Does Insurance Cover Weight Loss Medications?

Aetna  | Amerihealth Caritas | Anthem (Elevance) | Blue Cross Blue Shield | Centene Corporation | California Physicians’ Service (Blue Shield of California) | CareSource | Cigna | Emblem Health | GuideWell Mutual Holding (Florida Blue) | Health Care Service Corporation (HCSC) | Highmark Group | Humana | Independance Health Group | Kaiser Permanante | Medical Mutual of Ohio | Metropolitan Group | Molina Healthcare | United Healthcare | Wellcare Health Plans

Many people assume that if a physician prescribes a weight loss medication, insurance will help pay for it. In reality, coverage for anti-obesity drugs varies considerably between plans, insurers, and drug types. In this article, you’ll discover when insurance pays for weight loss medications, what criteria insurers use, how to handle denials or appeals, and alternatives when coverage isn’t available.

How Insurance Treats Obesity & Weight Loss Drugs

Obesity is now often recognized as a chronic disease rather than a cosmetic issue. Some health plans offer coverage for obesity screening, counseling, or bariatric surgery. But prescription medications—especially newer GLP-1 drugs—are often excluded or restricted. According to the National Association of Insurance Commissioners (NAIC), insurers typically do not cover weight loss injectables unless there’s a coexisting condition (e.g., diabetes or high cholesterol) or a documented medical necessity. NAIC

Are Weight Loss Medications Covered by Insurance?


Sometimes.

Insurance coverage for weight loss drugs varies significantly depending on the provider, the plan, and the patient’s medical condition. Some plans—such as those offered by Aetna, Blue Cross Blue Shield, and others—may cover FDA-approved medications like Wegovy, Saxenda, or Zepbound when prescribed for obesity and associated health conditions like Type 2 diabetes or hypertension. However, coverage is often subject to strict criteria, such as a minimum BMI, documented comorbidities, and failed attempts at diet and exercise alone.

Which Weight Loss Drugs Are Commonly Covered?


Covered medications may include:

Coverage for these drugs typically requires a diagnosis of obesity (BMI ≥30) or overweight (BMI ≥27) with at least one obesity-related condition.

What Conditions Must Be Met for Coverage?


Weight loss medications may be covered when:

  • The patient meets BMI or comorbidity criteria.
  • The medication is FDA-approved and prescribed for a medical need.
  • Previous attempts at lifestyle changes have failed.
  • The drug is deemed medically necessary by a healthcare provider.

Does Insurance Require Pre-Authorization?


Yes, often.

Many insurers require prior authorization before approving weight loss medication. Your healthcare provider must submit documentation that includes diagnosis, treatment history, BMI, and justification for medical necessity.

Are There Limits on Coverage?


Yes.

Insurance companies may restrict coverage to specific drugs, set annual caps on spending, or require step therapy (trying lower-cost alternatives first). Some plans may only cover weight loss drugs when used to treat other medical conditions, such as diabetes.

How Do I Get Pre-Authorization?


Your provider must submit a formal prior authorization request to your insurance company. This should include:

  • Your current weight and BMI
  • Documentation of other weight loss attempts
  • The prescribed drug and dosage
  • A detailed medical justification

Is a Referral Needed from My Primary Care Physician (PCP)?


Possibly.

Some insurance plans—especially HMOs—may require a referral from your PCP before beginning treatment with a weight loss drug. PPO plans may allow direct access.

Do I Need to Use Specific Pharmacies or Providers?


Yes.

Using in-network providers and pharmacies is often required to receive full insurance benefits. Specialty medications may need to be filled through preferred mail-order or specialty pharmacies.

Can I Get Reimbursed for Out-of-Pocket Weight Loss Drug Costs?


Maybe.

Some plans offer partial reimbursement for FDA-approved weight loss drugs if filled out-of-network. Others do not cover out-of-network prescriptions at all. Always confirm with your insurer.

Where Can I Find More Information?


Visit your health insurance provider’s official website or call customer service for details about your specific plan. Coverage for weight loss drugs changes frequently, so it’s important to verify eligibility and requirements before starting treatment.

