Medication Coverage
Many patients have insurance coverage for weight loss prescriptions—but it’s important to confirm ahead of time. Follow these simple steps:
Step 1: Call Your Insurance Company
- Use the member services number on the back of your insurance card.
Step 2: Ask the Right Questions
- Is this medication covered under my plan?
- Has my employer opted in for weight loss medication coverage?
- Both answers must be “yes” for coverage to apply.
Step 3: Clarify Your Out-of-Pocket Costs
- What portion of the medication is covered?
- What will I be responsible for (copays, deductibles, etc.)?
Prior Authorization
Most weight loss medications require a prior authorization (PA) before your insurance will agree to cover the cost. This means that your insurance company wants to make sure the treatment is medically necessary before they approve coverage.
What’s the PA process? Our office will electronically submit the prior authorization request on your behalf. Here’s how it works:
- The recommended medication (for example Wegovy or Zepbound) is sent to your pharmacy.
- The pharmacist will initiate the PA and send it to us.
- We will complete the PA form and send it to your insurance company with medical documentation showing why it’s needed.
- Your insurance company will review the request.
- You’ll be notified by your pharmacy or insurance company whether the medication has been approved or denied. If denied, we can sometimes file an appeal OR we can explore other medication options.
- Please note: The PA process can take at least 3-5 business days.
At our clinic, we believe effective weight loss care should be accessible—not a financial burden. Our team is here to help you understand your insurance coverage. We will complete your prior authorization process, and find the most effective and affordable medication options available to you. We will work with your insurance provider, explore cost-saving programs, and help you make the most of any HSA or FSA benefits—so you can focus on your health, and not the hassle.