Understanding Your Coverage

Many insurance plans do not cover GLP-1 medications for weight management. Around 50% of Tia patients receive denials for these medications. Of the plans that do provide coverage, requirements vary. Common requirements include but are not limited to:

• Body mass index (BMI): Some plans require that BMI is greater than 30 (class 1 +2 obesity), some require BMI greater than 40 (class 3 obesity).
• Co-morbidity requirements: for patients with BMI between 27-40, plans may require that the patient also has a diagnosis of a weight-related co-morbidity, like type 2 diabetes, hypertension, sleep apnea, or cardiovascular disease.
• Participation in a weight reduction program: many plans require at least 6 months of documented participation in a weight reduction program like Weight Watchers, Noom, or working with a registered dietitian.
• Trial of other medications: Many plans require the patient to have tried and failed to reduce their weight with a less expensive prescription medication like Metformin, Alli, or Contrave.

Your Tia provider will not have access to details about your insurance coverage. We recommend that you call your insurance to learn about your coverage for GLP-1 medications before your appointment at Tia.