GLP-1 Insurance Coverage Guide

Insurance coverage for GLP-1 medications is patchy and changes frequently. This guide covers what's typically covered, what requires prior authorization, and how to navigate by carrier.

Coverage by indication

Prior authorization criteria (typical)

• BMI ≥30, OR BMI ≥27 with at least one comorbidity.
• Documented lifestyle intervention attempt (3–12 months).
• Documented obesity-related condition.
• No contraindications.
• Some plans require step therapy.

By major carrier

• UnitedHealthcare
• Anthem BCBS
• Aetna
• Cigna
• Kaiser Permanente
• Medicare Part D

If your plan excludes weight-management drugs

1. Check eligibility under a different indication (CV risk reduction for Wegovy; T2D if newly diagnosed; OSA for Zepbound).
2. Ask employer/HR about adding coverage next plan year.
3. Consider cash-pay: compounded GLP-1 or manufacturer cash programs.
4. Appeal denials; document medical necessity carefully.