During your visit, you and your care provider may discuss GLP-1 medications for weight loss. This article can help you understand who qualifies for these medications and what to expect when it comes to insurance coverage and costs.
Note: This guide is for people without diabetes. If you have diabetes, please consult your care provider to discuss the medications and treatment plans that are right for you.
Eligibility
Your care provider will decide if a GLP-1 medication is a good fit for you based on your health needs and specific clinical criteria. You may be able to get GLP-1 medications if:
- You have obesity (BMI of at least 30)
- You are overweight (BMI of at least 27) and you also have a weight-related health issue like high blood pressure or sleep apnea
If your care provider determines that one of these medications will support your health journey, they will prescribe the medication. If you don’t qualify, your care provider will work with you to build a care plan that best suits your needs.
Insurance coverage
Coverage for GLP-1 medications varies by insurance plan. Some plans may not cover these medications for weight loss. Some plans may cover them if you meet additional requirements. Before your visit, check with your insurance provider to find out:
- If GLP-1 medications for weight loss are covered
- What your copay will be
- If there are any steps you need to take to qualify for coverage
- If you have full or partial coverage
Self-payment
If your insurance plan does not cover GLP-1s for weight loss—or if your copay is too high—you may be able to pay for the medication through a Teladoc Health pharmacy partner. Pharmacy partners offer reduced pricing on GLP-1 medication for eligible members. During your visit, talk with your care provider about self-paying for GLP-1 medication without insurance. Here are some important things to remember when using the self-pay option:
- Self-pay purchases happen outside of your insurance plan. They don’t count toward your deductible or out-of-pocket maximum.
- Your medication will be shipped directly to you. You won’t pick it up at your regular pharmacy.
- You may be able to use your Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay.
Preparing for your visit
If you’re considering a GLP-1 medication for weight loss, take these next steps before meeting with your care provider.
- Contact your insurance company to find out if they cover GLP-1 medications for weight loss. If they do, ask if there are additional requirements you must meet before they offer coverage.
- Discuss your insurance coverage at your visit. At your visit, talk about your insurance coverage with your care provider. If you decide to use the self-pay option, make sure your care provider sends your prescription to our self-pay pharmacy partner instead of your regular pharmacy.