For many patients ready to start on a GLP-1, the biggest hurdle isn’t the prescription, it’s the price. Insurance coverage for obesity drugs remains one of the most frustrating parts of the weight-loss journey. Even with growing evidence that obesity is a chronic disease, many plans still exclude the very medications designed to treat it.
San Diego internist and obesity specialist Eduardo Grunvald, MD sees this play out often. “If you have a commercial insurance, some policies completely just exclude these medications for people with just weight problems,” he says. “Some of them require prior authorization processes. The doctor has to do that.”
It’s a scenario that leaves patients confused and discouraged. “Many states just don’t cover them,” he adds about Medicaid. “That’s even changing, and coming 2026, many states are not going to cover them.”
Ahead, we’re diving into what to do if your insurance doesn’t cover these medications, with insight from Dr. Grunvald and New York internist and longevity expert Amanda Kahn, MD.
Featured Experts
- Eduardo Grunvald, MD is an internist and obesity medicine specialist in San Diego
- Amanda Kahn, MD is a board-certified internist in New York
The Documentation That Matters
When coverage is in question, strong documentation can make a difference. Dr. Kahn says a provider’s approach to testing and coding can impact outcomes. “Patients should confirm whether their plan specifically covers medications for obesity treatment and not just diabetes,” she explains. “Working with a provider who understands the nuances of coverage and prior authorization can be invaluable.”
That documentation often starts with comprehensive testing to establish a clear medical need. “When someone has been consistent with lifestyle habits but is still not achieving sustainable results, or shows early signs of metabolic imbalance such as visceral fat accumulation, elevated fasting insulin or PCOS, it’s time to move beyond lifestyle alone and consider a targeted medical approach.” These findings, she notes, can help strengthen the case for coverage by demonstrating that medication is medically necessary.
Check for Other Covered Indications
Dr. Grunvald explains that while Medicaid and commercial plans may deny coverage for obesity treatment, they might still approve the same medication under a different diagnosis. “If a patient has diabetes or prediabetes, those are often covered indications,” he explains. “In some cases, moderate to severe sleep apnea or certain cardiovascular conditions can also qualify, since these drugs have FDA-approved uses for those diagnoses.”
It’s worth reviewing your medical history and lab work with your provider to see whether related metabolic or cardiopulmonary conditions apply. This can make a significant difference in approval and ensure your documentation supports medical necessity.
When You Get a Denial
Even the most thorough paperwork doesn’t guarantee approval. “If you don’t have diabetes, some policies just exclude these drugs altogether,” says Dr. Grunvald. “That’s just the reality.”
So, what happens next? “There are cost savings options that can go directly through the manufacturer,” he explains. “Eli Lilly has a program. Novo Nordisk has a program where the medication is discounted to somewhere between four and five hundred dollars, which is about 50 percent of the retail cost.”
Dr. Kahn adds that patients who are denied can also explore “Eli direct vials, which are cash pay,” or “manufacturer coupons that can help.”
Recently, warehouse retailer Costco announced that it will offer GLP-1 drugs Ozempic and Wegovy to its members through its pharmacy program for $499 a month.
The Role of Compounding
While both experts agree that FDA-approved products are the standard, compounding under medical supervision has become a fallback option. “Other alternatives include compounding pharmacies, which provide bioequivalent versions of semaglutide or tirzepatide at a lower cost under medical supervision,” says Dr. Kahn.
Dr. Grunvald notes that compounding can be controversial, since quality varies between pharmacies. He urges patients to make sure any compounded medication comes through a reputable source working closely with a medical provider.
Looking Ahead
New oral GLP-1s may soon help fill the gap. “In 2026, oral medications are probably going to be available,” says Dr. Grunvald. “We don’t yet know what the cost is going to be. If it is significantly cheaper, that’s another option.”
Both experts say they are hopeful the future will include more accessible formulations and better coverage as obesity treatment continues to be recognized as essential care.
