Just a few years ago, you may have only heard about GLP-1 medications (aka Ozempic, Wegovy, Mounjaro, etc.) through tabloid headlines or celebrity gossip forums. Fast forward to today, and it’s actually gotten hard to avoid the conversation; we’re constantly bombarded by influencers on Instagram and Tiktok, social media ads, and even our own personal networks.

If you’re thinking about jumping on the GLP-1 bandwagon, you might be wondering if your insurance covers it or how much it would be out-of-pocket. That’s why we’ve broken down exactly how coverage works—from private insurance to Medicare and Medicaid—so you’ll know what to expect and how to get the most out of your consultations.

Are GLP-1 drugs covered by insurance?

When prescribed for FDA-approved uses, many patients can get insurance coverage for weight loss drugs. Each brand (e.g. Ozempic, Wegovy, Mounjaro, etc) has their own specific criteria set by the FDA. If you have type 2 diabetes, a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related health condition (e.g. high blood pressure, high cholesterol, etc) then you’ll be more likely to find a GLP-1 drug covered by insurance. If your prescription is considered off-label (i.e. its use is not approved by the FDA) insurance is far less likely to cover it.

Is Ozempic covered by insurance for weight loss?

Ozempic is FDA-approved for type 2 diabetes, not weight loss. While it may help with weight reduction, most insurers will only cover it for diabetes management. Some people with prediabetes, insulin resistance, or certain metabolic disorders may get coverage if their doctor can justify medical necessity, but this is not the norm.

Is Wegovy covered by insurance?

Wegovy contains the same active ingredient as Ozempic but is specifically FDA-approved for chronic weight management in adults with a BMI of 30 or higher or a BMI of 27 or higher with at least one weight-related condition. If the criteria isn’t met, it’s unlikely that the insurance provider will cover the prescription.

Will insurance cover Mounjaro for weight loss?

Insurance will most likely not cover Mounjaro® for weight loss since it is only FDA-approved for type 2 diabetes. If you want to take tirzepatide (vs. semaglutide) for weight loss, consider Zepbound™ which is FDA-approved for chronic weight management. Health insurance still has strict coverage criteria for Zepbound, similar to that of Wegovy.

What insurance covers GLP-1 medications?

Coverage for GLP-1 medications varies significantly depending on the type of insurance plan you have. Some private health insurance plans include benefits for weight-management drugs while others exclude them entirely. Medicare will cover GLP-1 medications when they are prescribed for type 2 diabetes, but federal law currently prohibits coverage of medications prescribed solely for weight loss. Medicaid coverage is determined by individual states, so while some states have begun covering GLP-1s for obesity treatment, others continue to limit their use to diabetes management.

How do I get Ozempic or Wegovy approved by insurance?

The approval process typically involves working closely with your healthcare provider to meet the insurance company’s coverage criteria. You will need to demonstrate that you meet the BMI and health condition requirements, and your doctor will usually have to provide detailed documentation of your medical history, including your weight over time, any past attempts at weight loss, and relevant lab results. This information is submitted to your insurer through a prior authorization request. If your initial request is denied, you can appeal the decision, and many patients do succeed in getting coverage after an appeal.

In Board-certified facial plastic and reconstructive surgeon Dr. William Kennedy’s experience, he shares "when we prescribe a GLP-1 medication, the process usually begins with a prior authorization request submitted to your insurance company. If the initial request is denied, you have the option to appeal the decision, and many patients do succeed in securing coverage through this process."

Why won’t my insurance cover GLP-1s for weight loss?

One of the main reasons insurers deny coverage is cost; GLP-1 medications can run over $1,000 a month. Many insurance companies still classify weight-loss medications as “lifestyle” treatments rather than medical necessities, despite growing evidence of their benefits for long-term health. For Medicare, there is an additional barrier: federal law currently prohibits the program from covering drugs prescribed solely for weight management.

Are GLP-1s covered by Medicare or Medicaid?

