Does Your Benefits Broker Know if Ozempic is Covered if a Doctor Prescribes it for Knee Pain?

Weight loss drugs are becoming more commonly prescribed by doctors, and there is some inconsistency in how insurance carriers are covering them. Historically, these drugs have been prescribed for patients with diabetes, but have been found to be helpful in treating various ailments. Prediabetes, joint pains, and other side effects of obesity can help to be treated with weight loss medicine. The issue is, there’s great inconsistency in when insurance carriers will cover these prescriptions, based on what it’s given for.

Prescriptions have long been given out for weight loss drugs, but their increased use for additional issues people are facing has been more common lately, and there is a gap between what doctors are giving out and what insurers want to cover. I have seen Ozempic, a weight loss drug be denied by insurers for prediabetes, even though it is covered by the same insurer for diabetes. This puts the insured in a tough position, with not much they can do about it. Their potential options are seeing a different provider, asking their current provider for another solution, or trying to work with the insurance company to get this covered.

As I mentioned, some insurers will cover this. Do you know if yours does? Concerns like this could be major in some of your employees’ lives, and it’s a discussion that your benefits broker should bring up with you. What seems like a minor exposure you often wouldn’t think of could lead to an employee looking for a new employer. If you would like to talk about how this could be affecting your company, feel free to reach out.

Written by: Xavier Bodnar

G. Kevin Nemith , Hilb Group Delaware