Insurances That Cover Weight Loss Medications


Click the specific drug name for your insurance company below to learn more about their specific policies.

Aetna


Aetna (now part of CVS Health) provides selective coverage for FDA-approved weight loss drugs such as Wegovy, Zepbound, and Saxenda, primarily when used for medical obesity or related chronic conditions. Coverage generally requires meeting strict clinical criteria, including a BMI of 30 or more, or 27 with associated comorbidities, along with documented attempts at lifestyle modifications. Aetna also typically requires prior authorization and may limit access through step therapy protocols. While many members appreciate the availability of these advanced treatments, others find the approval process to be restrictive and inconsistent.

View Specific Coverage For:

Semaglutide (Wegovy or Ozempic) | Tirzepatide (Zepbound or Mounjaro) | Liraglutide (Saxenda) | Phentermine–Topiramate (Qsymia) | Bupropion–Naltrexone (Contrave)

Blue Cross Blue Shield (BCBS)


Blue Cross Blue Shield plans may offer coverage for prescription weight loss drugs, but this varies by state and plan. Some BCBS affiliates include medications like Wegovy or Zepbound when prescribed for clinically obese patients who meet strict medical necessity guidelines. Pre-authorization is common, and step therapy rules may apply. BCBS plans often restrict coverage based on BMI thresholds and diagnosis of weight-related conditions. Members should review their specific state or employer plan for details.

View Specific Coverage For:

Semaglutide (Wegovy or Ozempic) | Tirzepatide (Zepbound or Mounjaro) | Liraglutide (Saxenda) | Phentermine–Topiramate (Qsymia) | Bupropion–Naltrexone (Contrave)

Cigna


Cigna may cover certain weight loss medications when medically necessary, but only under select plans. Coverage typically applies to drugs like Saxenda or Wegovy and often requires prior authorization, evidence of lifestyle intervention, and a diagnosis of obesity or related health issues. Patients may also face limitations based on dosage, length of treatment, or type of drug. Coverage is most likely in employer-sponsored or marketplace plans that include obesity treatment benefits.

Learn more…

United Healthcare (UHC)


UnitedHealthcare provides weight loss medication coverage under some of its employer-sponsored and commercial plans. Drugs such as Wegovy, Zepbound, and Saxenda may be covered with prior authorization. Requirements usually include a qualifying BMI, documentation of obesity-related health risks, and previous lifestyle treatment efforts. UnitedHealthcare may limit the quantity or duration of medication coverage.

View Specific Coverage For:

Semaglutide (Wegovy or Ozempic) | Tirzepatide (Zepbound or Mounjaro) | Liraglutide (Saxenda) | Phentermine–Topiramate (Qsymia) | Bupropion–Naltrexone (Contrave)

Humana


Humana offers coverage for certain FDA-approved weight loss drugs, primarily through its Medicare Advantage and commercial plans. Eligibility is based on diagnosis, BMI criteria, and prior use of non-pharmacological treatments. Pre-authorization is typically required, and not all plans include obesity medications in their drug formularies. Patients should contact Humana to understand benefit eligibility.

Learn more…

Kaiser Permanente


Kaiser Permanente covers some weight loss drugs for members with qualifying conditions under specific plans. Coverage often depends on integrated provider recommendations, medical necessity documentation, and participation in Kaiser’s weight management programs. Formularies vary by region, so members should check with their local Kaiser pharmacy and provider.

Learn more…

Molina Healthcare


Molina Healthcare may include weight loss medications in its Medicaid and marketplace plans, depending on state-level decisions. Coverage is usually limited and requires prior authorization, clinical documentation, and adherence to strict usage criteria. Some Medicaid plans may not include these drugs at all, so confirmation is necessary.

Learn more…

WellCare Health Plans


WellCare may provide limited coverage for weight loss medications under its Medicare Advantage or Medicaid programs. Typically, benefits are available when the drugs are used for treatment of obesity-related illnesses and require full documentation, including prior authorization and evidence of need. Not all plans offer this benefit.

Learn more…