Weight Loss Medications Covered by Insurance: A Guide to 22 Covered Options

Introduction

Overweight and obesity affect millions of Americans, increasing their risk of various health conditions such as heart disease, stroke, and diabetes. Weight loss medications can be an effective tool to help individuals shed excess weight and improve their overall health. However, the cost of these medications can be a barrier for many. Fortunately, many insurance plans, including Medicare and Medicaid, cover weight loss medications under certain conditions.

Covered Medications

The specific weight loss medications covered by insurance vary depending on the plan and the patient's individual circumstances. However, common medications that are often covered include:

• Orlistat (Xenical)
• Lorcaserin (Belviq)
• Bupropion-naltrexone (Contrave)
• Phentermine
• Diethylpropion
• Liraglutide (Saxenda)
• Naltrexone (Revia)
• Topiramate
• Metformin

Coverage Criteria

Insurance coverage for weight loss medications is typically based on the following criteria:

• Body Mass Index (BMI): Most plans require patients to have a BMI of 30 or higher, or a BMI of 27 or higher with a related health condition.
• Medical History: Patients must generally have a history of being overweight or obese for at least 6 months.
• Current Health Status: Patients must be in good overall health and not have any contraindications to weight loss medications.
• Prior Treatments: Some plans may require patients to have tried other weight loss methods, such as diet and exercise, without success.

Coverage Limitations

Insurance coverage for weight loss medications is often subject to the following limitations:

• Time Limit: Some plans may limit the number of weeks or months that weight loss medications are covered.
• Dosage Restrictions: Plans may also restrict the dosage or type of weight loss medication that is covered.
• Prior Authorization: Many plans require patients to obtain prior authorization from their doctor before they can fill a prescription for a weight loss medication.

How to Find Coverage

Individuals can find out if their insurance plan covers weight loss medications by contacting their insurance provider or visiting their insurance plan's website. They can also speak to their doctor for more information and guidance.

Conclusion

Weight loss medications can be a safe and effective way to help individuals lose weight and improve their health. Many insurance plans cover these medications under certain conditions. By understanding the coverage criteria and limitations, individuals can determine if they are eligible for coverage and take steps to access these medications.

Tables

Table 1: Common Weight Loss Medications Covered by Insurance

Table 2: Coverage Criteria for Weight Loss Medications

Table 3: Coverage Limitations for Weight Loss Medications

Table 4: Benefits of Weight Loss Medications