Weight Loss Medications

The news regarding the health advantages and even some problems with the GLP classes of medication are overwhelming. News coverage and conversations among friends can make it seem like a must have for every adult. There are many true health indications for which the GLP1 class medications are valuable. 

However, these medications only work properly when used in tandem with true healthy diet efforts and proper lifestyle. In fact, you can avoid some of the side effects such as facial wasting and hair loss, if it is coupled with mindful and supportive nutrition. 

Despite the commercials and other media that make it seem like insurance coverage is guaranteed for people for sleep apnea alone or other singular conditions, it is not truly simple. Generally, insurance will cover this medication class for patients with diabetes. This office has developed a construct to try to avoid wasting the time of patients, staff and insurance reviewers. We have tried to make these criteria uniform and understandable. We have placed them in a document called the Weight Loss Medication Agreement. When we plan to start a weight loss medication of any kind, GLP-1 or otherwise, we will review this agreement with patients and expect they do their own due diligence for this. 

We can try to get insurance authorization for weight loss medication in cases of patients with obesity with BMI >40; 1-2 comorbid conditions such as sleep apnea, cardiovascular disease,  hypertension etc; and only after documented proof of use of a formal diet program in the 3-6 months leading into medications start- this program can be nutrition consultant visits, Weight Watchers etc. It does not matter how many times patients have used such programs before, it has to be done in the immediate timeframe before medication start.

This is a constantly changing cost and insurance coverage environment. There is a lot of misinformation out there. Even specialty doctors who do not Rx these medications suggest them strongly to patients in such a  way that makes patients feel the coverage would be guaranteed. This however is not the case. They are speaking from the science side of medical care rather than considering the financial and insurance side.

There are exciting studies about various additional health benefits such as for neurologic and rheumatologic problems for patients with GLP-1s and this is irrespective of weight loss. Insurance coverage is not up with the science as yet.

There are patients for whom weight loss medication are never covered as they are a plan exclusion for their particular insurance. So patients who meet all of the above criteria may be declined medication coverage. For these patients and for some people who would be considered on the bubble of qualifying (could clearly benefit from medication, are doing the other healthy measures, but do not meet all of the health history criteria), we can discuss self-pay options. These are expensive, on average $400/month (as of 1/2026). People need to go into such a cost considering the medication as life long. Studies show patients regain all the lost weight on average 18 months after stopping GLP-1s. 

The providers at Quaker Medical are here to support your health and wellness as a whole person, not just a weight number. As such, we will support people in their goals and will consider medication treatments where appropriate. There is a lot of angst and emotion around this particular medication issue. We thank people for their patience and ask that they exercise self care and logic as we work together.