Health insurance plans frequently deny new weight loss medication claims

Health Insurance declined - weight loss medication

Patients are finding that the drugs they were hoping would help them fight obesity might not be an option.

Obesity patients prescribed new weight loss medications are discovering that the drugs they were counting on to help them to reduce their BMI often aren’t covered by their health insurance plans.

Medications such as Wegovy have been making headlines since they received FDA approval.

Many obesity patients who were desperate for a new option to try to treat their disease were thrilled when they heard that there were new medications available. This situation only seemed to improve as some of them were actually prescribed the drug by doctors who believed that the drugs could support their efforts to make lifestyle changes that would bring their weight within a healthy range.

weight loss drugs not covered by health insurance

However, disappointment often arrives when asking health insurance companies whether their plan covers the drug or, worse, when they submit a claim under the assumption that the drug was covered, only to discover that it was not.

The medication is expensive and is often cost prohibitive when health insurance doesn’t cover it.

Wegovy, for instance, can come with a monthly price tag of over $1,300 without coverage. Unfortunately, that is well beyond what most people can afford, particularly if they need to use it for several consecutive months in order to reach a target weight.

In the case of Wegovy, many patients need to keep using it over time in order to keep their hunger controlled. Stopping its use can cause the powerful hunger pangs to return, causing patients to risk their weight loss progress and the reduced health risks that came with it.

The majority of employer health insurance plans won’t cover GLP-1 drugs such as Wegovy or Zepbound, despite their approval and popularity. In fact, many plans won’t cover any obesity medications intended to support weight loss. The same can be said for Medicare coverage.

Survey data released by the International Foundation of Employee Benefit Plans and Savanta, an employee research firm showed that only about 1 in 4 employers in October 2023 – when the survey was conducted – offer plans covering GLP-1 drugs for weight loss. That said, both organizations indicated that a growing number of employers – a figure as high as 43 percent – intend to expand their health insurance coverage to include those medications in 2024.

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