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 is…no.

Weight loss drugs usually aren’t covered by insurance unless you’re using them to treat type 2 diabetes. A small number of American insurance providers and plans cover weight loss drugs for obesity, but you’ll have to meet eligibility criteria first.

Below, we’ll dive into why weight loss drugs aren’t typically covered by insurance, how to get coverage, how much they cost without insurance, and more affordable options to consider if you have to pay out of pocket.

In most cases, you can’t get weight loss drugs covered by insurance. 

If you have type 2 diabetes, you might be able to get drugs like Ozempic® and Mounjaro® covered. 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, 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). So if you don’t have diabetes, it’s unlikely your insurance provider will cover these drugs.

Drugs like Wegovy® and Zepbound® are FDA-approved for obesity, but many providers don’t cover them.

For example, a 2024 study found that only 18 percent of large companies offering health benefits covered GLP-1 (glucagon-like peptide 1) agonist drugs — the class of medication Wegovy and Zepbound belong to — for weight loss.

If you can get coverage, you’ll have to meet certain eligibility criteria like: 

• Having a body mass index (BMI) above a specific number

• Having a weight-related health condition like type 2 diabetes, high blood pressure (hypertension), or high cholesterol

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

Does Medicare Cover Weight Loss Medications? 

Medicare isn’t allowed to 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 for weight loss can’t be covered.

Does Medicaid Cover Weight Loss Medications? 

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.

Does Hims Take Insurance?

You don’t need insurance to get weight loss support through Hims. You can also use your health savings account (HSA) or flexible spending account (FSA) to reduce the cost.

Most of the time, semaglutide isn’t covered by insurance. But it all depends on why you’re taking the drug.

Semaglutide is sold under the brand names Ozempic and Wegovy: 

• Will my insurance cover Ozempic? Ozempic is FDA-approved for patients with type 2 diabetes, so if you don’t have type 2 diabetes, you won’t qualify for insurance coverage. Though it’s often prescribed off-label for weight loss, people typically 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. You may be able to get insurance coverage for it if you qualify, but there’s no guarantee.

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, make sure to check the fine print about any restrictions or steps you need to take, like getting prior authorization from a doctor.

We can’t speak for insurance providers, but many consider weight loss cosmetic — despite the many health risks associated with obesity. Insurance companies typically don’t cover anything cosmetic, like cosmetic surgery or facial fillers.

Allowing coverage for weight loss medications would also be an immense expense for insurance providers, so they might be waiting for the prices of these drugs to go down.

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 heart 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. Unfortunately, many brand-name weight loss medications come with a high price tag. And since you may need to take them for an extended period, the cost can add up. 

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

• Ozempic can cost $900 to over $1,000 a month. 

• Wegovy can cost $1,300 to $2,000 a month.

• Mounjaro can cost $1,000 to $1,100 per month.

• Zepbound can cost $1,000 to $1,100 per month.

Check out our guide to the cost of weight loss drugs to find out how much other obesity drugs will set you back.

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. Most providers don’t offer coverage, but those that do may have strict 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.  

Are weight loss drugs covered by insurance? In most cases, they’re not.

But if you can’t get insurance coverage for weight loss drugs, don’t panic. There are other, more affordable weight loss treatments that don’t cost an arm and a leg.

Here are your options and other ways to save on weight loss drugs:

• Consider compounded GLP-1s. Compounded medications use the same active ingredients as brand-name medications but aren’t reviewed or approved by the FDA. Compounded drugs are often more affordable. For instance, compounded semaglutide through Hims starts at $165 a month (for a 12-month plan, paid in full).

• Consider other medications for weight loss. Weight loss injections aren’t your only option. Weight loss pills like metformin, topiramate, and naltrexone-bupropion can also be effective. Customized oral weight loss kits through Hims include these medications and start from $69 a month.

• Look into coupons 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 from Hims are eligible for reimbursement with an HSA or FSA (check your plan for details).

Learn more ways to save on the cost of semaglutide.

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:

• Generally, most insurance providers won’t cover weight loss drugs. This can be true even for folks with weight-related health conditions.

• Consider affordable alternatives. Affordable alternatives include oral medications like metformin and compounded GLP-1s like compounded semaglutide.

• Save with coupons, payment assistance, and your 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. 

Ready to get started on the path to a healthy body weight? Take our free online weight loss assessment to find out if Weight Loss by Hims might work for you.