GLP-1 medications like Ozempic, Wegovy, Zepbound, and Mounjaro are gaining attention for their role in managing type 2 diabetes and supporting weight loss. However, access can be difficult due to limited insurance coverage, high costs, and confusion around eligibility criteria. Additionally, some GLP-1s are prescribed off-label for weight loss, which may impact whether the medication is covered under your plan.
Here’s what you need to know, whether you are managing your own care or supporting employee wellness.
1. What Are GLP-1s?
GLP stands for Glucagon-Like Peptide. GLP-1s are medications that mimic a natural hormone. The medication works to:
- Regulate blood sugar
- Slow digestion
- Reduce appetite
Some GLP-1s are FDA-approved for the treatment of type 2 diabetes, while others are approved for weight management, but coverage depends on the diagnosis. GLP1-s were originally prescribed for diabetes management, and now their role in weight management gained attention following FDA approval of Saxenda in 2014. This expanded further when Wegovy received FDA approval for chronic weight management in 2021. Despite these advancements, GLP-1s prescribed for weight loss still tend to face more restrictive insurance coverage compared to those used for diabetes treatment.
2. Why Is Coverage Complicated?
- Insurance restrictions: Not all insurance plans include weight-loss medications.
- Prior authorizations: Insurance companies require BMI thresholds, records of previous compliance to lifestyle changes, or failed response to other treatments.
- Cost: Without insurance, monthly costs can vary but are approximately $1,000 per month.
Coverage for GLP-1s depends heavily on the diagnosis, health plan, and insurer policies. In most cases, a healthcare provider must obtain prior authorization, meaning they must get approval from the insurance company before prescribing the medication. Additionally, the high cost of GLP-1s can create barriers for access.
3. How to Check Your Coverage for Employers
- Contact your insurance provider and your broker and ask if your plan covers the specific medication.
- Ask if the healthcare providers who are in-network for your plan need to submit prior authorization, and when is that needed.
- Ask your broker to check your plan’s online drug formulary and provide advice.
Your role in the HR department may also be where employees go to first to ask questions about coverage, especially if you’re on an employer-sponsored plan. Taking the time to understand your coverage upfront can save time and avoid unexpected costs later.
4. Why Does This Matter?
- Supporting access to GLP-1s may help improve employee health outcomes.
- Employee satisfaction increases when GLP-1s are covered.
- Untreated obesity and diabetes lead to higher healthcare costs and absenteeism.
Studies show that when GLP-1s are covered, employers often see improved satisfaction with health benefits and increased participation in wellness programs. With chronic conditions like obesity and diabetes impacting overall well-being, supporting employees with both medication access and lifestyle resources builds a healthy and productive workforce.
4. Working with a Registered Dietitian Nutritionist
Whether you’re considering a GLP-1 medication or already taking one, nutrition counseling is a viable part of long-term success. These medications can support blood sugar and weight management, but they work best when paired with healthy lifestyle habits.
Understanding how to fuel your body properly and build sustainable habits can help you feel your best, support the effectiveness of the GLP-1s, and improve long-term health. For those not on GLP-1s, working with a Registered Dietitian is an effective approach to managing obesity, diabetes, and related conditions through lifestyle changes.
If you’re not sure whether nutrition counseling is included in your benefits, contact your health insurance provider or, if you have employee-sponsored insurance, speak with your HR department.
B.Komplete offers educational and engaging programs led by Registered Dietitians to support your health and well-being. We also offer one-on-one wellness counseling and coaching for employees seeking individualized support. Click here to view all of our Nutrition and Food Programs.
Navigating GLP-1 coverage can feel overwhelming, but staying informed helps. Whether you’re looking into these medications for yourself or guiding someone else, understanding eligibility criteria, required documentation, and available resources is key.
At B.Komplete, we help organizations create healthier workplaces through tailored wellness programs, education, and interactive activities. If you’re looking to support your team’s health with the right resources and guidance, we’re here to help. Contact beryl@bkomplete.com to schedule a Corporate Wellness Consultation and support the health of your employees.
This blog post is for informational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Coverage for GLP-1 medications may vary by individual insurance plans and provider policies. Employees should consult with their healthcare provider and insurance company for personalized medical and coverage information.