now include coverage for obesity treatment for those who meet certain eligibility requirements.

We’ll dive into why coverage varies for weight loss drugs, how to navigate the insurance process, what these medications cost without coverage, and options to consider if you’re paying out of pocket.

If you have type 2 diabetes, you might be able to get drugs like Ozempic^® (which contains semaglutide) and Mounjaro^® (which contains tirzepatide) covered by insurance. These prescription medications are FDA-approved for type 2 diabetes and have weight loss as a side effect.

They’re often prescribed off-label for obesity and overweight, but insurance providers don’t usually cover off-label use. (Off-label means a drug is prescribed to treat something it’s not FDA-approved for.)

Drugs like Wegovy^® and Zepbound^® — which have the same active ingredients as Ozempic and Mounjaro, respectively — are FDA-approved for obesity. Insurance coverage for them can vary, so it’s always a good idea to check with your provider to see what’s included in your plan.

A 2024 study found that 18 percent of large companies offered health benefits that covered GLP-1 agonist drugs — the class of medication Wegovy^® and Zepbound belong to — for weight loss.

Some healthcare plans may offer coverage if you meet specific eligibility criteria, often based on factors like your body mass index (BMI) or the presence of weight-related health conditions, such as:

• Type 2 diabetes

• High blood pressure (hypertension) 

• High cholesterol

• Sleep apnea

It’s always worth checking your plan, just in case.

Medicare doesn’t cover weight loss medication when it’s used for weight loss alone. The 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA) states that drugs exclusively for weight loss can’t be covered.

However, if they’re prescribed to treat any underlying conditions, like diabetes or heart disease, Medicare may provide some coverage.

Medicaid covers some weight loss drugs in some states. For instance, you may be able to get Wegovy^® covered by insurance, depending on where you live. 

To find out if you could get coverage, check Wegovy^®’s website or your state’s Medicaid website.

You don’t need insurance for weight loss treatment through Hers. Hers offers access to a range of affordable treatment options.

Hers has a variety of subscription models and price points, so you can find a treatment plan that works for your goals and budget.

HSA and FSA Savings on Weight Loss Medications

You can also use your health savings account (HSA) or flexible spending account (FSA) to reduce the cost of weight loss medications. Eligibility and coverage vary by plan provider and tax rate, but when using FSA or HSA funds, people save about 30 percent on average. Check your plan for details.

It all depends on why you’re taking the drug.

Semaglutide is the active ingredient in Ozempic and Wegovy^®. Let’s go over more details about each of those weight loss drugs within the context of insurance coverage:

• Will my insurance cover Ozempic? Ozempic is FDA-approved for patients with type 2 diabetes. If you don’t have type 2 diabetes, your insurance plan may not cover it — even though some healthcare providers prescribe it off-label for weight management. In that case, you might need to pay out of pocket.

• Will my insurance cover Wegovy^®? Wegovy^® is FDA-approved for weight loss in people with a BMI of 30 or more or 27 or higher with at least one weight-related health condition. Some insurance plans do cover it, though coverage varies. It’s best to check with your insurance provider. 

To find out if you can get weight loss medications covered, look at your policy.

If you read through your policy and it seems like you might be covered, be sure to check for any requirements or steps to take — such as getting prior authorization from a doctor or another licensed healthcare provider.

We can’t speak for insurance providers. That said, coverage for weight loss medications may be limited in part because some insurance companies still classify weight management as a lifestyle issue rather than a medical one — despite growing research to the contrary.

Cost also probably plays a role. These medications can be expensive for providers, and wide-scale coverage might mean a big financial shift for many plans.

Will Weight Loss Drugs Ever Be Covered by Insurance?

There’s growing pressure on health insurance companies and employers to start covering weight loss medications. Obesity is just as much a medical condition as diabetes, after all.

Plus, GLP-1 medications can help with other things, like lowering the risk of cardiovascular disease and heart attack.

So, who knows? Weight loss medications may be covered by insurance in the future.

If you can’t get weight loss drugs covered by insurance, you might wonder about the out-of-pocket cost.

Here’s what these injections cost without insurance (at the time of publishing):

• Wegovy^® can cost $1,300 to $2,000 a month from retail pharmacies. The list price is $1,349.02 per month.

• Ozempic can cost $900 to over $1,000 a month from retail pharmacies. The list price is $997.58 a month.

• Mounjaro can cost $1,000 to $1,100 per month from retail pharmacies. The list price is $1,079.77 a month.

• Zepbound can cost $1,000 to $1,100 per month from retail pharmacies. The list price is $1,059.87.

Hers provides access to the following GLP-1 injections:

• Wegovy^®

• Ozempic

• Generic liraglutide

• Zepbound

• Mounjaro

To get weight loss medication covered by insurance in the U.S., you’ll need to do a few things:

• Find out if your insurance provider covers the medication for anyone. If your provider offers coverage, they may also have approval requirements. Check what weight loss drugs are covered by your insurance plan before seeking a prescription.

• Talk to your healthcare provider about your needs. They may need to write a note seeking prior authorization to confirm your health insurance plan will cover obesity medicine.

• When in doubt, appeal. If your coverage is unclear or your insurance company denies your request, you can appeal the decision. Though it’ll take time and might be a frustrating process, this can significantly increase your chances of getting approved.

Keep in mind that it really depends on which weight loss medication you take and whether you have any weight-related health conditions.

For example, when it comes to how to get insurance to cover Ozempic for weight loss, you’ll need to have a type 2 diabetes diagnosis.

If you can’t get insurance coverage for weight loss drugs, there are still options and other ways to save on weight loss drugs:

• Look into coupons, deals, and manufacturer savings programs. Coupons, discounts, and payment-assistance programs can make brand-name weight loss medications more affordable.

• Use your health savings account (HSA) or flexible spending account (FSA). You can set aside pre-tax dollars to use for eligible medical expenses. Both GLP-1s and oral weight loss medications through Hers are eligible for reimbursement with an HSA or FSA (check your plan for details).

Learn more about the cost of semaglutide in our guide.

So, are weight loss drugs covered by insurance? The answer varies depending on the medication prescribed, any underlying conditions you may have, your location, and your insurance plan.

Prescription drugs for chronic weight management are on lots of people’s radar right now — and not just those with conditions like obesity.

If you’re trying to get help with weight loss or weight management, keep this in mind:

• Some insurance providers will cover weight loss drugs, but it’s not super common. Double-check your plan before paying out of pocket.

• Consider alternatives. Affordable alternatives include compounded GLP-1s and oral medications like metformin, topiramate, and naltrexone.

• Save with FSA or HSA. If you’re paying out of pocket, look into using your FSA or HSA to reduce the high cost.

• Coupons and payment-assistance programs can also lower your bill. Look for savings offers on brand-name GLP-1s.

Ready to get started on the path to a healthy body weight? Take our free online weight loss assessment to find out if Hers is right for you.

Ozempic^® and Wegovy^® are registered trademarks of Novo Nordisk A/S. Hims, Inc. is not affiliated with or endorsed by Novo Nordisk A/S.