Many people want to lose weight.
Some try diet.
Some try exercise.
But for some, it’s not enough.
Weight loss injections can help.
But they are costly.
Can insurance help pay for them?
Yes — in some cases.
This guide will show you how to get weight loss injections covered by insurance.
Let’s make it simple.
What Are Weight Loss Injections?
These are shots that help you lose weight.
They are usually taken once a week.
Some are taken daily.
They work by:
- Controlling hunger
- Slowing digestion
- Helping your body use insulin better
Popular ones include:
- Wegovy (semaglutide)
- Saxenda (liraglutide)
- Zepbound (tirzepatide)
- Ozempic (used off-label for weight loss)
These medicines are FDA-approved for weight loss or diabetes.
They are not cheap.
That’s why many people want help from insurance.
Does Insurance Cover Weight Loss Injections?
The answer: Sometimes, how to get weight loss injections covered by insurance
It depends on:
- Your insurance plan
- The reason you are using the drug
- Your health conditions
- Your doctor’s approval
- What the drug is approved for
Some plans cover them.
Others don’t.
But you can try to get coverage.
Here’s how.
Step 1: Know Your Insurance Plan to how to get weight loss injections covered by insurance
First, read your insurance policy.
Look for:
- Weight loss coverage
- Obesity treatment
- Prescription drugs
- Wellness benefits
Call your insurance company.
Ask questions like:
- “Do you cover weight loss medications?”
- “Do you cover Wegovy or Saxenda?”
- “What are the requirements to get it covered?”
- “Is prior authorization needed?”
Take notes.
Write down the answers.
Step 2: Talk to Your Doctor
Your doctor can help.
Tell them your weight loss goals.
Share your struggles.
Talk about your past efforts — diet, exercise, etc.
If your Body Mass Index (BMI) is:
- 30 or more (obese)
- 27 or more with a health issue like diabetes or high blood pressure
— you may qualify for treatment.
Ask your doctor to:
- Write a detailed note
- Include your BMI
- List your health problems
- Recommend a weight loss injection
- Explain why it’s medically needed
This helps insurance say yes.
Step 3: Get Prior Authorization
Most plans need prior authorization.
That means the doctor sends a form to the insurance company.
The form includes:
- Your medical history
- Your BMI
- Other treatments you tried
- Why this drug is needed
Insurance will review it.
They may say yes or no.
It can take a few days or weeks.
If denied, don’t worry.
You can appeal. (More on that soon.)
Step 4: Check for Medical Necessity
Insurance wants to know:
Is it really needed for your health?
“Medical necessity” means:
- You have a real health issue
- You tried other ways to lose weight
- Your doctor says this treatment is important
The more proof you have, the better.
Step 5: Use the Right Diagnosis Codes
Doctors use codes to explain your health.
These go on insurance forms.
Examples:
- E66.9 – Obesity, unspecified
- E66.01 – Morbid obesity due to excess calories
- E11.65 – Type 2 diabetes with high blood sugar
- I10 – High blood pressure
Using the correct codes can increase your chances of approval.
Ask your doctor to be exact.
Step 6: Ask About Formulary and Tiers
Insurance plans have lists of covered drugs.
These are called formularies.
Each drug has a tier:
- Tier 1 – Generic, low cost
- Tier 2 – Preferred brand, moderate cost
- Tier 3 – Non-preferred, high cost
- Tier 4+ – Specialty drugs, highest cost
Most weight loss injections are Tier 3 or Tier 4.
If not listed, it may not be covered.
Ask your doctor to request an exception if needed.
Step 7: Try a Step Therapy Plan
Some insurance companies use step therapy.
That means you must try cheaper drugs first.
Only if they fail, you can get the expensive ones.
Example:
- Try diet and exercise.
- Then try pills.
- Then get approved for injections.
Your doctor must explain what steps you already tried.
Step 8: Appeal If Denied
Was your claim denied?
Don’t give up.
You can file an appeal.
Steps:
- Ask your insurance why it was denied.
- Get a denial letter.
- Ask your doctor to write a support letter.
- Fill out an appeal form.
- Send documents and wait for a response.
Appeals take time.
But many are approved in the end.
Step 9: Use Patient Assistance Programs
Drug companies want you to use their products.
Some offer help with payment.
Examples:
- Novo Nordisk (Wegovy, Saxenda) has a savings card
- Eli Lilly (Zepbound) offers coupons and assistance
- PatientAccessNetwork.org can help lower costs
You can:
- Download coupons
- Check income limits
- Apply online
These programs can save you hundreds every month.
Step 10: Use HSA or FSA Accounts
Do you have a Health Savings Account (HSA)?
Or a Flexible Spending Account (FSA)?
You can use it for weight loss prescriptions.
Even if insurance won’t pay, your HSA/FSA might.
Save your receipts.
Ask your HR team or provider what’s allowed.
Tips to Improve Your Chances of Approval
✅ Work closely with your doctor
✅ Get all documents ready
✅ Keep a record of diet/exercise efforts
✅ Be honest about your medical problems
✅ Stay polite but firm with your insurance company
✅ File appeals if needed
✅ Ask for samples during the waiting period
Real People, Real Stories
Sarah, 39, Texas:
“I tried every diet. I had PCOS. My doctor prescribed Saxenda. At first, insurance said no. We appealed. They approved it after two weeks!”
Marcus, 44, New York:
“I have type 2 diabetes. I started Ozempic. Insurance covered it because of my diabetes, not weight loss. My sugar is better now, and I lost 20 pounds.”
Tina, 32, California:
“My BMI was 31 with high cholesterol. I used Wegovy. I had to fight with insurance, but I won. The patient savings card also helped.”
Common Questions
Q: Can I get these injections if I don’t have diabetes?
Yes. Some are approved for weight loss only. Like Wegovy or Saxenda. But you must meet BMI and health criteria.
Q: What if I’m on Medicaid?
Coverage varies by state. Some states cover weight loss injections. Others do not. Ask your local Medicaid office.
Q: What if my employer plan doesn’t cover it?
You can still ask for exceptions. Also consider paying with HSA/FSA or using coupons.
Summary Table
| Step | What To Do |
|---|---|
| 1 | Check your insurance plan for coverage |
| 2 | Talk to your doctor and get a diagnosis |
| 3 | Get prior authorization |
| 4 | Show medical necessity |
| 5 | Use proper diagnosis codes |
| 6 | Check the drug’s tier level |
| 7 | Try step therapy if required |
| 8 | Appeal if denied |
| 9 | Use drug maker’s assistance |
| 10 | Use HSA or FSA to pay |
Final Thoughts
Getting weight loss injections covered by insurance takes time.
But it’s possible.
You need the right documents.
You need a good doctor.
You need to follow the steps.
It’s worth it.
Your health matters.
You deserve support.
Talk to your doctor today.
Check your insurance.
And start your weight loss journey — the smart way.
Some partial information from: www.goodrx.com , www.tebra.com, phlp.org/en/