Which GLP-1s Are Approved for Weight Loss?
Glucagon-like peptide-1 (GLP-1) receptor agonists and gastric inhibitory polypeptides (GIPs) are highly sought-after anti-obesity medications addressing type 2 diabetes and obesity. They are considered incretin hormones which are released by the intestine in response to glucose or nutrient intake, promoting insulin secretion from pancreatic B cells and influencing various organs, including the pancreas, adipose tissue, bones, and the brain. Their role extends to the regulation of appetite, satiety, and cognitive processes within the brain (Seino, Fukushima, & Yabe, 2010).
The current FDA-approved GLP-1s and GIPs for weight management include Saxenda (Liraglutide), Wegovy (Semaglutide), and Zepbound (Tirzepatide). Patients may be confused when checking coverage for medications like Ozempic (Semaglutide) and Rybelsus (Semaglutide), while they are the same medication as Wegovy (Semaglutide), their label is specifically for type 2 diabetes, and they have different dosing schedules than Wegovy (Semaglutide). While insurance may cover Ozempic and Rybelsus, they will likely only cover these if you have a specific type 2 diabetes diagnosis.
Similar nuances apply to Mounjaro (Tirzepatide) and Zepbound (Tirzepatide). Although these medications have the same dosing schedule, Mounjaro (Tirzepatide) is labeled for type 2 diabetes, while Zepbound (Tirzepatide) has approval specifically for weight management.
Obtaining these medications poses challenges due to supply shortages and insurance coverage issues. To facilitate the process, understanding qualification criteria, navigating insurance coverage, and taking necessary steps become essential.
Here's a step-by-step guide for obtaining GLP-1s for Weight Management:
Step 1: Qualification Criteria
Qualification requires a BMI ≥ 27 with a co-occurring weight-related disorder (e.g. hypertension, hyperlipidemia, sleep apnea, pcos, etc.) or a BMI ≥ 30. However, qualification doesn't guarantee insurance coverage.
Step 2: Be Your Own Advocate
Before consulting your healthcare provider, you can look up your pharmacy benefits online for coverage for these medications. Look for common GLP-1s and pay attention to terms like "approved with prior authorization" or "exclusion to the plan." If they are “approved with prior authorization,” this involves a process of the pharmacy running the claim, the pharmacy getting a prior authorization notification, which then prompts the provider to call insurance to discuss the case. The prior authorizations are then approved or denied.
Step 3: Insurance Approval and Starting the Medication
If your plan approves it, and you can start, that's great! Regular check-ins with your provider are important for monitoring weight loss progress, assessing side effects, and addressing lifestyle factors such as exercise, nutrition, sleep, and stress management. If your insurance plan excludes these medications, your options are to pay cash ($1000/month), use a coupon (if you qualify), or consider other anti-obesity medications.
References:
Seino Y, Fukushima M, Yabe D. GIP and GLP-1, the two incretin hormones: Similarities and differences. J Diabetes Investig. 2010 Apr 22;1(1-2):8-23. doi: 10.1111/j.2040-1124.2010.00022.x. PMID: 24843404; PMCID: PMC4020673.
