Let's talk about the part of the GLP-1 journey nobody prepared me for: the absolute nightmare of insurance coverage and costs.

If you're considering these medications, buckle up. This might be the most frustrating part of your entire weight loss journey. Not the nausea. Not the lifestyle changes. The insurance battles.

The Sticker Shock

Here's what these medications cost without insurance:

Ozempic: $900-$1,000 per month
Wegovy: $1,300-$1,500 per month
Mounjaro: $1,000-$1,100 per month

Yes, you read that right. Over a thousand dollars. Per month. For a medication you'll likely need to take for months or years.

At those prices, losing 100 pounds would cost me $15,000-$20,000. More than a decent used car. More than I spent on my college education.

Absolutely absurd.

Why Insurance Won't Cover It

Here's the catch-22: GLP-1 medications are FDA-approved for weight loss. But most insurance plans don't cover weight loss medications—period.

They'll cover the exact same medication for diabetes. Ozempic for diabetes? Covered. Ozempic for weight loss? Denied.

Wegovy is literally just higher-dose semaglutide packaged specifically for weight loss. But because the label says "weight loss" instead of "diabetes," insurance companies can refuse to pay.

It's the same drug. Made by the same company. With the same mechanism of action. But one costs $50 copay and the other costs $1,300 out-of-pocket.

Make it make sense.

My Insurance Denial Letter

When my doctor submitted the prior authorization for Wegovy, I was optimistic. I have a good insurance plan through my employer. Surely they'd cover it.

Three weeks later, I got the denial letter.

Reason: "Weight loss medications are not a covered benefit under your plan."

Never mind that I'm 100 pounds overweight. Never mind my elevated blood pressure. Never mind that obesity significantly increases my risk for diabetes, heart disease, and about a dozen other conditions that will cost them way more to treat than this medication would.

Nope. Not covered. Good luck!

The Appeals Process

My doctor encouraged me to appeal. She wrote a letter explaining that my obesity was a serious medical condition, that I'd tried multiple other interventions without success, and that this medication was medically necessary.

I also wrote a letter detailing my health issues, weight loss attempts, and how my weight was affecting my quality of life.

Six weeks later: Denial upheld.

I could appeal again, but my doctor warned me it was unlikely to change anything. Insurance companies have policies, and those policies explicitly exclude weight loss medications.

The Workaround: Using Ozempic "Off-Label"

Here's where it gets creative. My doctor could prescribe Ozempic (the diabetes formulation) "off-label" for weight loss. Since I'm technically pre-diabetic (thanks, obesity!), there was a legitimate medical reason.

My insurance covers Ozempic for pre-diabetes. So now I take Ozempic, titrate up to the 2mg dose (which is technically off-label for pre-diabetes but legal to prescribe), and my insurance pays for most of it.

My copay: $25 per month.

This shouldn't have to be this complicated. But I'm grateful it worked.

What If You Can't Get Insurance Coverage?

Not everyone has the option I had. Some people don't have pre-diabetes or other qualifying conditions. Some insurance plans don't even cover the diabetes formulations.

If you're in that boat, here are some options:

1. Manufacturer Savings Cards

Novo Nordisk and Eli Lilly offer savings programs that can reduce the cost significantly—sometimes down to $25-$500 per month. But these usually have income limits and restrictions.

Check:
- Novo Nordisk Savings Card (for Ozempic/Wegovy)
- Lilly Savings Card (for Mounjaro)

2. Telehealth Services

Online weight loss clinics often offer GLP-1s through compounding pharmacies at lower prices—sometimes $200-$400 per month. The medications are slightly different (compounded semaglutide vs. brand-name), but many people report similar results.

Services like Hims, Ro, and others offer these options. Do your research on quality and legitimacy.

3. Clinical Trials

If you qualify for a clinical trial studying GLP-1 medications, you might get the medication for free. Check clinicaltrials.gov.

4. Canadian or International Pharmacies

Some people order from Canada or other countries where these medications are cheaper. This exists in a legal gray area and comes with risks. I'm not recommending it, just acknowledging it happens.

5. Wait and Hope

Prices will likely drop as generic versions become available and as more insurers are forced to cover these medications. But that could be years away.

The Ethical Question

Here's what makes me angry: these medications work. They're effective, relatively safe, and could help millions of people lose weight and improve their health.

But they're priced out of reach for most people. And insurance companies won't cover them because they see obesity as a lifestyle choice rather than a medical condition.

Meanwhile, those same insurance companies will pay for bariatric surgery ($15,000-$30,000), diabetes medications ($500-$1,000/month ongoing), heart disease treatments, joint replacements from weight-related damage, and a host of other expensive interventions to treat obesity-related conditions.

Wouldn't it be cheaper to just cover the weight loss medication in the first place?

The whole system is broken and makes no sense.

My Advice

If you're trying to get insurance coverage for GLP-1s:

1. Check your plan benefits first. Don't assume they're not covered. Some plans do cover them, especially if you have pre-diabetes, diabetes, or other qualifying conditions.

2. Get your doctor involved. They can submit prior authorizations, write letters of medical necessity, and code things appropriately to maximize chances of approval.

3. Be persistent. Appeal denials. Sometimes the second or third appeal succeeds.

4. Consider alternative formulations. Ozempic for pre-diabetes might be covered even if Wegovy for weight loss isn't.

5. Explore all cost-reduction options. Manufacturer cards, telehealth services, patient assistance programs—use every available resource.

6. Be prepared to pay out-of-pocket. It sucks, but for many people, the only option is paying full price or using discount programs. Budget for it if you can.

The Bottom Line

Getting access to GLP-1 medications is harder than it should be. The costs are unconscionable. The insurance system is adversarial and frustrating.

But if you can find a way to afford it—through insurance, savings cards, telehealth, or scraping together the money—it might be worth it. These medications are changing lives.

I just wish they were accessible to everyone who needs them, not just those who can afford them or who get lucky with insurance.

We can do better as a society. We should do better.