Weight-Loss Medications: What to know BEFORE you schedule and BEFORE we begin
We’re Here to Help You! We understand how life-changing these medications can be, and our goal is to support you in starting—or continuing—your weight-loss journey. At the same time, we want to be transparent about the challenges patients face in accessing GLP-1 agonists. The two biggest barriers are: Insurance coverage limitations and national shortages of these medications
**For safety reasons, our office does not prescribe the “active ingredient” of a GLP-1 through compounding pharmacies, as these are not FDA-regulated. For example: Semaglutide and/or Tirzepatide
Insurance Coverage
Many insurance carriers changed their coverage policies on January 1, 2024 (or earlier in 2023 at renewal) and continue to update them frequently. Unfortunately, requirements differ between carriers and even between plans:
Some policies list GLP-1 medications as an excluded benefit, meaning they are not covered at all.
If coverage is available, most insurers require a Prior Authorization (PA) with detailed medical documentation proving medical necessity.
Some carriers have eliminated coverage for weight-loss medications altogether.
One consistent requirement is that our office must provide ongoing, face-to-face documentation to support therapy. This includes:
An initial visit and then quarterly follow-up visits
Documentation of weight, height, weight goals, and progress
Lifestyle modifications (calorie reduction, exercise, nutrition therapy, and/or behavioral support)
These visits are required, will be billed to your insurance and are subject to your plan’s copay and deductible. If your insurance does not cover weight-loss/obesity treatment, you will be responsible for the full cost of the visit.
What We Need From You
Because of the barriers described above, we need your assistance in completing two important steps:
Step 1: Contact Your Insurance Carrier
Call the Member Services or Pharmacy Benefits number on the back of your insurance card and ask the following:
It is important to ask ALL questions! Some carriers will cover but “only if you meet xyz criteria is met”
Does my plan cover weight-loss medication therapy?
Does this coverage include any of the following GLP-1 medications: Wegovy, Zepbound, or Saxenda?
Does my policy provide better coverage for one over another?
If covered, is a Prior Authorization (PA) required?
Request the specific PA requirements and ask the insurer to email you the form or direct you to their website where you can download it.
Please complete as much of the form as possible to help with the approval process.
Schedule a follow-up visit with your PFP provider (telemedicine is fine) to review the requirements and submit the PA through your insurance or thir party, CoverMyMeds.
Will a new PA be required for each dose?
Important: If the insurance denies coverage after PA submission, our office will not appeal the decision. You will need to meet with your provider to discuss alternative, out-of-pocket options.
If covered, what will my out-of-pocket cost be?
Please note: Even when “covered,” these medications can be very expensive. We don’t want to go through the lengthy PA process if the cost won’t fit your budget.
Does my plan require step therapy (failing another medication first) before covering Wegovy, Zepbound, or Saxenda?
If so, have you already met that requirement?
What medical criteria must be met for coverage?
(Examples: a certain BMI, diagnosis of a medical condition, specific lab results, proof of nutrition therapy, or documented lifestyle modifications.)If required, have these been discussed and documented with your PFP provider?
If these three medications are not covered, what alternative weight-loss medications are covered?
Ask if specific criteria (such as those above) apply to these alternatives.
Please note: We cannot and will not alter medical records, diagnoses, or provide false information for any reason.
Step 2: Contact Your Pharmacy
Due to nationwide shortages and frequent changes in pharmacy stock, please confirm availability before contacting our office to send your prescription. Our office cannot track pharmacy inventories, delivery schedules, or insurance acceptance.
Once you have confirmed that your pharmacy has the medication and dose available, notify our office:
Preferred method: Send a portal message with your name, date of birth, medication name and dose, and your pharmacy’s name, cross streets, and phone number.
If you do not have portal access: Call 303-948-2676, dial extension #140, and leave a detailed voicemail with the same information.
It can take up to two-business days to process these requests
Important to note: If Wegovy is unavailable but your insurance will cover Zepbound (or visa-versa), we must complete the entire PA process again for the new medication.
Medication Details
Below are the GLP-1 medications and common doses, should you need to provide this information to your insurance carrier or pharmacy:
Wegovy (semaglutide) injection
0.25 mg, 0.5 mg, 1 mg, 1.7 mg, 2.4 mg
Zepbound (tirzepatide) injection
2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg
Saxenda (liraglutide) injection
0.6 mg, 1.2 mg, 1.8 mg, 2.4 mg, 3 mg
The Prior-Authorization Process
Prior Authorizations can take up to 30 days for a final decision. Our team processes requests in the order they are received and works diligently to expedite them. You will be notified by your insurance carrier, who also informs your pharmacy of their decision. We are typically the last to be notified. Please direct any status inquiries to your insurance carrier or pharmacy, they can provide the most current updates. Calls to our office may not be returned timely due to the number of requests received daily. We will not submit appeals if your insurance denies.
Don’t want to wait? Ask your pharmacy about cash price, GoodRx coupons or Manufacturer discounts. If you’re okay with paying out of pocket, let us know, and we can proceed without PA delays.