Exploring GLP-1 Weight-Loss Medication Options When Insurance Doesn’t Cover Them

Medications known as GLP-1s (glucagon-like peptide-1 receptor agonists) have gained attention for helping people manage weight and related health conditions. Many health plans, including BCBS, Priority Health and UHC in Michigan, do not cover GLP-1 drugs when prescribed specifically for weight loss, which can leave employees wondering what, if any, alternatives exist.

The good news is that insurance coverage isn’t the only path. There are legitimate, medically supervised ways to access these medications on a self-pay basis. This overview explains what GLP-1s are commonly prescribed for and outlines options employees may consider if insurance coverage is limited or unavailable.

When Can GLP-1 Medications Be Prescribed?

GLP-1 medications are FDA-approved for certain medical conditions, and providers may also prescribe some of them off-label based on clinical judgment.

Common diagnoses include:

• Type 2 diabetes

• Obesity (generally a BMI of 30 or higher)

• Overweight (BMI of 27 or higher) when combined with a related health condition such as high blood pressure, high cholesterol, sleep apnea, or insulin resistance

Some GLP-1 medications approved for diabetes are often prescribed off-label for weight loss. This is a common and legal practice when a provider believes it is appropriate for a patient’s health needs.

GLP-1 Medications You May Hear About

You may recognize some of these brand names:

• Wegovy® (semaglutide) – approved for weight management

• Saxenda® (liraglutide) – approved for weight management

• Zepbound® (tirzepatide) – approved for weight management

• Ozempic® (semaglutide) – approved for Type 2 diabetes; commonly used off-label for weight loss

• Mounjaro® (tirzepatide) – approved for Type 2 diabetes; commonly used off-label for weight loss

• Trulicity® and Victoza® – primarily prescribed for diabetes, with potential weight-related effects

These medications generally work by helping regulate appetite, slowing digestion, and increasing feelings of fullness. Results and side effects vary from person to person. Many users report reduced appetite and weight loss, while others experience nausea or gastrointestinal discomfort, especially during early dose increases. Most people experience only mild side effects with GLP-1 medications, but in rare cases, more serious side effects can occur.

What to Do If Your Health Plan Doesn’t Cover GLP-1s for Weight Loss

If your plan excludes weight-loss medications, you still have several legitimate self-pay options that involve licensed clinicians and regulated pharmacies.

Telehealth and Virtual Care Programs

Several telehealth companies offer medical evaluations for weight management and GLP-1 prescriptions without involving your insurance.

Examples include (but are not limited to):

• National telehealth providers such as Hims & Hers, CareVolidate/CareGLP, Ro, Sprout, MEDVi, SkinnyRx, MyStart, Noom, etc. or retail-based programs affiliated with major pharmacies.

• TrumpRx is a federal prescription drug pricing initiative designed to help individuals access lower-cost medications by reducing supply-chain markups. It does not provide medical care or prescriptions, but it may help locate more affordable pricing once a valid prescription is obtained. This program is expected to rollout in spring 2026.

Reported pricing projections suggest:

• Injectable GLP-1 medications may be available at significantly reduced monthly cash costs compared to typical retail pricing.

• Oral GLP-1 options, as they become available, may be priced even lower.

• Patents expire starting in 2026 in countries like India, China, Brazil and Canada. Patents in the US remain in place until the late 2020’s at the earliest. When a medication comes off patent, cheaper generics/biosimilars tend to come to market.

A Note About Compounded GLP-1 Medications

Some pharmacies offer compounded versions of GLP-1 medications. These are not FDA-approved and can vary in strength, formulation, and quality. If you are considering compounded medications, it’s important to discuss the risks and benefits with a licensed healthcare provider and use a reputable pharmacy.

Avoid online sellers that do not require a prescription. Counterfeit and unsafe products remain a concern in this space.

Helpful Tips for Employees

• Ask your provider to document your diagnosis clearly; this can help with eligibility across programs.

• Compare self-pay pricing between telehealth services, retail pharmacies, and discount programs.

• HSA and FSA funds may be used for eligible prescription expenses.

• Medication works best when paired with nutrition, physical activity, and lifestyle support.

Bottom Line

While insurance coverage for GLP-1 weight-loss medications remains inconsistent, employees are not without options. Telehealth platforms and cash-pricing programs can help bridge the gap—often with more predictable costs and ongoing clinical support.

We know that as HR professionals, you’re probably receiving a lot of questions about GLP-1s. Please feel free to share this blog with your employees. As always, if you have any questions, please reach out to your Rose Street Advisors’ Relationship Manager.