Does Workplace-Sponsored Insurance Cover Anti-Obesity Medications?

If you are considering taking injectable anti-obesity medication such as Wegovy or Zepbound, you will also have to consider the cost.

The medications, which belong to a class of drugs called glucagon-like peptide (GLP-1) receptor agonists, have list prices of over $1,000 per month. While people with health insurance through their employer or the Affordable Care Act (ACA) typically have coverage for medications, fewer than 30% of employers currently cover GLP-1s indicated for weight loss, according to a fall 2023 survey by the International Foundation of Employee Benefit Plans. When similar medications, like Ozempic and Mounjaro, are prescribed for diabetes, the likelihood of coverage increases to 76%.

ACA health insurance plans are not required to cover anti-obesity medication.

Rick Kelly, National Practice Leader at professional services firm Marsh McLennan, told Verywell more employers used to cover anti-obesity medication and related diabetes medications, but the popularity of GLP-1s has prompted them to pump the brakes.

“A couple of years ago, that number was much higher,” Kelly said. “It was probably around 70% to 75% [of employers] before people really understood the financial exposure of covering those drugs.”

Employer Coverage Can Get Complicated

Moving forward, companies that agree to offer insurance coverage for GLP-1s may require employees to complete several steps.

“The question is going to be what processes, what prior authorizations, what utilization management programs will be in place,” Kelly said.

For instance, rather than just charging a copay, a workplace insurance plan may introduce its own prerequisites for a BMI threshold, mandate a patient try other medications, diet, or exercise plans first, and/or require a letter from a physician confirming the patient meets the company’s criteria for drug coverage.

Appealing an insurer’s decision to deny coverage is possible. But Kelly said that, in 2024, you’re not likely to have much success. Appeals allow insurers and employers to learn about treatments they might not have been aware of.

“There are very few employers in the country who don’t know about these drugs at this point,” Kelly said. “They have probably already been approached by employees if they’re not covering this drug.”

Will Insurance Coverage For Anti-Obesity Medications Improve?

There are some potential bright spots when it comes to coverage of GLP-1s, but likely not during 2024. For example, while Medicare does not cover weight loss drugs at all—by law, they are not permitted to—pending legislation called the Treat and Reduce Obesity Act could change that. It will probably take several years to take effect, Juliette Cubanski, deputy director of the Program on Medicare Policy at health research firm KFF, told Verywell. 

More immediately, new uses of medications initially intended for obesity could prompt coverage for those indications. For example, the Food and Drug Administration (FDA) recently added an indication to Wegovy for the prevention of cardiovascular events in people who have obesity or overweight and have heart disease. Insurers, including Medicare, are now covering that use.

There are ongoing clinical trials studying the use of GLP-1 drugs for a range of conditions beyond obesity, including kidney disease and sleep apnea. FDA approvals of those uses could prompt insurers to cover the drugs for those indications.

“Going forward, it may be harder and harder not to cover them as we see indications expand,” Andrea Ducas, vice president for health policy at the Center for American Progress in Washington, D.C., told Verywell. “But the prices could also drop as new weight loss drugs enter the market, and one or more become subject to Medicare price negotiation, which, if successful, would put downward pressure on the price of the drugs for other payers.”