Medicare will cover GLP-1 medications like Ozempic or Mounjaro when prescribed for type 2 diabetes. Medicaid’s policies differ depending on the state. In some states, GLP-1s are available for weight management if strict clinical criteria are met while in other states coverage remains restricted to diabetes treatment only.

Does insurance cover compounded semaglutide?

Compounded semaglutide refers to a version of the medication that is mixed or prepared by a compounding pharmacy rather than manufactured by the original brand-name drug company. Because compounded versions are not FDA-approved, they are typically not covered by insurance. Patients may encounter compounded semaglutide if brand-name products are on backorder or if a prescriber is seeking a very specific dosing option that isn’t offered by the manufacturer.

While compounded semaglutide can seem like a more affordable option, Board-certified facial plastic and reconstructive surgeon Dr. William Kennedy reminds us to be cautious. "When it comes to GLP-1 medications, safety should always be the top priority. Unfortunately, there are online sources selling compounded or counterfeit products illegally, and the Drug Enforcement Administration has warned against using them. To protect your health, it’s essential to obtain treatment only through a trusted, licensed medical provider and reliable pharmacy, this ensures you receive authentic medication."

How much do GLP-1 drugs cost without insurance?

Without insurance, GLP-1 drugs can be quite expensive. Ozempic typically costs between $900 and $1,200 per month, Wegovy can range from $1,300 to $1,600, and Mounjaro or Zepbound generally fall between $1,000 and $1,400. The exact GLP-1 prescription cost can vary depending on your pharmacy, location, and any available discounts.

What diagnosis is needed for insurance to cover GLP-1s?

The most reliable path to coverage is a diagnosis of type 2 diabetes, which is the FDA-approved indication for several GLP-1 medications. Some weight-loss versions, like Wegovy or Zepbound, may also be covered if you have a BMI of 30 or higher, or a BMI of at least 27 with an additional weight-related health condition.

Can I get Wegovy or Mounjaro covered with a BMI under 30?

It is possible to get coverage with a BMI under 30 if you have another qualifying health condition. For example, people with a BMI between 27 and 29.9 who also have high blood pressure, high cholesterol, sleep apnea, or type 2 diabetes may still meet the criteria for insurance approval.

How do prior authorizations work for GLP-1 prescriptions?

A prior authorization is essentially your insurer’s way of confirming that you meet all their requirements before they agree to cover the medication. Your doctor will need to provide documentation of your BMI, medical history, and previous weight-loss attempts. The process can take days to weeks, depending on your insurer. If your request is denied, you and your doctor can submit an appeal with additional evidence.

Board-certified facial plastic and reconstructive surgeon Dr. William Kennedy elaborates on what this authorization could look like, "When insurers ask for proof of 'prior weight-loss attempts' as part of the prior-authorization process for GLP-1 medications, what they’re really looking for are structured, sustained efforts. This often means documenting three to six months of participation in a formal weight-management program such as medically supervised programs, working regularly with a dietitian or nutritionist, or following a defined exercise. These records, along with your BMI and medical history, are essential to show that lifestyle interventions were made under clinical guidance before moving to prescription treatment."

Are weight loss medications like GLP-1s ever covered for aesthetic reasons?

No, insurance companies will not cover GLP-1 medications for purely cosmetic weight loss. Coverage is reserved for patients who meet specific clinical guidelines and whose health may be at risk without treatment.

Can I use a savings card if insurance denies GLP-1 coverage?

A savings card, sometimes called a copay card or manufacturer coupon, is a discount program offered by the drug’s manufacturer that can lower your out-of-pocket cost if you have commercial insurance. These cards work by reducing your copay at the pharmacy, and in some cases, they can bring the price down to a small fraction of the retail cost. If your insurance denies coverage for a GLP-1, you may still be able to use a savings card, provided you meet the manufacturer’s eligibility requirements. Most programs exclude people on Medicare or Medicaid due to federal regulations, and the discount typically applies only to brand-name medications purchased at participating pharmacies.