Unlocking Coverage for Weight-Loss Drugs: Strategies to Get Insurance to Pay for Ozempic and Other Medications

As someone who has struggled with weight loss, I was intrigued by the recent Wall Street Journal article on how to get health insurance to pay for weight-loss drugs like Ozempic. The high cost of such drugs can be a barrier for many people, but there are strategies to help offset the expense. Here are some key takeaways from the article:

Weight-Loss Drugs Can Be Effective, but Pricey

  • Ozempic is a once-a-week injectable drug that has been shown to help people lose an average of 15 pounds.
  • Other weight-loss drugs, such as Qsymia and Belviq, can also be effective but can cost hundreds of dollars per month.

Insurance Coverage Varies

  • Some insurance plans cover weight-loss drugs, but coverage varies widely.
  • Medicare and Medicaid do not cover weight-loss drugs.

Strategies for Getting Insurance to Pay

  • Ask your doctor to submit a prior authorization request, which can help demonstrate medical necessity.
  • Consider enrolling in a weight-loss program, as some insurers require participation in such programs as a condition of coverage.
  • Appeal a denied claim, as insurance companies do sometimes change their decision after an appeal.
  • Consider using a prescription discount program, such as GoodRx, to help lower the out-of-pocket cost.

Overall, it's clear that weight-loss drugs can be a valuable tool for those struggling with obesity, but the cost can be prohibitive. By being proactive and persistent in pursuing insurance coverage, however, it may be possible to get the help needed to achieve a healthier weight.

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