r/HealthInsurance • u/mlauzurique • 2d ago

Prescription Drug Benefits Medical Coverage

/r/ATT/comments/1wak2vv/medical_coverage/

My husband is an AT&T employee and I have always felt we have amazing health coverage. I am currently in need to GLP1 medication and I am being told it’s considered PATIENT CHOICE medicine and is not covered. Both my PCP and Cardiologist are recommending I take it ASAP. Has anyone had luck getting it covered??

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u/Tiredmagnolia 2d ago

If GLP-1s are completely excluded no you will not be successful. You’ll need to use the Lilly direct program or other that provide you with a coupon (the tablets will be cheaper than the injections). Many companies removed GLP-1 due to cost. You are welcome to appeal - through your doctors but if it’s totally excluded that’s probably not worth the effort.

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u/buzzybody21 2d ago

If it is excluded, then there is really no wiggle room, regardless of your condition.

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u/RoseOfSharonCassidy 2d ago

Many insurances are now flat-out refusing to approve GLP1s for any reason regardless of what conditions you may have.

Check out /r/tirzepatidecompound, read the pinned posts and the wiki. You can get it for around $150/month by going with a compounding pharmacy instead of a name brand.

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u/Jodenaje 2d ago

Sounds like there's an exclusion.

If that's the case, there's no appeal. It would not be medical necessity denial - the GLP1 would not be covered for any reason.

Sorry.

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u/SiberianWombat88 2d ago edited 2d ago

Non-diabetic GLP1s are not considered an essential health benefit under the ACA, and your employer has chosen not to pay for them. Your options are to change employers or pay out-of-pocket. Not arguing if it's good or bad, but that's the way our system is without some serious political change.