How to get insurance to cover weight loss medication in 2025

Key takeaways:

1. To get GLP-1 treatment covered by your health insurer, confirm your plan offers GLP-1 medication benefits. 
2. Then, have your provider file a prior authorization (PA) request detailing that the treatment is medically necessary. For weight loss, the PA may include your BMI and related conditions like high cholesterol, hypertension or sleep apnea.
3. In 2024, insurers denied 62% of GLP-1 prescription coverage requests. If they initially reject yours, you can resubmit the prior authorization with additional supporting details or appeal the denied claim. 

Brand-name glucagon-like peptide 1 (GLP-1) medications like Wegovy®* (Semaglutide) and Zepbound®*(Tirzepatide) come with high out-of-pocket price tags. They’re also expensive for insurers, which is why many plans don’t automatically cover their cost.

But according to one report, 42% of adults under 65 with private insurance qualify for GLP-1 coverage. To get your treatment covered, check your insurance benefits, file a prior authorization, get a copy of your claim file, and, if necessary, appeal denied requests.

Here’s a breakdown of the coverage process—and where Dr. B can help.

1. Check your insurance coverage for weight loss drugs

First, you need to confirm your insurance plan covers the cost of GLP-1 medications for any patient. Look through your plan documentation, put the medication name into the search tool on your online insurance portal, or call your insurance company. This free online GLP-1 benefit checker from Dr. B does the hard work for you!

If your plan covers prescription weight loss medications, your documentation will also most likely show the estimated medication copay amount (what you’ll pay for the medication at your pharmacy). But such benefit confirmation does not mean your insurance will automatically pay for treatment. Most plans require proof that you need the medication, which they’ll require via a prior authorization request.

2. Have your provider submit a prior authorization request

To prove to your insurer that a weight loss prescription is medically necessary, your provider may file a prior authorization (PA) request sharing details about your medical history, like your body weight and body mass index (BMI). They may also relay medical problems that GLP-1 treatment could improve, like high blood pressure (hypertension), high cholesterol, sleep apnea or diabetes.

If you get insurance through your employer, the insurer may request that you try other prescription drugs or a non-medical diet and exercise program before they consider coverage.

3. Be patient, but follow up

Insurers usually deliver filed PA results within a few business days. Some can take longer—maybe a week or more. If you haven’t received results within a reasonable window, check in with your insurer or the provider who submitted the request. Make sure no missing information delays your results.

(Patients of Dr. B’s holistic prescription weight loss program, Shed It, should connect with our Patient Success team via chat or email. We’ll have details on your PA status to share!)

4. Understand a denied request

Around 30-35% of prior authorization requests for GLP-1 treatment are approved. If you feel yours was wrongly denied, check to make sure all submitted information was accurate.

Then, discuss with your provider what additional information may help. They may have you take a blood test to show you have elevated blood glucose (A1C), high cholesterol or high blood pressure levels. These can confirm that GLP-1 treatment is medically necessary.

5. Submit a new prior authorization request

If your insurer denied your first prior authorization request, submit a new request. Have your provider include any additional information that might confirm GLP-1 treatment is medically necessary. This resubmission process can be much faster than appealing a denied request.

6. Appeal a denied prior authorization

If your insurer denies your PA repeatedly and you believe the denial is in error, you can officially appeal it. First, request the claim file from your insurer: this internal document details all points that contributed to the denial. Oftentimes, insurers will blame their denial on patients or providers, saying they did not supply needed information. But you may also spot cost-cutting or administrative errors that wrongly lead to denials.

Legally, insurers must send a copy of the claim file within 30 days when requested. Only 1 in 10 patients appeal a denied claim, and it can take 90 days for insurers to process an appeal. But for patients who appeal, up to 80% have their denial overturned!

7. Consider alternative medications

If you have a BMI of 30 or above, you may qualify for GLP-1 treatment. Below that, you’ll need a BMI of at least 27 and one related health issue.

Even with these parameters, your insurer may not offer GLP-1 medication benefits to any enrollee. If they don’t cover the medication your provider recommends, ask to discuss a different kind of medication or a different GLP-1. As their costs differ, so does their coverage!

Summary

Over 40% of adults under 65 qualify for GLP-1 insurance coverage. Confirm your plan offers GLP-1 benefits by calling your insurer, looking into your documentation, or trying a free GLP-1 insurance checker. Have your provider submit a prior authorization (PA) request detailing why you need treatment. If your insurer denies the request, submit a new PA with additional information or appeal the denial. The process may seem laborious, but it will save you high out-of-pocket medication costs!

Wegovy® and Zepbound® are registered trademarks of their respective owners. Our use of these names is for informational purposes only and does not imply any affiliation, endorsement or approval by the trademark holders.

Sources:

Cassidy, John. (2024). How did we end up with such an opaque and costly health-care system? The New Yorker.

Gilbert, Daniel. (2025). Patients navigate an ‘absolutely insane’ maze to afford weight-loss drugs. Washington Post.

McGough, M. et al. (2024). How many adults with private health insurance could use GLP-1 drugs. KFF.

Miller, Maya. (2023). You have a right to know why a health insurer denied your claim. Some insurers won’t tell you*. ProPublica.*