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Navigating Insurance for GLP-1 Weight Loss Medications: What You Need to Know

Rise Up Health


Hand filling a medical form with a black pen on a table. A stethoscope is placed nearby. The form includes patient information.

GLP-1 medications, like Semaglutide and Tirzepatide, have transformed the landscape of weight loss treatments. If you’re considering these medications, the first step is understanding whether your insurance plan covers Wegovy™ and/or Zepbound™ for weight loss. At Rise Up Health, we’re here to guide you through this process.


1. Understand Your Insurance Plan

Start by reviewing your insurance benefits. Look for coverage details on weight loss medications or treatments for obesity. Some plans may have exclusions, while others might require specific conditions, like a documented BMI threshold, or a certain diagnosis to approve GLP-1 medications such as Wegovy™ (Semaglutide) and/or Zepbound™ (Tirzepatide).


2. Contact Your Insurance Provider

Reach out to your insurance company directly. Be prepared with the following questions:

  • Does my plan cover GLP-1 medications for weight loss, such as Semaglutide or Tirzepatide?

  • Are there any pre-authorization requirements?

  • What out-of-pocket costs, such as copays or deductibles, should I expect?


3. Consult Your Healthcare Provider

At Rise Up Health, we specialize in personalized weight loss solutions. We can assist with obtaining pre-authorization if required by your insurance. Our team can provide the necessary documentation and work with your insurer to streamline the approval process.


4. Explore Alternative Options

If your insurance doesn’t cover these medications, don’t worry! We offer cash-pay options that make weight loss treatments affordable and accessible. Additionally, pharmaceutical manufacturers may provide savings programs or patient assistance for eligible individuals. Unfortunately, this is very limited with weight loss medications.


Novo Nordisk Patient Assistance Program: Provides medications at no cost to eligible patients.


Lilly Cares Foundation: Provides prescribed Lilly medications for free to qualifying U.S. patients.


Why Are Insurance Companies Limiting Coverage for GLP-1 Medications?

GLP-1 medications like semaglutide and tirzepatide have gained popularity as effective treatments for weight loss and metabolic health. However, many insurance companies are reevaluating their coverage for these medications, leaving patients with fewer options or higher out-of-pocket costs. Here’s a closer look at why this is happening and how Rise Up Health can help you navigate these changes.


High Demand and Rising Costs

As the demand for GLP-1 medications has skyrocketed, so have their costs. Insurance companies are often hesitant to cover expensive drugs, especially when prescribed for weight loss rather than for other approved conditions like Type 2 diabetes. This financial strain on insurance providers has led some to restrict or eliminate coverage.


Off-Label Usage Concerns

Many GLP-1 medications were initially approved for diabetes management. Their success in promoting weight loss has led to widespread use for weight loss, which insurers may see as an unnecessary expense. Some companies are now limiting coverage to patients with specific diagnoses, such as diabetes or obesity-related health complications, to control spending.


Lack of Long-Term Data

While GLP-1 medications have shown impressive short-term results, insurers have banded together and are using the excuse that there is a lack of long-term studies on their efficacy and safety for weight loss alone. This uncertainty makes some companies reluctant to fully cover these treatments in spite of repeated record setting earnings year over year.


Why Choose Rise Up Health?

At Rise Up Health, serving patients in multiple states via telehealth and in-person at our clinic location, we’re committed to helping you achieve your weight loss goals. Whether you’re considering GLP-1 medications like Semaglutide or Tirzepatide, or other treatment options, our team ensures transparency, affordability, and support every step of the way.


Take the first step towards better health today by scheduling a free consultation. Let us help you navigate insurance, explore cost-effective solutions, and create a plan tailored to your needs.


Visit the Rise Up Health Website to see if our services are a good fit for you and to schedule a free evaluation. www.riseupinfusions.com


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