How to get GLP-1 medication through your insurance
LAST UPDATED: Jul 19, 2023
7 MIN READ
HERE'S WHAT WE'LL COVER
If you’ve ever picked up a script from the pharmacy, you know that getting a prescription is just step one of a potentially long, confusing, and sometimes even frustrating journey. It can be even more complicated when your medication requires prior authorization or some back and forth with your insurance company.
Wegovy Important Safety Information: Read more about serious warnings and safety info.
Ozempic Important Safety Information: Read more about serious warnings and safety info.
What are GLP-1 medications?
Glucagon-like peptide-1 (GLP-1) medications are prescribed to help people with obesity or overweight lose weight and help people with type 2 diabetes manage their blood sugar levels. Some GLP-1 medications include Ozempic (semaglutide), Wegovy (semaglutide), Saxenda (liraglutide), and Trulicity (dulaglutide). Mounjaro (tirzepatide) is also often considered a member of the bigger GLP-1 family, even though it’s a dual GLP-1/GLP receptor agonist.
These drugs work by mimicking GLP-1, a gut hormone produced naturally by your body that is involved in insulin release and appetite regulation. GLP-1 medications have been shown to encourage insulin release after you eat, while also inhibiting glucagon production and slowing down digestion. Together, these effects help to control blood sugar, reduce appetite, and lead to weight loss.
Currently, some GLP-1 medications are only FDA-approved to manage blood sugar levels or reduce cardiovascular risk in people with type 2 diabetes, like Ozempic and Mounjaro. Others, including Wegovy and Saxenda, are specifically approved for weight loss. However, health providers may prescribe medications like Ozempic and Mounjaro off-label for weight loss, if they feel the drug is the best option for their patient.
Get access to GLP-1 medication (if prescribed) and 1:1 support to meet your weight goals
How much do drugs like Wegovy, Ozempic cost?
Without insurance, the average cost of drugs like Ozempic and Wegovy can range from $900 to over $1,300. At the time of writing, Ozempic costs $935.77 for a monthly supply, and a monthly supply of Wegovy costs $1,349.02. Saxenda costs the same as Wegovy, with a price of $1,349.02, while Mounjaro costs $1,023.04 for a monthly supply.
The price you’ll pay for Ozempic, Wegovy, or another GLP-1 medication will depend on your insurance coverage, the condition you are using the drug to treat, and the pharmacy you use. For example, some insurance plans will cover medications that treat type 2 diabetes, but not weight loss. Drug prices can also vary from pharmacy to pharmacy.
If you have a valid prescription and commercial or private insurance, you may be eligible for a GLP-1 savings offer from the manufacturer. For example, Novo Nordisk, the manufacturer of Ozempic, Wegovy, and Saxenda, offers savings coupons for Wegovy and Ozempic. These can bring down the monthly cost to as low as $25. (Novo Nordisk ended their savings program for Saxenda as of June 30, 2023.) Eli Lilly, the maker of Mounjaro, offers a similar savings card that can bring the cost down to as low as $25 for a monthly supply.
Additionally, Novo Nordisk offers a patient assistance program (PAP) which helps cover the cost of GLP-1 drugs for people who meet certain eligibility requirements. To be eligible, you must have a household income that puts you at or below 400% of the federal poverty line, and have either Medicare or no insurance coverage. You cannot have insurance through a private or government-funded program, including Medicaid or VA benefits.
Prepare for your appointment
GLP-1 medications like Ozempic, Wegovy, and others require a prescription. So, the first thing you’ll need to do is get a prescription from a health provider. You can do this in person by meeting with your primary care physician or another health professional. Or, you can get a prescription through an online weight loss program like the Ro Body Program, which connects you with a licensed healthcare professional for a virtual consultation.
Regardless of your chosen route, preparing for your appointment ahead of time can help the process go more smoothly. By reading this article, you’re already one step ahead!
Review your weight loss journey
During your appointment, your healthcare provider will ask you questions about your personal and family medical history. Some pre-existing health conditions can mean you can’t take GLP-1 medications, such as pancreatitis or certain thyroid cancers. By sharing your full medical history with your provider, you can help them determine which medication is safe for you.
Tell them about any medications you are taking, including prescription medications, over-the-counter supplements, and vitamins. GLP-1 medications work by delaying gastric emptying, which can affect your body’s absorption of oral medications.
Also, share your experience with losing weight through other methods. Understanding how your body has responded to different diets, exercise, or other medications can help your healthcare provider determine whether a GLP-1 drug like Wegovy or Ozempic is a good choice for you or if another weight loss drug or intervention could be more effective.
“Patients can collect the complete history of their weight challenges to help with the process,” shared Dr. Raoul Manalac, MD, a board-certified Internal Medicine Physician with Ro. “This will help our providers advocate for them and demonstrate to the insurance provider that a patient has tried many different types of medications/diets/exercise plans and they have not worked.”
