Does Insurance Cover Weight Loss Drugs?
10 Minutes
Team Curative
Feb 21, 2024
Prescriptions for weight loss drugs have doubled over the past five years. Last year about one in nine overweight adults with a prescription for any reason had at least one prescription for a weight loss drug, too.
This new wave of medications, when combined with preventive care measures like a healthy diet and exercise, can help you address obesity and make long-term improvements to your well-being. Glucagon-like peptide-1 (GLP-1) weight loss drugs are marketed as weekly injectables to slow down your rate of digestion which suppresses your appetite. For example, the drug semaglutide imitates the hormone GLP-1, which prompts the body to create more insulin and makes a person feel satiated.
As one user said, “I don’t daydream or obsess over eating as much. I’m grabbing smaller plates, and I’m very satisfied with those portions in a way I wasn’t before.”
These drugs also reshape the way healthcare professionals and the public perceive obesity, a condition historically viewed as a problem of willpower. “Now we have the option to treat obesity like we treat any other disease—with medication,” said Shauna Levy, medical director of Tulane University’s Bariatric and Weight Loss Center.
Despite this shift in perspective and rise in popularity, not all health insurance plans will cover GLP-1 weight loss drugs. Let’s learn more about what’s popular, how they work, and insurance coverage for weight loss drugs.
What’s on the market?
Several different types of drugs are used for weight loss today. Here are the most notable prescriptions:
Oral Medications
Naltrexone & bupropion: the generic name for Contrave
Phentermine & topiramate: the generic name for Qsymia
Oral weight-loss medications are less commonly known but are designed to help control your appetite and assist in developing healthier eating habits. It is often recommended that you try oral medications before moving on to GLP-1 injectables.
GLP-1 Injectables
Semaglutide: the generic name for Wegovy
Tirzepatide: the generic name for Zepbound
Liraglutide: the generic name for Saxenda
While you may have heard about other injectable drugs like Ozempic, Mounjaro, and Victoza, only Saxenda, Wegovy, and Zepbound are currently approved by the FDA for weight loss.
Paying for these treatments out-of-pocket isn’t an option for many people due to high costs. Here are the list prices of the most popular brand-name weight loss drugs:
Contrave (naltrexone & bupropion): $260 for 70 tablets of 8 to 90 mg
Qsymia (phentermine & topiramate): $197 for 30 tablets of 7.5 to 46 mg
Wegovy (semaglutide): $1,349.02 for a package of 4 pens of a 2.4 mg dose
Zepbound (tirzepatide): $1,059.87 for a package of 4 pens of a 2.5 mg dose
Saxenda (liraglutide): $1,349.02 for a package of 5 pens of a 3 mg dose
These are retail prices and are subject to change. Coupons may also be available to lower out-of-pocket costs. Be aware that what is considered a “one-month supply” will vary by individual and by drug. Be sure to always follow your healthcare provider's instructions when taking any of these medications.
Does insurance cover weight loss drugs?
Not all weight loss drugs are covered by insurance. If you are interested in taking control of your wellness, you should opt for comprehensive health insurance that focuses on preventive care and support for you during your health and weight-loss journey.
If the out-of-pocket costs for these weight loss drugs are too expensive for your budget, you are not alone. According to one study, 45% of people reported an interest in taking a safe and effective prescription weight loss drug to lose weight if they knew it was covered by insurance. However, that interest dropped to only 16% if they were told the drug was not covered by insurance.
How effective are weight loss drugs?
Results vary by drug and by the individual. According to one study, participants taking Wegovy who were encouraged to eat healthy and exercise experienced “an average of >15% weight loss” compared to >3% in the placebo group.
Many of these drugs have beneficial side effects outside of weight loss. Novo Nordisk, the maker of Ozempic and Wegovy, announced findings that indicate semaglutide can cut the risk of cardiac complications by 20% in some patients.
What are the costs of poor health and obesity?
Obesity is a public health issue affecting approximately 42% of people in the United States and is associated with a range of health complications including:
cardiovascular disease
type 2 diabetes
hypertension
respiratory problems
depression
Many factors can contribute to excess weight gain including eating patterns, physical activity levels, sleep routines, genetics, and taking certain medications. Obesity has negative effects on almost every aspect of health, from reproductive and respiratory function to memory and mood.
Given the health risks associated with obesity, there is no question excess weight affects lifestyle. According to a 2023 consumer report, poor health negatively impacts work performance and out-of-pocket costs make it harder to receive needed care. In 2021, individuals covered under employer-sponsored health insurance who were diagnosed as obese or overweight had an average of $12,588 in total annual health costs. That’s more than double the $4,699 in health spending for those with no obesity or overweight diagnosis.
If you struggle with obesity, you most likely have higher out-of-pocket costs than those without diagnoses. In 2021, people with large employer coverage who had an obesity diagnosis faced an average of $1,487 in out-of-pocket costs compared to $698 for those without an obesity diagnosis.
How can preventive care assist you in weight management?
If you are interested in prescription weight loss drugs, engaging in a healthy lifestyle is key for long-term results. Prioritize preventive health in your daily routine through:
physical activity
a healthy diet
attention to mental health
clinical preventive services
The best employer-sponsored health insurance plans ensure their workforce has the access, benefits, and support to integrate preventive care services into a routine that fits each person’s needs.
Curative can help you lose weight with a holistic approach
For members with prior authorization who who qualify for bariatric surgery or whose employer provides a rider, Curative will fully cover the following GLP-1 weight loss medications for a limited time dependent on measured effectiveness:
Wegovy
Saxenda
Zepbound (non-formulary)
GLP-1 weight loss drugs should be seen as a supportive addition to lifestyle adjustments, enhancing rather than substituting preventive care and behavioral shifts. At Curative, we know health is ever-changing, and we are creating customized approaches that meet you at any point in your journey to help you make those lasting changes.
Our holistic approach helps with sustainable, long-term weight management by offering comprehensive coverage and access to preventive care services and strategies:
physical health wellness programs, such as Noom.
nutritional counseling and programs
no-cost preferred prescription medications* such as oral weight loss medications
support from a Curative clinician with regular check-ins
At Curative, we assist you with this combination of strategies designed to maximize your success before considering a GLP-1 medication. For those who qualify for bariatric surgery, GLP-1s may be prescribed by your clinician as part of your treatment pathway. All GLP-1 weight loss drugs require prior authorization as Curative is dedicated to patient safety, quality of care, engagement, monitoring, support, and saving money for everyone. Learn more about our weight management program offerings.
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References
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