How to get GLP-1 covered by insurance?

[Anonymous]

Has anyone been successful in getting a GLP-1 covered by insurance for weight loss?

[Anonymous]

It really depends on your specific policy. Even if 2 people have Aetna, one might be covered and one not. If your policy specifically excludes weight loss medications, then it won’t be covered.

If your plan does cover weight loss meds, you most likely need a pre auth. I worked with my dr to provide all the supporting info necessary for the pre auth and it sailed though. I was able to document weight watchers, enrollment in the healthcare sponsored weight loss program, previous medications tried, as well as invoices from the gym. My documentation was probably overkill but it worked.

[Anonymous]

Anonymous wrote:Has anyone been successful in getting a GLP-1 covered by insurance for weight loss?

Not without diabetes, no. I only have 1 friend who has been successful.

She went the route that "her weight & apron belly are prohibiting her from having a baby" and so far, her insurance covered it. But it took many visits to several doctors before she could find one who would fight the insurance that her fertility chances would be increased without the weight and belly. She's based in NY but I think the doctor she found was in NJ.

[Anonymous]

Pre-diabetes for us...we both need to lose about 20 lbs and while technically not pre- in most medical settings our concierge doc writes it this way for insurance to cover.

[Anonymous]

Yes.

I have FEP BCBS standard. It covers Wegovy, but recently dropped it to a Tier 3 drug which only covers 50% of the cost. I managed to get a Tier Exception, though, so my cost is relatively low.

This all depends on your plan though. Either it is covered, or it isn't.

[Anonymous]

Anonymous wrote:Yes.

I have FEP BCBS standard. It covers Wegovy, but recently dropped it to a Tier 3 drug which only covers 50% of the cost. I managed to get a Tier Exception, though, so my cost is relatively low.

This all depends on your plan though. Either it is covered, or it isn't.

+1 Also, while Weygovy is approved for the prevention of heart disease, a plan's formulary may authorize coverage only for patients who have had prior heart attacks, strokes, or heart surgery, not to prevent heart disease in patients with morbid obesity.

[Anonymous]

Aetna - if you are obese (27 bmi) and have another issue (high blood pressure for example), you can get Wegovy with $0 co-pay. IMF/World Bank coverage

[Anonymous]

Some plans have an exclusion for weightloss medication but will pay for them if you have prediabetes. My A1C was 4.6 so I did not qualify

[Anonymous]

Yes, Fed GEHA standard. Zepbound is $100.

[Anonymous]

FEHBP Basic and no coverage with 30+BMI and high blood pressure. Have tried for PA but no. I do compound.

[Anonymous]

I just pay cash and it’s the best money I’ve ever spent.

[Anonymous]

Anonymous wrote:Aetna - if you are obese (27 bmi) and have another issue (high blood pressure for example), you can get Wegovy with $0 co-pay. IMF/World Bank coverage

This very much depends on your employer, ding dong.