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      GLP-1 Medications

      GLP-1 Medications: What They Are and How They’re Covered by Insurance

      GLP-1 medications are becoming a staple in the management of both Type 2 diabetes and weight management. When you encounter names like Ozempic, Wegovy, or Mounjaro, you are likely looking at a medication that falls within this expanding category.

      Whether you are contemplating enrolling in a health plan and want to confirm coverage for these medications, or you are already enrolled and seeking clarity on your options, this guide will provide you with essential information.

       

      What Are GLP-1 Medications?

      GLP-1 (glucagon-like peptide-1) medications work by:

      • Helping your body manage blood sugar levels
      • Slowing digestion and reducing appetite
      • Supporting weight loss or diabetes control
      These medications are prescription-only and are often taken as weekly injections or daily pills, depending on the brand.

       

      Common GLP-1 Brand Names

      There are two main uses for GLP-1 medications:

      • Type 2 Diabetes
      • Weight Loss
      The medication may be the same — but the brand and coverage eligibility can differ based on its approved use.
      Condition Brand Names
      Type 2 Diabetes Ozempic, Mounjaro, Rybelsus, Trulicity, Victoza
      Weight Management Wegovy, Zepbound, Saxenda

      Tip: It is important to note that while Mounjaro and Zepbound share the same active ingredient, tirzepatide, they are marketed for distinct purposes; Zepbound is specifically indicated for weight management.

      Will My Insurance Cover It?

      Coverage for GLP-1 medications is influenced by several key factors:

      • Your specific health plan
      • The diagnosis under which the medication is prescribed
      • Whether the medication is included on your plan’s formulary

      Generally, most insurance plans will:

      • Provide coverage for GLP-1 medications prescribed for Type 2 diabetes
      • Typically exclude coverage for GLP-1 medications intended for weight management, even when prescribed by a healthcare provider.

      How to Find a Plan That Covers GLP-1 Medications

      When exploring your options in benefitbay or if you've already selected a plan and want to verify GLP-1 coverage, follow these steps:

      1. Access your plan card in benefitbay and click on "Show more details."
      2. Review the Summary of Benefits, which will open in a new tab.
      3. Click on the link for the drug formulary (this will open in a new window) and search for the specific GLP-1 medication. Identify the tier it falls under.
        1. Take note of any requirements or limitations, including specific diagnoses, prior authorization, and quantity restrictions.
      4. Return to the Summary of Benefits to review the coverage details for that tier.
      5. Confirm the network and preferred pharmacies on the carrier's website.
      If you have any questions or uncertainties, you can always reach out to the carrier’s customer service for assistance or email us at support@benefitbay.com.

      Final Tips

      • Double-check the diagnosis
        • GLP-1 medication for diabetes may be covered, but typically not when prescribed for weight loss
      • Expect prior authorization for most GLP-1 medications
      • Use a preferred pharmacy to avoid higher costs
      • Formularies can change so always confirm with the carrier
      • Coverage is not guaranteed across plans, even for the same medication 

      Need Help?

      Have questions or need help reviewing your plan options? We're here to support you.

      Email us at support@benefitbay.com