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Key takeaways
Health insurance companies may stop covering GLP-1 medications for weight loss due to their rising costs and questions about their necessity.
Some generic GLP-1 drugs are now available at a lower out-of-pocket cost.
A SingleCare prescription discount card can substantially lower the cost of your prescription without insurance.
Glucagon-like peptide-1 (GLP-1) receptor agonists are a class of drugs that lower blood sugar levels in people with Type 2 diabetes and promote weight loss when used with a healthy diet and exercise. Although health insurance companies tend to cover GLP-1 agonists as a treatment for Type 2 diabetes, coverage for weight loss is less common. That said, insurance formularies can change for a variety of reasons, and it can be frustrating to find that your GLP-1 medication is no longer covered. If that’s happened to you, we’ll help you figure out what to do next.
Possible reasons why your insurance stopped covering your GLP-1
Insurance companies may stop covering a medication for several reasons:
- A low-cost generic version has become available, so it stops covering the brand-name medication.
- There may be similar brand-name drugs available that the insurance company can cover at a lower cost.
- The price of the drug may have increased beyond what the insurance company is willing to pay.
- The Food and Drug Administration (FDA) may no longer approve the drug based on new safety evidence.
- An individual may no longer fit the insurance company’s criteria for the drug.
- The drug may no longer be manufactured or available in the U.S.
Changes in GLP-1 insurance coverage may be due to the rising costs to health plans of the medication and the recent FDA approval of generic versions of Victoza (liraglutide) and Byetta (exenatide).
Drug formularies may cover GLP-1 agonists prescribed for Type 2 diabetes but not for weight loss. That’s because insurers sometimes consider weight management cosmetic in nature rather than a medical necessity, even though the American Medical Association considers obesity a chronic disease.
Medication exclusions are becoming more common
The number of formulary exclusions has risen steadily over the last decade. A study by Xcenda found that only about 40 diabetes, weight loss, endocrine, and metabolic drugs had been excluded from at least one pharmacy benefit manager (PBM) formulary in 2014. By 2022, that number had jumped to 179.
What to do if your insurance won’t cover your GLP-1
If insurance stopped covering your GLP-1 medication, do the following:
1. Contact your insurance company.
Find out why your GLP-1 medication is no longer covered so you can develop a plan going forward. You may want to ask your insurance company the following questions:
- Do they think you no longer qualify for the medication? For weight loss, insurers sometimes want to see proof of a healthy diet and exercise routine before they approve the medication.
- Did they drop coverage for everyone? It may not be an individual decision at all.
- Did they drop a brand-name in favor of a generic? This would be easy to fix—simply ask the pharmacy to fill your prescription with the generic medication, or ask your healthcare provider to prescribe the generic instead.
RELATED: Are there generic GLP-1 drugs?
2. Talk to your healthcare provider about appealing the insurance company’s decision.
Insurance companies may make exceptions on a case-by-case basis, but they’ll need to review some documentation from your healthcare provider.
“The provider needs to clarify what medical condition(s) or purpose the GLP-1 drug is intended to treat, why it is medically necessary and others aren’t appropriate, any prior failed treatments, and include additional documentation like clinical notes,” says Michaela Robbins, a doctor of nursing practice (DNP) at East x West Med in New York City.
“Thanks to new technology that streamlines the prior authorization and appeal process, the process can take minutes, but the response rate from insurance companies to review the appeal and decide can vary from hours to days,” she says.
Angela Fitch, MD, who is board-certified in obesity medicine and previously served as the president of the Obesity Medicine Association, says the appeals process can take hours without that streamlined technology. “It’s a lot of time that isn’t compensated, and many clinics do not have time or resources to do it.” She warns that decisions can take months to arrive.
Because it can take a while to hear back from the insurance company, contact your healthcare provider as soon as you learn about the dropped drug coverage.
RELATED: Does Aetna cover Zepbound?
3. Don’t suddenly stop taking your GLP-1.
Quitting a medication cold turkey may lead to withdrawal symptoms, so it’s best not to make any changes to your dose until you talk to your healthcare provider.
“I generally do not advise patients to discontinue abruptly, not only because of the increased risk of rebound, but also because it can cause uncontrolled sugar spikes initially,” Dr. Robbins says. It’s safer to slowly taper off the medication under your healthcare provider’s guidance.
Dr. Fitch agrees that weight gain is likely to occur when someone stops taking a GLP-1 medication, so she recommends talking to your healthcare provider about more affordable options.
GLP-1 alternatives for weight loss
GLP-1 agonists have surged in popularity over the last few years, but they’re not the only weight loss medications available. “We’ve been using medications to successfully treat obesity for many years before GLP-1s,” Dr. Fitch says. “Medications such as Contrave and Qsymia can be effective for treatment.”
If you can’t afford your GLP-1 medication without insurance, talk to your healthcare provider about some alternatives:
- Qsymia (phentermine-topiramate), an appetite suppressant available as a once-daily oral capsule
- Contrave (naltrexone-bupropion), an oral tablet typically taken twice per day to manage cravings and reduce appetite
- Adipex-P (phentermine), an appetite-suppressing tablet typically taken once per day
- Diethylpropion extended-release, a long-lasting appetite-suppressing tablet typically taken once per day
- Phendimetrazine tartrate, available as a tablet that’s taken before meals (up to three times per day) to increase the body’s metabolism and reduce appetite
- Alli (orlistat), an oral capsule that limits how much fat the body absorbs and can be taken up to three times per day, about an hour before eating
- Xenical (orlistat), a capsule that contains the same active ingredient as Alli but in a higher dose
Your healthcare provider may also prescribe a generic GLP-1 agonist: liraglutide or exenatide. These are FDA approved to treat Type 2 Diabetes, but healthcare providers may prescribe them off-label for weight loss. Because they’re generic, they have a lower out-of-pocket cost than the brand-name versions.
