Members in our Weight Management and Diabetes Prevention programs may be eligible for GLP-1 medications for weight loss. Your employer or plan sponsor may have program engagement requirements you must meet before coverage kicks in. These engagement requirements may not include all coverage requirements. So, be sure to check with your insurance provider to confirm.
These FAQs can help you understand key details about these requirements. You’ll know what to expect and how to prepare.
Note: These FAQs are for people without diabetes. If you have diabetes, consult your care provider. Together, you can discuss the medications and treatment plans that are right for you.
What to know before you get started
Does meeting these requirements guarantee coverage?
Your insurance requires that you complete these actions before it will cover your GLP-1. But they may have other requirements we don’t know about. Check with them or your benefits manager before you fill your prescription. That way, you can avoid any surprises.
How much will insurance cover?
It’s important to know that “covered” doesn’t always mean “free.” You can expect to have out-of-pocket costs. Your cost depends on your plan benefits, your deductible and other factors.
GLP-1 medications can be costly even if your insurance covers some cost. Some people say they pay hundreds of dollars even with insurance coverage. It’s possible that your costs will be higher before you hit your deductible. Again, it depends on your plan benefits.
Teladoc Health doesn’t set pricing. So we encourage you to contact your benefits manager or insurance company. They can give you more details on what your costs will be.
Why do I have to wait to start tracking?
Your employer/plan sponsor requires that you're in the program for a certain number of days before you start tracking. This gives you time to use our tools and form positive habits. These habits can maximize the benefits of GLP-1s.
How were the required actions chosen?
Your employer/plan sponsor chose actions that can make the most positive impact on your health. Regular weigh-ins, coaching sessions, lessons and food tracking are proven to support weight loss. Plus, our 5-minute lessons explore the science behind weight loss and GLP-1s. You’ll learn what to expect and how to prepare for taking them.
Many people expect quick results from taking a GLP-1 medication. But remember, GLP-1 medications are just one part of your weight loss journey. We encourage you to make use of the other features your program offers.
What do I need to do to maintain coverage?
You must continue completing the required actions on a rolling 30-day basis. Or in the 30 days prior to your refill date.
What is a rolling 30-day basis?
This is an ongoing period that considers the most recent 30 days. Instead of being fixed to a calendar month, your completed action log updates daily. This means that the timing of your completed actions can impact coverage. Your coverage depends on a 30-day look-back period from your prescription fill or refill date.
Here’s what happens once you’ve completed the requirements
Can I fill my prescription once I’ve completed these requirements?
There may be a slight delay between the time you complete the requirements and your pharmacy confirming your coverage. If your pharmacy has your script, call them to confirm before you pick up your medication.
What do I need to fill my GLP-1?
You need an active GLP-1 prescription. If you don’t have one yet, schedule a visit with your care provider. They’ll determine if it’s clinically appropriate for you. For some plans, you must have a GLP-1 prescription from a Teladoc Health care provider. Check if your plan requires this before scheduling a visit.
Do I need to keep meeting the required actions once I fill my prescription?
Yes. You need to continue meeting the required actions in the 30 days prior to your refill date.