Who Can Take Weight Loss Medications?

Are you an overweight or obese adult with health risks or conditions associated with your weight? If you have tried numerous diets and exercise routines but have been unable to manage your weight successfully, prescription weight loss drugs may be a good option.

Prescription weight loss medicines are approved by the Food and Drug Administration (FDA) to treat overweight or obesity and certain associated health conditions. Their use cases are very specific and you need a healthcare provider to prescribe them for you. Typically, they will also monitor your use of the medicine.

Medications for weight loss may be prescribed if a person has:

• A body mass index (BMI) of 30 or higher, which is considered obese. BMI is a measure of a person's body fat percentage relative to their height.
• A BMI over 27, which is considered overweight, and if they have at least one weight-related condition.

Before your doctor prescribes a medication, they also have to consider your health history, risks, and lifestyle. These drugs should not be taken by certain individuals, such as pregnant or breastfeeding women.

These medications are formulated specifically to help with chronic weight management. But even the best weight loss medication is not supposed to be a substitute for a healthy diet and regular exercise. Health experts recommend using weight loss drugs together with lifestyle interventions.

Top Rated Weight Loss Pills

Medications that contain semaglutide are among the top rated weight loss pills today. These FDA-approved medicines have a common active ingredient: glucagon-like peptide-1 (GLP-1).

Semaglutide (the generic name for GLP-1 medications) is the active ingredient in popular brand name drugs Ozempic, Wegovy, and Rybelsus. Among these brands, only Rybelsus is available as a pill. Tirzepatide is another popular weight loss medication, and is the active ingredient in Zepbound and Mounjaro. It is actually a GLP-1 and GIP (gastric inhibitory polypeptide) agonist combo. Tirzepatide is not available as a pill. Both semaglutide and tirzepatide mimic the mechanisms of action of naturally occurring GLP-1 hormones in the gut.

More specifically, semaglutide and tirzepatide trigger insulin release to regulate blood sugar levels after food intake. They also help suppress appetite and delay gastric emptying to promote satiety.

Take note that Ozempic, Rybelsus, and Mounjaro are indicated for the treatment of type 2 diabetes; weight loss is a common side effect of these drugs. Wegovy and Zepbound are the FDA-approved medications for weight loss.

Here are other prescription medications for weight loss that you can ask your doctor about:

• Liraglutide (Saxenda). A daily injectable that inhibits hunger signals from the brain and promotes satiety.
• Phentermine (Adipex, Suprenza). This class of weight loss drugs has been around the longest. Both brands are available as oral medications.
• Phentermine-topiramate (Qsymia). This once-daily pill helps suppress appetite and cravings.
• Naltrexone-bupropion (Contrave). The drug targets the brain's pleasure centers to decrease appetite and cravings.
• Setmelanotide (Imcivree). The drug is formulated for chronic weight management in adults and children aged 6 years and older with obesity associated with a rare genetic disorder.
• Orlistat (Xenical, Alli). The drug inhibits the body's absorption of dietary fats by blocking the enzyme that breaks down fats from food.

How To Get Weight Loss Medication

It's always best to consult a healthcare professional if you want to know how to get weight loss medication. Determining whether or not you can benefit from pharmaceutical intervention usually begins with your BMI.

Most prescription drugs for weight loss require a minimum BMI. A BMI of at least 30 may be required for obesity treatment, or a BMI of 27 for overweight individuals with a weight-related condition.

Your doctor will also take a complete medical history and lifestyle check. Those who have been struggling to lose weight despite dieting and exercise are top candidates for weight loss drugs. You can also be a candidate if you are at a high risk for or already have cardiovascular disease.

Make sure to ask your doctor about the side effects of these drugs. Common ones include GI issues, such as nausea, vomiting, diarrhea, constipation, gas, and stomach pain. They typically occur at the start of treatment and with every dosage increase.

Does Medicaid Cover Ozempic for Weight Loss?

Does Medicaid cover Ozempic for weight loss? Unfortunately, state Medicaid programs cover Ozempic only for the treatment of approved conditions. These include type 2 diabetes, cardiovascular risk reduction, and chronic kidney disease associated with type 2 diabetes. Off-label use of Ozempic for weight loss is not covered under Medicaid.

How To Get Insurance To Cover Weight Loss Medication

Do you want to know how to get insurance to cover weight loss medication? By law, medications prescribed specifically for weight loss cannot be covered by Medicare. However, most insurance plans do cover other weight loss interventions if the individual meets specific eligibility criteria.

According to the Affordable Care Act (ACA),most health insurers are required to cover preventive care services, such as obesity screening and counseling. Adults with a higher risk for chronic conditions may also be covered for diet counseling. Some insurers may cover additional services, such as surgery, medication, nutrition counseling, and nutrition therapy.

If you have a commercial health plan, you should check if your policy covers prescription weight loss medications. Take note that if covered, it often comes with restrictions. You should also check with your provider if you can secure prior authorization or a specific FDA approval to get coverage.