Some health insurance plan in Colorado plans may cover GLP-1 drugs, the new weight loss drugs, if they are deemed medically necessary, for example a diagnosis of type 2 diabetes. Individual health insurance plan in Colorado do not cover GLP-1 drugs when prescribed for weight loss, including semaglutide (Wegovy) and tirzepatide (Zepbound).
Some consider the current situation a nation-wide policy problem, where health insurance companies do not cover these new “miracle” weight-loss drugs as medically necessary. Doctors can prescribe Wegovy for people…and the pharmacy will fill it, but the insurance companies do NOT cover it. So full price. Primary Care Doctors are likely familiar with the insurance requirements for this class of drugs.
Sarah, a resident of Boulder, had been struggling with weight management and was considering weight-loss medication as part of her treatment plan. However, she was uncertain whether her Colorado Health Insurance plan would cover these medications. Sarah reached out to our agency for clarity.
We conducted a thorough review of her policy and explained the nuances of coverage for weight-loss drugs in Colorado. Our team helped Sarah educate on the approval process, reviewing the necessary criteria she should discuss with her doctor. With our assistance, Sarah discovered that her insurance did cover the prescribed medication for her particular needs. Today, Sarah is on a healthier path, feeling confident that her treatment is supported by her insurance plan.
Weight-loss Drug Coverage Considerations:
Coverage for weight-loss drugs under Colorado exchange health insurance can vary based on the specific plan.
- Plan Specifics: Not all health insurance plans cover weight-loss drugs. Coverage depends on the specific benefits and formulary (list of covered medications) of the plan you choose.
- Medical Necessity: Some plans may cover weight-loss drugs if they are deemed medically necessary. This usually requires a prescription and may involve meeting certain criteria.
- Prior Authorization: Even if a plan covers weight-loss drugs, it may require prior authorization.
- Coverage Tiers: Weight-loss drugs fall into different tiers in the plan’s formulary, affecting the co-pay or co-insurance amount.
Click Here to watch an Ian Young Health Insurance video addressing the question: Are Weight-loss Drugs Covered?
Schedule an appointment with Ian Young Health Insurance today for help understanding exactly how Colorado Health Insurance plans cover weight-loss and the impact to your costs. Email us with any questions.
