By now we’ve all heard about or may even know someone using weight loss drugs to help them lose weight. Some common weight loss drugs are Phentermine, Mounjaro, Contrave, Wegovy, and Ozempic, just to name a few. The biggest question we get calls about and are asked during appointments is if any of these drugs are covered under health insurance plans.

Each insurance company has what is called a Formulary or list of drugs that are approved under their respective plans they offer beneficiaries. Each formulary offers at least two drugs in each commonly prescribed area. Generic drugs are often approved over Brand named drugs. Some drugs require a medical diagnosis or even step therapy before being approved. If you and your doctor do not find a medication on your health insurance plan’s formulary that you believe will work for your condition, your doctor can file an appeal with your health insurance company to try to get the drug you want approved.

Most of these fad weight loss drugs are being denied coverage due to lack of diagnosis. Some of these drugs are used to treat diabetic conditions. If you are borderline diabetic, it is more than likely your health insurance company will deny coverage until you reach full diabetic status.

WHAT WE CAN DO TO HELP

At Hartman Insurance Services all our agents can help you look up formularies and provider list to see what is covered under your health insurance plan. We pride ourselves on empowering you to make an informed decision regarding your health insurance options. If your current plan doesn’t meet your needs, we can discuss other options and let you know when you can make a change. Click here to get scheduled or submit a question.

The Marketplace offers a list of preventive services for all their health plans. Among this list are Diet counseling and Obesity screening and counseling. Medicare covers obesity screenings and behavioral counseling. To learn more about Medicare obesity surgeries and costs click here.