Last updated 10/14/23

Background

Insurance companies offer variable coverage of GLP-1 agonists and related medications. Miga clinicians have to submit prior authorizations to insurance companies in an attempt to get medications covered, especially for patients that do not have a diagnosis of type 2 diabetes. These prior authorizations can take up to several weeks and may also involve an appeal if denied. You can help us to expedite your care by calling your insurance company and asking about coverage. We suggest you ask the following questions and let us know what you learn:

Questions to ask your insurance company or prescription drug plan:

1. Do you cover GLP-1 or GIP class of medication WITHOUT a diagnosis of type 2 diabetes?
2. Can you authorize these medications for “off label use” with the diagnosis of any of the following (only ask about conditions applicable to you):
1. Prediabetes
2. Hypertension
3. Overweight
4. Obesity
5. Mixed hyperlipidemia
6. Cardiovascular disease
7. History of Stroke
3. Which medication do you cover with PRIOR AUTHORIZATION WITHOUT the diagnosis of type 2 diabetes?
1. Ozempic
2. Mounjaro
3. Trulicity
4. Rybelsus
5. Victoza
6. Saxenda
7. Wegovy
8. Zepbound
4. Is there cost sharing / tiered pricing available for any of the above medications?