13220 Rosedale Hill Avenue, Huntersville, North Carolina 28078, United States
Weight Loss Medication Coverages: How These Changes Impact You
Posted 07.24.2025
We want to inform you about recent changes to insurance coverage for Wegovy and Zepbound, which became effective July 1, 2025. These changes are making it more difficult to secure prior authorizations (PAs) for patients already established on these medications, as well as those who wish to begin treatment.
Key Points to Note:
Insurance Coverage: Many insurance plans now require patients to first try and fail on Wegovy before they will approve Zepbound. This is currently impacting CVS Caremark patients, but could impact other insurances in future.
Patient Action Required: Before starting either medication, we ask that you contact your insurance directly to confirm whether weight loss medications are covered under your plan. Please note that these medications are prescribed specifically for weight loss, not for diabetic use. When speaking with your insurance, please clarify that you are seeking coverage for weight loss medications. If coverage is confirmed, please notify our office so we may proceed with submitting a PA request on your behalf.
PA Denials: If a PA is denied, you will be notified by our team via your patient portal or phone call. At that point, it is the patient’s responsibility to work with their insurance to address the denial, or to pursue an appeal. A virtual or in-person office visit with your provider will be required to ensure appropriate documentation for any appeals.
Patient Expectations: Please remember that our office does not control insurance denials or approvals. We may submit a request for prior authorization; however, the final determination lies with your insurance provider and what is covered under your plan. If a PA is denied, we ask that you treat our staff with kindness and professionalism. Our team is here to assist you and understands that dealing with insurance issues can be frustrating. We appreciate your cooperation in maintaining positive and respectful interactions.
Thank you in advance for your understanding and cooperation. Please don’t hesitate to contact our office if you have questions after speaking with your insurance plan. We may be reached at (704) 766-0320 and are happy to assist you!