Once Mounjaro is approved for weight loss, is that all it will take for me to get it covered by insurance?

Not necessarily. You’ll need to check with your insurance plan to find out what sort of coverage, if any, they will provide for Weight Loss medication. Most insurance plans don’t cover for weight loss medication, even if they do cover for weight loss surgery. Hopefully this will change in time as more is learned about obesity and the medications coming out show efficacy and safety.

 

Ask your company’s HR for weight loss medication to be added to your health insurance prescription coverage. It is currently in most cases a requirement that a company must request a separate rider for insurance to cover this. It is not currently “standard,” it is “extra.” Lobbying your employer is a good step.

 

Also, looking into getting Medicare to include it may help. Medicare doesn’t include it, because the old weight loss medications that looked promising in the past were detrimental to cardiovascular health (phen-fen I& amphetamine type appetite suppressants). By setting a policy against covering weight loss medication, they “threw the baby out with the bath water.” Science and medicine has evolved and continuously improved, as it should. The new GLP-1RA style therapies are cardioprotective, so policies should be revised to ensure whether policies set in the past are still sense-making, then changed with the new data available.