Understand your weight loss goals
It’s important to know that GLP-1 medications are designed to be used with other lifestyle changes, shared Dr. Manalac. “The weight loss seen in trials is always in combination with diet and exercise recommendations. The same is true for patients receiving GLP-1 medications. The best way to get the most out of these medications is to combine them with diet and exercise.”
For the best results, it is helpful to have a plan in place for making changes to lose weight, beyond just taking the medication.
Your healthcare provider may make recommendations themselves, or they may refer you to another health professional such as a nutritionist. If you join the Ro Body Program, a health professional will prescribe a GLP-1 medication if appropriate, and you’ll be connected with a dedicated health coach to support you with these lifestyle changes on an ongoing basis.
GLP-1 drugs for weight loss, like Saxenda and Wegovy, are FDA-approved for people with obesity (defined as a body mass index, or BMI, of 30 or higher) or with a BMI of 27 or higher and a weight-related health condition, such as high cholesterol, type 2 diabetes, or high blood pressure. When prescribing other GLP-1 drugs off-label for weight loss, such as Ozempic or Mounjaro, health providers will typically follow these same guidelines. Your insurance plan may also require you to meet these guidelines before they cover a GLP-1 medication for weight loss.
If your body weight falls below these BMI measurements, your health provider may recommend a different weight loss intervention, such as a reduced-calorie diet or increased exercise.
“These medications are a great option for many, but not all patients,” shared Dr. Manalac. “For example, patients with a history of Medullary Thyroid Cancer are not appropriate candidates for these treatments. It's also important to know that this is an injectable, weekly medication. Some patients may be surprised to learn that, particularly those with a fear of needles.”
Fad diets stop here
If appropriate, get effective weight loss treatment prescribed for your body.
Find out if your plan covers GLP-1 medications
If you have a deductible on your commercial insurance plan, it may cover GLP-1 medications once you’ve met it. Whether coverage is provided before then will depend on your specific plan’s coverage.
Start by reviewing your plan policy, which you may have received a copy of in the mail. If not, you can usually find it on your insurance provider’s website or patient portal. If you have any questions about whether GLP-1 medications are covered, call your insurance provider directly and ask them.
Generally, insurance plans are more likely to cover a medication for its FDA-approved condition. In other words, your insurance plan may be more likely to cover Wegovy or Saxenda for chronic weight management, as opposed to Ozempic or Mounjaro, which are approved for type 2 diabetes.
One major exception to this rule is Medicare. Medicare prescription drug plans usually do not cover weight loss drugs. If you have Medicaid, your coverage can vary by state. Review your drug’s formulary to be sure.
Veterans who receive VA benefits may be able to get coverage for Wegovy through the MOVE! Weight Management Program. Contact your local MOVE! Coordinator or VA provider for specific coverage information.
How to handle a prior authorization
Insurance plans require prior authorization before they will cover a medication for an off-label condition. So, if your healthcare provider wants to prescribe Ozempic off-label for weight loss, you will need them to request prior authorization on your behalf. Once they submit the form, it can take up to 10 business days for your insurance company to review it and issue a response. If they approve your request, you’re good to go!
If they don’t approve your request, they could deny coverage outright, or they could ask for more information or recommend another less expensive alternative. In these scenarios, you and your healthcare provider can ask for a review of their decision.
With the Ro Body Program, once you are approved for treatment with a GLP-1, our insurance concierge manages this process for you. They will verify your benefits and submit for prior authorization if needed, before finding a pharmacy that has your prescription in stock. The process takes 1–3 weeks.
Determine out-of-pocket costs for GLP-1 medications
It takes some legwork to calculate your out-of-pocket costs for GLP-1 medications. You’ll first want to check with your insurance plan whether you’ll need to hit your deductible first, or if the drug is covered, what your copay will be. If you’ll need to hit your deductible first, you will likely need to pay the full cost of the prescription. You can call your pharmacy for a price check.
Novo Nordisk, the manufacturer of Ozempic, runs a hotline that you can call six days a week at 1‑844‑Novo4Me (1‑844‑668‑6463). Their representatives can help you estimate your out-of-pocket costs for Ozempic. Have your prescription card handy when you can call them. You can also do this via a form on their website.
For some GLP-1 medications, such as Saxenda, you must purchase needles separately to use with your pen. A box of 100 needles costs about $60, or 60 cents per needle. Mounjaro and Wegovy are single-dose pens and come with an integrated needle, so you don’t need to worry about this additional cost.
What if I am denied insurance coverage for GLP-1s?
If you are denied insurance coverage for GLP-1s, there are still ways you can save on the medication.
Start by price-shopping at local pharmacies. Prices can vary from pharmacy to pharmacy, and some may have promotions or coupons that lower the price of the drug. Also check online pharmacies, which may include free shipping to your home.
If you can afford it, sometimes purchasing a two- or three-month medication refill can be more cost-effective over the long run than a one-month refill.
Finally, if you have a commercial insurance plan and a prescription for Wegovy, you may still be eligible for the Wegovy Savings Offer. This card offers a maximum savings of up to $500 for a one-monthly supply of Wegovy for people who have commercial insurance but no coverage for Wegovy.
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
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