Insurance coverage for GLP-1 weight loss medications has expanded significantly in 2025 but remains complex to navigate.
Private Insurance
~50-60% of large employer plans now cover at least one GLP-1 for weight management (up from ~25% in 2022). Requirements: documented BMI ≥30 or ≥27 with comorbidity, prior authorisation, often documentation of prior weight loss attempts. Many require step therapy — trying less expensive options first.
Medicare (2025)
Medicare Part D now covers Wegovy for patients with established cardiovascular disease — following the SELECT trial showing 20% reduction in major cardiac events. Coverage for obesity without cardiovascular disease remains limited but is subject to ongoing legislation.
Medicaid
Coverage varies by state. ~30 states now cover at least one GLP-1 for obesity. California, New York, and Massachusetts have comprehensive coverage. Check your state's Medicaid formulary for current status.
Coverage Summary by Drug
- Ozempic: Widely covered for T2D; off-label obesity coverage varies
- Wegovy: Increasingly covered for obesity with comorbidities
- Zepbound: Growing coverage; prior auth almost always required
- Mounjaro: Covered for T2D; obesity off-label varies by plan
Appealing a Denial
Include: physician letter of medical necessity, BMI and comorbidity documentation, record of prior weight loss attempts, references to clinical guidelines (AHA/ACC, Obesity Medicine Association). First-level appeals succeed ~50% of the time.