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Insurance Coverage: Coverage Likelihood: Most Likely to Be Covered: Ozempic for type 2 diabetes (diabetes indication) Mounjaro for type 2 diabetes (diabetes indication) Sometimes Covered: Wegovy for weight loss (if plan covers obesity treatment) Zepbound for weight loss (newer, fewer plans cover) Rarely Covered: Weight loss medications on most plans Medicare/Medicaid dont cover for weight loss (federal law) Typical Copays (If Covered): Tier 2 (preferred): $25-$75/month Tier 3 (non-preferred): $100-$200/month Specialty tier: $200-$300/month or 25-33% coinsurance Prior Authorization Requirements: Insurance Typically Requires: Documentation of: BMI 30 or BMI 27 with comorbidities (documented) Failed weight loss attempts (6-12 months documented diet/exercise) Medical necessity letter from provider No contraindications May Also Require: Nutrition counseling documentation Exercise program participation Weight loss journal Commitment to lifestyle modifications Regular follow-up appointments Timeline: Prior authorization: 1-4 weeks processing Appeals if denied: Additional 2-8 weeks No guarantee of approval Manufacturer Savings Programs: Eli Lilly (Mounjaro/Zepbound): Savings Card: May reduce cost to $25/month Requirements: Commercial insurance (not Medicare/Medicaid) Not available for: Uninsured cash-pay patients Income limits: May apply Novo Nordisk (Wegovy/Ozempic): Savings Card: May reduce cost to $25/month Requirements: Commercial insurance (not Medicare/Medicaid) Not available for: Uninsured cash-pay patients If you qualify for savings cards, brand-name medications become very affordable ($25-$50/month)

May 17, 2023

GLP 1 therapy helps control these risk factors at the root level

Use this checklist before signup if you are close to choosing a program