Is GLP-1 Covered by Insurance? Criteria, Copay, Appeal
Most plans cover GLP-1 medicines for type 2 diabetes; for weight loss it depends on the plan, and Medicare covers it only through the GLP-1 Bridge. Pick your insurer and the reason to see the rule that applies.
Check your GLP-1 coverage
Half-life and weight loss in brief
Half-life in days measures how long your body needs to remove half a dose. This figure comes from section 12.3 in each FDA label.
Body weight percentage. Trials, doses, and lengths vary, so compare each result with the placebo on its own page.
Coverage by insurer
| Insurer | Type | For weight loss | For type 2 diabetes | Prior authorization |
|---|---|---|---|---|
| Medicare | federal program | bridge program only | covered by Part D plans | Yes medicare.gov |
| Medicaid | state programs | varies by state | covered | Yes KFF |
| Aetna | commercial insurer (CVS Health) | employer option | covered on formulary | Yes aetna.com |
| Blue Cross Blue Shield | federation of independent plans | plan dependent | covered on formulary | Yes bluecrossma.org |
| Cigna (Evernorth / Express Scripts) | commercial insurer | plan dependent | covered on formulary | Yes static.cigna.com |
| UnitedHealthcare (Optum Rx) | commercial insurer | plan dependent | covered on formulary | Yes uhcprovider.com |
| Kaiser Permanente | integrated insurer | plan dependent | covered on formulary | Yes healthy.kaiserpermanente.org |
| Humana | Medicare Advantage insurer | bridge program only | covered by Part D plans | Yes humana.com |
| TRICARE | military health plan | Prime and Select only | covered with PA | Yes militaryrx.express-scripts.com |
| VA (Veterans Health Administration) | federal health system | covered with criteria | covered | Yes va.gov |
| GEHA | federal employee plan | covered with PA | covered | Yes geha.com |
| Ambetter (Centene) | ACA marketplace insurer | excluded | covered on formulary | Yes ambetterhealth.com |
| ACA Marketplace plans | individual market | rare | common | Yes KFF |
| CVS Caremark | pharmacy benefit manager | plan sponsor choice | covered on formulary | Yes cvshealth.com |
| Express Scripts | pharmacy benefit manager (Cigna) | plan sponsor choice | covered on formulary | Yes express-scripts.com |
| Optum Rx | pharmacy benefit manager (UnitedHealth) | plan sponsor choice | covered on formulary | Yes welcome.optumrx.com |
| Navitus | pharmacy benefit manager | plan sponsor choice | covered on formulary | navitus.com |
| Amerigroup (Elevance Medicaid) | Medicaid managed care | follows state Medicaid | covered with PA | Yes provider.amerigroup.com |
Policies (18)
medicare.gov, KFF 1 2, aetna.com, bluecrossma.org, static.cigna.com, uhcprovider.com, healthy.kaiserpermanente.org, humana.com, militaryrx.express-scripts.com, va.gov, geha.com, ambetterhealth.com, cvshealth.com, express-scripts.com, welcome.optumrx.com, navitus.com, provider.amerigroup.com.
If your plan says no
How prior authorization works
Prior authorization means your prescriber sends proof to the plan that you meet its rules. Usually that means a BMI of 30, or 27 if you have a weight-related condition. Sometimes a diet program comes first. For renewal, you often need proof of the weight you have lost.
