Why Do Most Insurance Companies Deny Coverage for Zepbound & Wegovy

Why Do Most Insurance Companies Deny Coverage for Weight Loss Medications

Insurance coverage depends on your plan, and there are several reasons why insurance may not cover it, including:

• Weight loss medications are new -Insurance providers aren't required to cover weight loss medications, and it can take time for them to catch up.

• Cost -non-generic, expensive medications may denied by your insurance company due to cost.

• Plan benefits -Your plan's prescription drug benefits may not cover it.

• Employer coverage -If you have commercial insurance through your employer, your employer may not opt in to covering anti-obesity medications.

Questions to Ask Your Insurance Company About Your Zepbound (tirzepatide) Prescription

• Does my insurance plan cover the Zepbound pen?

• How will my insurance plan determine eligibility? Prior Authorization will likely be required and still does not guarantee insurance will pay.

  • Is your BMI high enough

  • Failed on other weight loss plans such as diet and exercise?

  • Have you completed weight loss counseling?

• If my insurance plan does cover the Zepbound pen, how much will I pay?

• Are there any specific steps my doctor needs to take before my coverage can be approved, such as submitting a prior authorization (PA) form?

• What is my insurance plan’s deductible (the amount you need to pay in healthcare costs before your insurance plan starts paying)?

• What is the amount that my insurance plan will cover?

• If my insurance plan does not cover the Zepbound pen, how much will I pay?

***Image is from the Zepbound Website:

If your insurance does not cover branded weight loss medications, we may have other medically guided weight loss programs that are right for you. Contact us for a complimentary consultation to learn your options. Text/Call 904-293-1692