How to Get GLP-1 Medications Covered

Step 1: Check Your Plan's Formulary

Your insurance plan's formulary (drug list) shows which GLP-1 medications are covered and at what tier. Use this lookup tool to get started, then verify with your specific plan.

Step 2: Gather Documentation

• Body Mass Index (BMI) calculation from your doctor
• Documentation of weight-related health conditions (if applicable)
• Records of previous weight loss attempts
• Lab results showing blood sugar levels (for diabetes indication)

Step 3: Work with Your Doctor

Your healthcare provider will need to submit a prior authorization request with medical necessity documentation. This typically includes your BMI, health history, and reasons why GLP-1 therapy is appropriate for you.

Step 4: Appeal if Denied

If your insurance denies coverage, you have the right to appeal. Many denials are overturned on appeal. Request your doctor submit additional supporting documentation.

Medicare and Medicaid Coverage

Medicare: Part D plans cover GLP-1 medications for diabetes only, not for weight management. Wegovy and Saxenda are typically not covered. Some Medicare Advantage plans may offer additional benefits.

Medicaid: Coverage varies significantly by state. Most states cover GLP-1s for diabetes with strict prior authorization requirements. Weight management coverage is extremely limited.