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- Wegovy (semaglutide) and Saxenda (liraglutide) are glucagon-like peptide-1 (GLP-1) medications approved by the FDA to treat obesity. Doctors can also write off-label prescriptions for weight loss for Ozempic (semaglutide) or Mounjaro (tirzepatide). Off-label refers to when a physician prescribes a medication for a health condition that has not been approved by the FDA.
- Without insurance, the average out-of-pocket cost is between $900 and $1,400 for a one-month supply of a brand-name GLP-1 medication.
- Working closely with a healthcare provider or a service like Robin by One Drop can improve your chances of getting a GLP-1 medication like Wegovy covered by insurance.
Weight loss can be difficult, especially for moms. You're busy caring for your kids, running a household, and maybe even working outside the home. But you also know that being overweight or obese can put you at risk for health problems like heart disease, stroke, and diabetes.
If you're looking for a safe and effective way to lose weight, a glucagon-like peptide-1 (GLP-1) medication or GLP-1 agonist may be a good option. But with insurers pulling back on coverage as demand for GLP-1s like Ozempic and Wegovy surges, getting a GLP-1 prescription can be prohibitively expensive and complicated.
In this blog post, we'll explain how to get Wegovy covered by insurance or gain coverage for another GLP-1 and what to do if you're denied coverage.
Demystifying GLP-1s and Their Benefits
GLP-1 receptor agonists are medications that mimic the action of a naturally occurring hormone in your body, glucagon-like peptide-1. While initially developed for diabetes management, they've gained traction for their remarkable impact on weight loss. GLP-1s work by inhibiting glucagon production and slowing digestion. The results—improved blood sugar control, feelings of fullness, and reduced appetite—can make it easier to shed extra pounds.
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Beyond weight loss, some GLP-1 medications can also support heart health for people with or without type 2 diabetes. For example, a five-year clinical trial by Novo Nordisk showed significant cardiovascular health benefits for patients who stay on Wegovy, citing a 20% reduction in risk of heart attack, strokes, and cardiovascular deaths.
Popular brands of GLP-1 medications include Ozempic (semaglutide), Wegovy (semaglutide), Saxenda (liraglutide), and Trulicity (dulaglutide). Mounjaro (tirzepatide) is a dual GLP-1/GLP receptor agonist, but is often grouped with the other GLP-1s.
Wegovy and Saxenda are FDA-approved for weight loss. However, your doctor may write you an off-label prescription for Ozempic or Mounjaro for weight loss if they feel the medication is your best option.
How Much Do GLP-1s Like Ozempic Cost?
Much like insulin and other commonly prescribed medications, the out-of-pocket (OOP) cost for a one-month supply of a GLP-1 medication may shock you. Ultimately, the price you’ll pay for Ozempic or another GLP-1 will come down to your insurance coverage, the condition you’re trying to treat, and your pharmacy of choice.
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Average Monthly Out-Of-Pocket Cost (USD) |
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$935.77 |
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$1,349.02 |
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$1,349.02 |
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$930.88 |
|
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$1,023.04 |
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Savings Programs
With a valid prescription and insurance coverage, you may be eligible for savings from the GLP-1 manufacturer, like Eli Lilly, who offers a savings card for Mounjaro. Novo Nordisk offers a savings card for Ozempic and Wegovy, as well as a patient assistance program for those who meet strict eligibility criteria, including a household income that puts you at or below 400% of the federal poverty line.
Cracking the Insurance Coverage Code
Whether you're dealing with home, auto, or, in this case, health insurance, securing adequate coverage involves a series of steps that require patience and understanding. Here’s a breakdown of how to navigate this process efficiently.
Talk to your doctor
Insurance coverage for GLP-1 medications begins with a prescription from a licensed provider. You can schedule an appointment with your primary care physician or obtain a prescription through an online weight loss program like Robin by One Drop, which facilitates a virtual GLP-1 treatment consultation through our provider partner, OpenLoop.
Try the only GLP-1-supported weight loss program designed specifically for moms. Find out if you’re eligible ▸
Prepare for your doctor's appointment by reviewing our list of health, family history, and weight loss journey questions. Your answers will help inform whether a weight loss medication could be right for you.
- Do you have any preexisting physical or mental health conditions?
- Does anyone in your family have a history of physical or mental health conditions?
- Are you currently taking any medications?
- Are you currently breastfeeding?
- Are you currently pregnant or do you plan to become pregnant in the next six months?
- What weight loss methods have you tried to date and how did your body respond?
- What are your weight loss goals?
- Are you comfortable with needles and self-injecting medication?
Find out if your insurance covers GLP-1 medications
Most insurance plans cover a medication for its FDA-approved condition(s). Saxenda and Wegovy are FDA-approved for weight loss for people with a BMI of 30 or greater or with a BMI of 27 or greater and a weight-related condition, such as type 2 diabetes, high blood pressure, or high cholesterol. So, your insurance plan is more likely to cover Saxenda or Wegovy for weight management compared to Ozempic or Mounjaro, both of which are FDA-approved for type 2 diabetes.
However, if a provider is prescribing Ozempic or Mounjaro off-label for weight loss, they typically follow the same BMI guidelines as Saxenda and Wegovy. If your BMI measurements do not fall within this range, be prepared for your doctor to recommend an alternative weight loss intervention.
With or without assistance from a GLP-1 agonist, a healthy diet and regular exercise are critical components of a successful weight loss strategy.
Familiarize yourself with your insurance policy's prescription medication coverage. Look for clauses related to weight management or non-diabetic uses of medications. This knowledge will empower you during interactions with insurance representatives.
Submit a strong case to your insurance company
Once your provider is ready to prescribe you a GLP-1, they will submit forms to your insurance company citing their recommendation, your medical history, lab results, and other evidence.
With Robin by One Drop, once approved for a GLP-1 medication, we can help manage the insurance process by verifying your benefits, submitting for prior authorization if required, and sending your prescription to the pharmacy of your choice.
What if My Insurance Won’t Cover a GLP-1 for Weight Loss?
If your insurance denies a prior authorization request, they may ask for more information or suggest a more affordable alternative. In each scenario, you may request a secondary review of their decision.
If your insurance plan outright denies coverage for a GLP-1, you may want to pay out-of-pocket. Monitor prices at local and online pharmacies and look for promotions and coupons that discount GLP-1s. Commercial insurance plan policyholders may qualify for manufacturer savings cards. For those able to pay the list price for a GLP-1 medication, your monthly cost may be lower if you purchase a two- or three-month supply instead of a one-month supply.
Talk to your doctor about alternatives like Metformin and consider following the Robin program without a GLP-1 prescription. As mentioned, lifestyle changes are fundamental to long-term weight loss. Robin offers data tracking tools for food, activity, and other important health data, bite-sized, step-by-step learning modules, and access to a dedicated health coach who can answer your questions and offer support when you need it. Learn more about Robin by One Drop.
This article has been clinically reviewed by Hanna Rifkin, RD, CDCES, clinical health coach at One Drop.