| GLP-1 alternative | Average retail price* | SingleCare price* | Savings |
|---|---|---|---|
| Qsymia (phentermine-topiramate) | $307 per 30, 7.5/46 mg capsules | $87 per 30, 7.5/46 mg capsules of generic phentermine-topiramate at CVS | Get coupon |
| Contrave (naltrexone-bupropion) | $844 per 120, 8/90 mg tablets | $614 per 120, 8/90 mg tablets of brand-name Contrave at Kroger | Get coupon |
| Adipex-P (phentermine) | $115 per 30, 37.5 mg tablets | $10 per 30, 37.5 mg tablets of generic phentermine at Kroger | Get coupon |
| Diethylpropion | $129 per 30, 75 mg tablets | $52 per 30, 75 mg tablets of generic diethylpropion at Walgreens | Get coupon |
| Phendimetrazine tartrate | $61 per 90, 35 mg tablets | $20 per 90, 35 mg tablets of generic phendimetrazine at Walmart | Get coupon |
| Alli (orlistat) | $103 per 120, 60 mg capsules | $103 per 120, 60 mg capsules of brand-name Alli at Kroger | Get coupon |
| Xenical (orlistat) | $910 per 90, 120 mg capsules | $640 per 90, 120 mg capsules of generic orlistat at Kroger | Get coupon |
| Liraglutide (generic Victoza) | $341 per 1, 3 mL of 18 mg/3 mL pen | $92 per 1, 3 mL of 18 mg/3 mL pen of generic liraglutide at CVS | Get coupon |
| Exenatide (generic Byetta) | $1,000 per 1, 2.4 mL of 10 micrograms (mcg)/0.04 mL pen | $792 per 1, 2.4 mL of 10 mcg/0.04 mL pen of generic exenatide at Kroger | Get coupon |
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing in ZIP code 23666 as of [date]. The listed price without insurance references the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available.
How to save on your GLP-1 without insurance
If you still want to take your GLP-1 without insurance coverage, a free SingleCare prescription discount card can reduce your out-of-pocket expenses.
Here’s how to use it:
- Search for your GLP-1 on the SingleCare website, enter your ZIP code, and find your preferred pharmacy in the list.
- Click the Get Free Coupon button to generate your unique discount code.
- Print it, email it to yourself, or save it in your SingleCare account for easy access.
- When you collect your prescription, show your SingleCare coupon to the pharmacist before paying.
Only pharmacies listed on the coupon page will accept a SingleCare discount card. You may need to switch pharmacies to get the best price on your GLP-1.
Based on our data, generic liraglutide is the cheapest GLP-1 without insurance:
| GLP-1 | Average retail price* | SingleCare price* | Savings |
|---|---|---|---|
| Mounjaro (tirzepatide) | $1,517 per 4, 0.5 mL of 5 mg/mL pens | $872 per 4, 0.5 mL of 5 mg/mL pens of brand-name Mounjaro | Get coupon |
| Zepbound (tirzepatide) | $1,519 per 4, 0.5 mL of 5 mg/0.5 mL pens | $950 per 4, 0.5 mL of 5 mg/0.5 mL pens of brand-name Zepbound | Get coupon |
| Ozempic (semaglutide) | $1,382 per 1, 3 mL of 2 mg/3 mL pen | $825 per 1, 3 mL of 2 mg/3 mL pen of brand-name Ozempic | Get coupon |
| Rybelsus (semaglutide) | $1,388 per 30, 7 mg tablets | $875 per 30, 7 mg tablets of brand-name Rybelsus | Get coupon |
| Wegovy (semaglutide) | $1,849 per 4, 0.75 mL of 2.4 mg / 0.75 mL pens | $1,225 per 4, 0.75 mL of 2.4 mg / 0.75 mL pens of brand-name Wegovy | Get coupon |
| Saxenda (liraglutide) | $1,803 per 5, 3 mL of 18 mg/3 mL pens | $1,213 per 5, 3 mL of 18 mg/3 mL pens of brand-name Saxenda | Get coupon |
| Victoza (liraglutide) | $1,440 per 3, 3 mL of 18 mg/3 mL pens | $139 per 3, 3 mL of 18 mg/3 mL pens of generic liraglutide | Get coupon |
| Trulicity (dulaglutide) | $1,340 per 4, 0.5 mL of 1.5 mg/0.5 mL pens | $774 per 4, 0.5 mL of 1.5 mg/0.5 mL pens of brand-name Trulicity | Get coupon |
| Exenatide | $1,106 per 1, 2.4 mL of 10 mcg/0.04 mL pen | $792 per 1, 2.4 mL of 10 mcg/0.04 mL pen of generic exenatide | Get coupon |
*Drug prices fluctuate and vary by location. This is the most current price at the time of publication.
Bottom line
Your weight loss journey doesn’t have to be put on hold just because insurance stopped covering your GLP-1. You have options. Start by talking to a healthcare provider who is familiar with your health history and any other conditions you may have. They may be able to appeal to the insurance company or help you find a safe and affordable alternative. Use a SingleCare coupon to save even more money on out-of-pocket costs.
- Rising costs lead insurers to drop weight loss drug coverage, further increasing patient burden, American Journal of Managed Care (2024)
- FDA approves first generic of once-daily GLP-1 injection to lower blood sugar in patients with type 2 diabetes, Food & Drug Administration (2024)
- What is medical necessity? National Association of Insurance Commissioners
- Advocacy against obesity-related bias by insurance providers, American Medical Association House of Delegates (2023)
- Skyrocketing growth in PBM formulary exclusions continues to raise concerns about patient access, Xcenda (2022)