Congratulations on your decision to lose weight! If you want to seek coverage for weight loss drugs through your insurer, complete the attached Weight Management Patient Questionnaire (WMPQ).
We receive many requests for initiating weight loss medications and it's important to understand the following:
- Ozempic (semaglutide) and Mounjaro (tirzepatide) are for patients with Type 2 Diabetes only. We will only submit a prior authorization for medical indications as determined by the FDA.
- Wegovy (semaglutide) and Zepbound (tirzepatide) are for weight management. Once again, we will only submit prior authorization for medical indications as determined by the FDA.
- We will only make one attempt to prior authorize a weight loss medication. Because they are in the same class of medication, if one is denied, the others will be as well, so we will only make one attempt. There will be no exceptions to this policy.
- Completion of the WMPQ is required before the prior authorization attempt is made. (Link highlighted at the top of the page.)
- If the medication is denied, or your plan is exempt from covering weight loss medications, there are self-pay options available. The websites are listed at the bottom of this page. They still require a prescription for the medication.
- Refills and dosage changes for any weight loss drug may require in-office visits or virtual visits depending on the judgment of the prescribing clinician and/or the requirements of the insurer.
- There are weight loss management programs such as CoreLife (https://corelifemd.com/) that can help with the entire weight loss program and they will often handle prescribing; insurance coverage varies.
SELF-PAY OPTIONS
Lilly, Inc.
Novo Nordisk, Inc.