My Insurance Won’t Cover GLP-1 Drugs. What Now?

Note: Compounded drugs are not approved by the U.S. Food and Drug Administration (FDA) and may carry greater risks than FDA-approved treatments.

There are no easy answers for people who cannot afford a GLP-1 drug but remain desperate to lose weight or maintain their weight loss. From finding discounts to considering alternative prescription medications, we’ve rounded up the top tips on the next steps to take if you lose (or don’t have) access to GLP-1s.

In the confusing world of healthcare and insurance, it pays to pursue every possible option. Insurance rejections can be appealed, and the price that your pharmacy quotes is not necessarily the lowest price you can find.

Search for Discounts

For years, it was widely reported that semaglutide and tirzepatide cost about $1,000 per month. Cash prices may still be that high at the counter of your neighborhood pharmacy, but the drugmakers have recently made their products available for much lower prices through different avenues.

In some cases, these lower-cost medications may be administered with a vial and syringe, rather than easy-to-use prefilled injector pens.

In addition, the drugmakers sometimes offer coupons and savings cards that can considerably lower the out-of-pocket cost for as long as one year. Not everyone qualifies for these programs, however, and they can't be used indefinitely. 

Appeal Lost Coverage

Bridget Roberts, 37, was reapproved for Zepbound by remaining persistent. It started when the Pottsgrove, Pennsylvania, resident received a letter that her insurance company was no longer covering the GLP-1.

“Initially, I felt I was doomed,” she says. “Something was finally working for me, and I was more alive than ever, and they wanted to take it from me.”

“It was like she was talking in code, like she knew something I didn’t,” Roberts says. She and her doctor were equally confused because she already had a prior authorization, but when the doctor put in the new request, her medication was approved.

Switch Diagnoses

Other GLP-1 users have successfully retained coverage by changing the diagnosis indicated on their prescriptions.

“Many GLP-1s are FDA approved for more than just weight loss, including type 2 diabetes, cardiovascular risk reduction, and even stroke prevention in certain populations,” says Supriya Rao, MD, an obesity physician and the director of medical weight loss at Lowell General Hospital in Lowell, Massachusetts. Some are also approved for metabolic dysfunction-associated steatohepatitis.

If your insurer canceled coverage for a weight loss medication, it's possible that it will cover the same medication for a different condition, such as sleep apnea, heart disease, or the liver condition metabolic dysfunction-associated steatohepatitis. A new prescription for a new condition “can make the difference between full denial and full coverage,” says Dr. Rao.

Brianna Johnson-Rabbett, MD, an endocrinologist with Nebraska Medicine and a director of the American Board of Obesity Medicine, offers some examples. “If someone has established cardiovascular disease and obesity or overweight, Wegovy can be prescribed under that indication,” Dr. Johnson-Rabbett says. “If someone has moderate to severe obstructive sleep apnea and obesity, Zepbound can be prescribed for that indication.”

Switching diagnoses is no guarantee of coverage, however. “Insurance still may decide not to cover a medication, even if FDA indications for prescribing that medication are met,” says Johnson-Rabbett.

Megan Wyatt, 43, of China Grove, North Carolina, considered compounded semaglutide after her employer-provided insurance plan suddenly revoked coverage. “I was devastated,” she says. She had lost about 45 pounds on her medication and felt improvements in migraine and back pain issues. “My experience with this medicine was only positive,” she says, adding that losing access “was most definitely a shock to my core.”

Although compounded GLP-1 drugs are less expensive than their brand-name counterparts, their cost can still be considerable. Wyatt initially thought she would not be able to afford compounded semaglutide. She eventually found a provider offering a price she could pay but only after taking an additional part-time job. In the meantime, she had missed so many doses that she had to start back with the lowest possible dosage, delaying her progress.

“As of now, the compounded GLP-1 medications are still possible to obtain,” says Brynna Connor, MD, a family medicine physician in private practice in Austin, Texas. Compounders can sell GLP-1 drugs in a novel dosage or formulation. As a result, some online pharmacies are marketing semaglutide and tirzepatide that have been combined with other medications or that take a significantly different form, such as a pill. These new drug forms have not been publicly tested for safety or how well they work, which can only magnify the concerns held by public health authorities.

“These aren’t well studied, and I advise against them,” says Rao. “Compounded versions in pill form or mixed with other ingredients haven’t undergone rigorous trials. Mixing active compounds without clinical data raises concerns about absorption, bioavailability, and patient safety. Just because it’s cheaper doesn’t mean it’s better or safe. If it sounds too good to be true, it probably is.”

Some people who cannot afford full access to GLP-1 medications try tapering or microdosing to stretch out their supply.

