Why Do Most Insurance Companies Deny Coverage for Zepbound & Wegovy
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Why Do Most Insurance Companies Deny Coverage for Zepbound & Wegovy
Insurance coverage depends on your plan, and there are several reasons why insurance may not cover it, including:
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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.
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Cost -non-generic, expensive medications may denied by your insurance company due to cost.
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Plan benefits -Your plan's prescription drug benefits may not cover it.
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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
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Does my insurance plan cover the Zepbound pen?
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How will my insurance plan determine eligibility? Prior Authorization will likely be required and still does not guarantee insurance will pay.
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Is your BMI high enough
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Failed on other weight loss plans such as diet and exercise?
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Have you completed weight loss counseling?
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If my insurance plan does cover the Zepbound pen, how much will I pay?
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Are there any specific steps my doctor needs to take before my coverage can be approved, such as submitting a prior authorization (PA) form?
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What is my insurance plan’s deductible (the amount you need to pay in healthcare costs before your insurance plan starts paying)?
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What is the amount that my insurance plan will cover?
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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, our Rocking Bod 2.0 Weight Loss Program offers an excellent, cost-effective alternative. This program includes the GLP-1 peptide, commonly known as semaglutide, providing a safe and effective solution for weight loss at an affordable price. Additionally, you may utilize your HSA funds to cover the program’s costs.