What Weight Loss Medications Are Approved by Express Scripts?

When you’re trying to lose weight and your doctor recommends medication, one of the first questions you might ask is: Does my insurance cover it? For millions of people in the U.S., Express Scripts is the pharmacy benefit manager handling their prescriptions. But not all weight loss drugs are approved for coverage - and the list changes often.

What Is Express Scripts?

Express Scripts is one of the largest pharmacy benefit managers (PBMs) in the United States. It doesn’t sell drugs directly. Instead, it works with health plans - like employer insurance, Medicare Part D, and Medicaid - to manage prescription drug benefits. That means they decide which medications are covered, how much you pay out of pocket, and whether you need prior authorization before getting a refill.

They maintain a formulary - a list of approved drugs. If a weight loss medication isn’t on that list, you’ll likely pay full price. And even if it is, coverage rules can be strict.

Which Weight Loss Medications Are Covered by Express Scripts?

As of late 2025, Express Scripts covers several FDA-approved weight loss medications - but coverage depends on your specific plan, your BMI, and whether you’ve tried other treatments first.

Here are the most commonly covered options:

• Wegovy (semaglutide) - Approved for adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related condition like high blood pressure or type 2 diabetes. Most plans require a 3-month trial of diet and exercise before approving it.
• Ozempic (semaglutide) - Technically approved for type 2 diabetes, but often prescribed off-label for weight loss. Express Scripts typically only covers it for diabetes unless your plan has special exceptions.
• Saxenda (liraglutide) - Approved for chronic weight management in adults with BMI ≥30 or ≥27 with comorbidities. Requires documentation of failed lifestyle changes.
• Contrave (naltrexone/bupropion) - Covered for patients with BMI ≥30 or ≥27 with hypertension, dyslipidemia, or prediabetes. Often requires prior authorization and lab tests.
• Qsymia (phentermine/topiramate) - Covered for BMI ≥30 or ≥27 with related conditions. Not for people with glaucoma, hyperthyroidism, or a history of heart disease.
• Belviq (lorcaserin) - No longer available in the U.S. due to cancer risk. Not covered.

Notice a pattern? Most of these are GLP-1 receptor agonists - the same class of drugs used for diabetes. They work by slowing digestion, reducing appetite, and helping your brain feel full faster. But they’re expensive. Without insurance, Wegovy can cost over $1,300 a month. With Express Scripts coverage, your copay might drop to $25-$100, depending on your tier.

Why Isn’t Every Weight Loss Drug Covered?

Express Scripts doesn’t cover every FDA-approved drug because they have to balance cost, safety, and clinical effectiveness. They follow guidelines from organizations like the American Heart Association and the Obesity Medicine Association.

For example, phentermine - a stimulant used for short-term weight loss - is rarely covered long-term because of potential side effects like increased heart rate and dependence. Express Scripts limits it to 12 weeks unless you have a documented medical reason to continue.

Even newer drugs like Mounjaro (tirzepatide) and Zepbound (tirzepatide) - which are showing powerful weight loss results - are still being evaluated. As of December 2025, Zepbound is not yet on the standard Express Scripts formulary, though some employer plans may offer it as a specialty benefit.

How Do You Get Coverage?

Getting a weight loss medication covered by Express Scripts isn’t automatic. Here’s how it usually works:

1. Your doctor prescribes the medication and confirms your BMI and related health conditions.
2. The pharmacy submits the claim to Express Scripts.
3. Express Scripts checks your plan’s formulary and coverage rules.
4. If it’s not automatically approved, your doctor may need to submit a prior authorization - a form explaining why this drug is medically necessary.
5. Express Scripts reviews the request, often within 24-72 hours.
6. If denied, you can appeal - and many appeals succeed with proper documentation.

Some plans require you to try cheaper options first - like generic phentermine or lifestyle programs - before approving GLP-1 drugs. Others only cover them if you’re enrolled in a weight management program.

What If It’s Not Covered?

If your plan denies coverage, you still have options:

• Ask your doctor for a patient assistance program. Novo Nordisk (maker of Wegovy) and Eli Lilly (maker of Zepbound) offer savings cards that can cut the cost to under $25/month for eligible patients.
• Use a discount pharmacy like GoodRx or SingleCare. These aren’t insurance, but they can give you prices lower than cash at some pharmacies.
• Check if your employer offers a wellness stipend. Some companies now include weight loss meds in their health incentives.
• Switch plans during open enrollment. Some Medicare Advantage or employer plans have better coverage for GLP-1 drugs than others.

Don’t give up if you’re denied. Many people get approved on their second try - especially if they provide lab results showing improved blood sugar, cholesterol, or blood pressure after starting the medication.

What About Over-the-Counter Weight Loss Pills?

Express Scripts doesn’t cover any over-the-counter (OTC) weight loss supplements. That includes things like Garcinia cambogia, green tea extract, or appetite suppressants sold at pharmacies. These aren’t FDA-approved for weight loss and often lack clinical proof.

Even if a product claims to be "doctor-recommended," if it’s not a prescription drug with an FDA approval code, it won’t be covered. Stick to FDA-approved medications - they’re the only ones with proven safety and effectiveness data.

How to Check Your Coverage

Don’t guess - check directly. Here’s how:

• Log in to your Express Scripts account at expressscripts.com and use the Drug Search tool.
• Call the number on your insurance card and ask: "Is [drug name] covered under my plan, and what are the prior authorization requirements?"
• Ask your pharmacist - they can check your plan’s formulary in real time before filling the prescription.

Always confirm coverage before your doctor writes the script. A prescription doesn’t guarantee payment - only your plan’s rules do.

What’s Changing in 2026?

More insurers, including Express Scripts, are starting to cover weight loss meds more broadly - not just as a last resort, but as part of chronic disease prevention. The CDC now classifies obesity as a disease, and Medicare is expanding coverage for GLP-1 drugs in 2026.

Express Scripts is expected to add Zepbound to its formulary by mid-2026, and may lower prior authorization barriers for Wegovy and Saxenda. Some employer plans are already removing the requirement to try diet and exercise first.

But coverage still varies. What’s covered under your employer’s plan might be different from what’s covered under your spouse’s Medicare plan. Always verify your own benefits.

Final Thoughts

Weight loss medications aren’t magic pills - they work best when paired with healthy eating, movement, and behavior changes. But for many people, they’re the missing piece. Express Scripts covers several effective options - but only if you meet their rules.

Know your plan. Talk to your doctor. Get the right documentation. And don’t let a denial stop you - appeals work. With the right approach, you can get the medication you need without paying thousands out of pocket.