Does Insurance Cover GLP-1 Medications? Here's What to Know in 2025
Insurance coverage for GLP-1 drugs varies significantly based on diagnosis and plan type.
The short answer: sometimes, but usually not for weight loss alone. Insurance coverage for GLP-1 medications depends on your specific plan, your diagnosis, and which drug you're being prescribed. Here's how to navigate it.
When GLP-1 Drugs ARE Typically Covered
- Type 2 diabetes diagnosis: Ozempic and Trulicity (dulaglutide) are widely covered for diabetes management. If your doctor prescribes it for T2D, most commercial insurance and Medicare Part D will cover it.
- Cardiovascular risk with obesity: Since late 2023, Medicare Part D covers Wegovy for patients with cardiovascular disease and obesity — a significant expansion.
- Employer plans with obesity benefits: Some large employers (including several Fortune 500 companies) have added Wegovy to their formulary. Worth checking your Summary of Benefits.
When GLP-1 Drugs Are NOT Covered
- Weight loss alone without a qualifying diagnosis
- Most Medicaid plans (though this varies by state)
- Compounded semaglutide — almost universally excluded
- When prescribed off-label (e.g., Ozempic for weight loss in non-diabetics)
Let Ro handle your insurance coordination
Ro's care team will check your coverage and handle prior authorization paperwork — included in their membership.
Start with Ro →How to Appeal a Denial
If you're denied coverage for Wegovy or a GLP-1 drug, you have the right to appeal. Here's the process:
- Get your denial in writing — request the specific reason code from your insurer
- Have your doctor submit a Letter of Medical Necessity — this should document your BMI, comorbidities, and prior weight loss attempts
- Request a peer-to-peer review — your doctor speaks directly with the insurer's medical reviewer
- File a formal appeal — insurers are required to provide an appeals process; success rates are higher than most people expect
- Contact your state insurance commissioner if the appeal is denied — especially if you have documented medical necessity
If Insurance Won't Cover It: Your Best Options
Most people end up self-paying. Here's how to minimize cost:
- Compounded semaglutide through Hims & Hers or Ro — same active ingredient, 70–80% cheaper than brand name. Not covered by insurance, but makes the math work.
- Novo Nordisk savings cards — Wegovy has a $0/month copay card for eligible commercially insured patients. Check WegovySavings.com.
- GoodRx — can reduce out-of-pocket brand-name costs by 20–40% at certain pharmacies.
Most affordable path: Hims & Hers
Compounded semaglutide starting from $79/month — all-in, no separate membership fee. Medical consultation included.
See Hims & Hers Pricing →