Will my insurance cover a GLP-1 for weight loss?

The structural reality: insurance treats the same molecules completely differently by indication. Ozempic with a type 2 diabetes diagnosis sails through most formularies; Wegovy for obesity hits a wall of exclusions and prior-auth hurdles at many of the same insurers — because plans price “weight-loss benefits” as an optional rider employers may decline. The four-step process that actually works: 1. Read the formulary, not Reddit. Log into your plan portal, search Wegovy, Zepbound, Saxenda by name. Note the tier and the letters “PA” (prior authorization) or “ST” (step therapy). 2. Build the PA case before the visit. Typical requirements: BMI ≥ 30, or ≥ 27 plus a documented comorbidity (hypertension, sleep apnea — get the sleep study on record); 3–6 months of documented lifestyle attempt; sometimes a trial of an older drug first. Your prescriber’s office files it; your job is making sure the chart contains the evidence. 3. Appeal the denial. First denials are partly attrition strategy — a large fraction reverse on appeal, especially with a letter of medical necessity citing comorbidities. Persistence is the meta-skill. 4. Exploit adjacent indications. Post-SELECT, semaglutide carries a cardiovascular risk-reduction indication (covered situations where “weight loss” is excluded); Zepbound’s sleep-apnea indication does similar work — a documented OSA diagnosis can flip a “no” to “yes” (details). If the plan excludes weight-loss drugs categorically, no PA brilliance fixes it — your routes are the employer (benefits teams do add the rider when asked by enough employees), open-enrollment plan switches, or the cash-pay paths that have gotten genuinely reasonable. Covered-but-expensive? Savings cards knock commercial copays down dramatically.