Microdosing involves using an injection pen to deliver smaller doses than those indicated on a prescription. The practice is easiest with Ozempic, which comes in a multidose pen, or with the glass vials that can be purchased directly from the drug manufacturers. Microdosing can be used to gradually taper a dosage down to zero, stretching out your supply rather than ending your usage abruptly.

Rao says, “It’s never a good idea to stop cold turkey,” and it is critical to consult with your doctor before adjusting your doses.

Microdosing can also introduce new hazards, according to Johnson-Rabbett, including “contamination and unintended dosing, for example, taking a much higher dose than intended,” she says, adding that another way to stretch your supply is by taking injections less often than every seven days, but this can be difficult to tolerate. “Depending on the person, the dose, and the duration between doses, that practice can result in an individual having side effects when they do take their next dose,” she says.

Although stretching out your supply and tapering your doses under a doctor’s supervision may smooth the transition away from a GLP-1 weight loss drug, it’s not a permanent solution.

Long before Ozempic became a blockbuster, the FDA approved a variety of other medications to help people slim down.

• Liraglutide (Saxenda), a less powerful older GLP-1 drug, “works well for appetite suppression,” says Rao.
• Orlistat (Xenical, Alli) reduces fat absorption in the gut and is the only effective over-the-counter weight loss pill available, says Johnson-Rabbett, though it can have significant gastrointestinal side effects.
• Naltrexone-bupropion (Contrave) combines an opioid blocker with an antidepressant to help control appetite and “may work better for emotional or reward-based eating,” says Rao.
• Phentermine (Lomaira) is a stimulant that suppresses appetite.
• Phentermine-topiramate (Qsymia) combines phentermine with an anti-seizure medication to promote weight loss and “is on average the most effective oral medication,” says Johnson-Rabbett.

Rao says that some doctors may consider prescribing the type 2 diabetes drug metformin. This daily pill helps with insulin resistance, is sometimes used to treat prediabetes off-label and leads to modest weight loss.

None of these drugs work as well as semaglutide or tirzepatide, experts say, but they may help with weight loss maintenance.

Anderson, who had to quit Zepbound cold turkey, was prescribed phentermine to help keep off the weight, but she has been disappointed with the results. She has regained 20 pounds, and her polycystic ovarian syndrome symptoms, which had disappeared with weight loss, are returning.

Rao says, “This will be very individualized. For patients with a body mass index over 40, or 35 with comorbidities, bariatric surgery is safe and effective. Some patients may respond better to surgery than medication, especially if they have struggled with severe obesity for years and also have metabolic complications. Surgery is a valid, proactive tool that can save lives.”

“It can certainly be a good option to consider for an individual if they meet the criteria,” says Johnson-Rabbett.

There’s always the old-fashioned way: diet and exercise. After all, GLP-1 drugs are approved to be used as a supplement to, rather than a replacement for, healthy lifestyle changes.

While a quality diet and exercise are pillars of any healthy lifestyle, with effects on health measures besides weight, they have historically fallen short of treating obesity. “For many,” says Rao, “lifestyle changes aren’t enough.”

Many people try to maintain weight loss by following a healthy diet and exercising regularly, which are important to practice while on a GLP-1, too.

A new wave of supplements, each claiming to be nature’s Ozempic, sprung up during the initial GLP-1 craze. Despite the aggressive marketing, there are no “randomized clinical trials that show over-the-counter supplements have a substantial effect on lasting weight loss,” Connor says.

Be wary of claims that ingredients like berberine and psyllium husk can mimic or replace the effects of a powerful drug like semaglutide or tirzepatide. “There are no supplements, magic pills, or over-the-counter products that will reduce appetite and slow gastric emptying the way GLP-1s do. Don’t fall for anything that says otherwise,” Rao says.

These substances probably don’t work, and they might not even be safe: “Many physicians have concerns about the minimal regulations that supplements are subject to and have concerns about potential contamination of supplements, in particular supplements marketed for weight loss, with unsafe substances,” Johnson-Rabbett says.

The Takeaway

• Despite recent price reductions, GLP-1 weight loss drugs remain expensive, and insurers have tightened up coverage.
• You may be able to work the system to access GLP-1s at a price you can afford: Some patients are appealing denials by insurers, switching diagnoses, and finding manufacturer discounts.
• If you can’t afford GLP-1 drugs, alternatives may include older weight loss drugs, pursuing weight loss surgery, or exploring different types of diet and exercise.
  
• Working with a healthcare provider is crucial when managing weight and maintaining weight loss, since obesity is a chronic disease that requires professional treatment.