Topic
How do I get a GLP-1 covered?
Prior authorization, appeals, employer and Medicaid coverage, patient assistance.
GLP-1 Prior Authorization: What Insurers Actually RequireWhat the published prior authorization criteria from UnitedHealthcare, CVS Caremark, Aetna, Cigna, Express Scripts and BCBS FEP actually say about BMI, comorbidities, lifestyle programs, step therapy, quantity limits and renewals — with the documents quoted and linked.How to Appeal a GLP-1 DenialHow to read a denial letter, tell an exclusion from a medical necessity denial, work through internal appeals, and use your right to an independent external review — with deadlines, required notice contents, and what the data says about your odds.How to Get Wegovy or Zepbound Covered by InsuranceA step-by-step process for finding out whether your plan covers a GLP-1 for weight loss, what it will require, and what to do at each fork in the road — written for the person holding the insurance card, not the prescription pad.HSA and FSA for GLP-1 DrugsWhether you can pay for Wegovy, Zepbound, Ozempic or a compounded GLP-1 with tax-free HSA or FSA money, when a letter of medical necessity is needed, what the tax deduction really requires, and how to work out whether to run a fill through insurance or pay cash.Medicaid Coverage of GLP-1s by StateWhich state Medicaid programs cover GLP-1s for obesity, which coverage is required in every state no matter what, what changed in 2025 and 2026, and how to check your own state's rules — plus how ACA Marketplace coverage compares.Medicare GLP-1 Bridge: How It WorksThe step-by-step mechanics of Medicare's GLP-1 Bridge demonstration: who qualifies, which products and devices are covered, how the prescription and prior authorization must be sequenced, what the $50 copay does and does not count toward, and why there is no appeal.Novo Nordisk and Lilly Patient Assistance Programs ExplainedWho actually qualifies for the Novo Nordisk Patient Assistance Program and the Lilly Cares Foundation, what the savings cards really cap out at, why a $25 card can turn into a $500 bill in month six, and how copay accumulators and alternative funding programs change the picture.Which Employers Cover GLP-1s?What the 2025 and 2026 employer surveys actually show about GLP-1 coverage, why the numbers disagree with each other, the strings employers attach, which state and federal plans cover the drugs, and how to find out what your own employer does.