So you’re interested in prescription weight-loss medication—now what?

So you’re interested in prescription weight-loss medication—now what?

So you’re interested in prescription weight-loss medication—now what?

Getting a weight-loss prescription is easier said than done. Here’s what you need to know about the requirements and insurance coverage for these meds.

Kaitlyn Dykman
Last updated:
August 1, 2023
5 min read
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Weight-loss medication might seem too good to be true, but one thing’s for sure—it can work. The catch is that these meds aren’t meant for cosmetic purposesk and they’re intended to be paired with diet and exercise. For some, taking weight-loss medication can even make it easier to adopt positive lifestyle changes. 

But even if you check all the boxes for a prescription, it’s not all that easy to get one—thanks to drug shortages, high out-of-pocket costs, and limited insurance coverage. Here are top tips for helping you navigate the process of getting weight-loss medication. 

How to see if you qualify for prescription weight-loss medication

To find out if weight-loss medication is right for you, start with your doctor or an obesity specialist. They can determine if you’re a candidate for a weight-loss drug and which medication, if any, might work best for you. Different types are designed to help with different aspects of weight loss. For example, some weight-loss medications can help curb cravings while others help control blood sugar levels. What you might need all depends on your biology. 

You can also get a prescription for weight loss medication online. But you still want to ensure it’s prescribed by a licensed health care provider. Right now, three medications* are approved by the FDA for chronic weight management: Wegovy® (semaglutide), Saxenda® (liraglutide), and Alli® (orlistat). Saxenda and Wegovy are both prescription GLP-1 receptor agonists (or GLP-1s*). Orlistat, available over the counter, is a lipase inhibitor, a type of drug that can reduce the body’s absorption of fat from consumed foods. 

Other generics and GLP-1 medications can be used off-label to treat obesity and excess weight, too. Off-label prescribing is when clinicians prescribe an FDA-approved drug at a different dose or for a reason other than what the drug was approved for based on solid clinical evidence. 

Your doctor may suggest medication if you’ve been unable to lose weight through diet and exercise alone and your body mass index (BMI) is 30 or higher (the medical definition of obesity), or your BMI is 27 or higher, and you have a weight-related medical condition (including type 2 diabetes or high blood pressure). 

What you need to know about insurance policies and weight-loss medication 

If you qualify for a prescription weight-loss medication, how do you get insurance to cover the cost? That’s the tricky part. Many insurance policies don’t cover weight loss medication, and neither does Medicare. And out-of-pocket costs for medications like GLP-1s can start at $800 a month. 

Even if your insurance does cover weight-loss medication, it can be a headache to go through the process. Some insurance companies offer coverage only if you get prior authorization, meaning the insurance company will review your case to decide whether they think the medication is medically necessary. Others might require you to try a different weight-loss drug or a structured diet and exercise program before offering coverage for GLP-1s. 

Staying covered is a whole other issue. When you take a GLP-1 medication, increasing your dose over time is common. But if your policy requires prior authorization to start the medication and also before you can up your dosage, that could disrupt your treatment. GLP-1s are intended for continuous long-term use. 

Some weight-loss programs offer medication (including prescribing GLP-1s), behavior change guidance, and support with navigating health insurance. 

How it works at Found

Found is a clinician-led, online weight-care program that offers 13 different weight-loss medications—including generics and brand-name GLP-1s. The program provides more than 60 treatment paths customized to each member. Found membership includes access to licensed clinicians trained in obesity medicine, health coaching, behavior change guidance through an app, and prescription medication (for those who are eligible). Found healthcare providers consider members’  medical history and biology before prescribing medication.

Costs for many medications that Found offers are included in the Found membership fee when filled through a Found third-party preferred pharmacy. GLP-1s are an exception. For GLP-1s specifically, many members opt to use their insurance to help cover the cost. Found partners with members, to help navigate  the insurance verification process on their behalf. For members who lack insurance coverage, Found can help find an effective, alternative medication that’s included in the cost of the program. To see if Found might be a fit for you, take the quiz

*These medications may cause side effects and are not advised for those with certain conditions or risk factors. Common side effects include nausea, stomach discomfort, and diarrhea. More serious but less common side effects can occur. Those who have a personal or family history of medullary thyroid cancer or multiple endocrine neoplasias should not use GLP-1s. Those who have had an organ transplant should not use orlistat. Find more detailed side effect and risk information for specific medications by name here.

About the author, Kaitlyn Dykman

Kaitlyn Dykman is a certified health education specialist, a women’s holistic hormone health practitioner, and a former Found coach who writes about health and medicine at Found.

About Found

Found is among the largest medically-supported weight care clinics in the country, serving more than 200,000 members to date. To start your journey with Found, take our quiz.

Published date:
August 1, 2023
Meet the author
Kaitlyn Dykman
Health writer

Sources

  • Prescription weight-loss drugs. (2022, October 29). Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss-drugs/art-20044832#:~:text=Who%20can%20take%20weight%2Dloss,BMI
  • Moody, C. (2021). Does Medicare Cover Weight Loss Medication? Medicare & Medicare Advantage Info, Help and Enrollment. https://www.medicare.org/articles/does-medicare-cover-weight-loss-medication/
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