Am I eligible for GLP-1s?

Key takeaways

• Glucagon-like peptide-1 (GLP-1) receptor agonists like Wegovy, Zepbound, and Ozempic may be prescribed for weight loss or managing blood sugar in type 2 diabetes, depending on the medication and your health profile.
• Eligibility for GLP-1 medications typically requires having obesity or overweight with at least 1 weight-related condition, such as hypertension, or a type 2 diabetes diagnosis.
• You may not be suitable for GLP-1 treatment if you have a personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), a history of pancreatitis, or if you’re pregnant or breastfeeding.

Overview

Glucagon-like peptide-1 receptor agonists (GLP-1s), such as Wegovy, Zepbound, and Ozempic, have become increasingly popular because of their ability to support weight loss and blood sugar management. They’re typically very effective, but not everyone will be eligible to use these medications.

Whether or not you’re a candidate for a GLP-1 will depend on several factors, including the medication, your individual health history, and the condition it’s being used to treat. Let’s take a look at some of the eligibility requirements for GLP-1s.

————–

New to GLP-1s or due for a refill? For just $39, connect with a U.S.-licensed healthcare professional today — no membership fees required. If prescribed, your medication ships straight to your door. Start your Rx request here.

Can I take GLP-1s for weight loss?

There are many different GLP-1s on the market, but not all of them are approved by the Food and Drug Administration (FDA) for weight management. The ones that are approved for weight loss are:

• Wegovy (semaglutide)
• Zepbound (tirzepatide)
• Saxenda (liraglutide)
• Foundayo (orforglipron)

The following table lists the eligibility requirements for each of these medications for weight loss.

Your doctor will diagnose obesity or overweight by taking different factors into account, such as your body mass index (BMI). You may need to show that you haven’t been able to lose weight or maintain weight loss through diet, exercise, and behavioral changes alone.

You may also need to ensure you have no history of gallbladder disease, severe gastrointestinal issues, or a personal/family history of medullary thyroid cancer or MEN 2 syndrome, as some GLP-1s carry warnings for these.

————-

If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.

Can I take GLP-1s for diabetes?

Some GLP-1s are approved specifically to manage blood sugar in people with type 2 diabetes. These are:

• Ozempic (semaglutide)
• Mounjaro (tirzepatide)
• Victoza (liraglutide)
• Trulicity (dulaglutide)

All of these can be used for type 2 diabetes in adults. Victoza and Mounjaro are also approved to treat type 2 diabetes in children older than 10 years.

In some cases, these medications may also be used for weight management. This is known as off-label prescribing. It’s safe and effective, but your doctor will still need to determine that you meet eligibility criteria.

Who should avoid GLP-1s?

Some GLP-1s carry warnings that certain people may not be suitable for GLP-1 treatment, including:

• people with a personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
• people with a history of pancreatitis or severe gastrointestinal disease
• pregnant or breastfeeding people
• people with a history of severe allergic reactions to GLP-1 medications

Your doctor will aim to take a thorough medical history before prescribing a GLP-1 to ensure it’ll be safe for you.

How do I know if GLP-1s are right for me?

Deciding whether a GLP-1 is right for you depends on several factors, including your health goals, medical history, lifestyle, and potential risks. Here’s a structured way to evaluate if GLP-1s might be suitable for you:

• Assess your health: Are you looking to manage blood sugar or lose weight? Do you meet the prescribing criteria?
• Weigh the risks and side effects: GLP-1s are generally safe, but they may cause some side effects. Consider whether these may be tolerable for you.
• Evaluate costs and insurance: GLP-1s may be very expensive, and insurance coverage is limited. Consider whether GLP-1s are covered by your plan or whether you can pay for them out of pocket.
• Lifestyle and commitment: GLP-1s are generally prescribed alongside diet and exercise recommendations. Make sure you’re ready to make these changes to your lifestyle to support your treatment.

Questions to ask your doctor

If you’re not sure if a GLP-1 is right for you, you can ask a doctor for advice. Questions to help you make the most of this discussion include:

• Am I a good candidate for a GLP-1? Why or why not?
• Would a GLP-1 medication fit in my current treatment plan?
• Which GLP-1 medication would be best for me?
• What are the benefits of taking a GLP-1?
• What side effects should I watch for?
• Are there any special instructions or precautions?
• What types of follow-up appointments or tests are necessary for starting a GLP-1?

Online care for GLP-1s

If a doctor has prescribed a GLP-1, it’s important to take the medication as directed for as long as your doctor recommends. However, some people might face barriers to accessing GLP-1s, including high costs and access to healthcare appointments.

With Optum Perks Online Care, you can request a new weight loss prescription, get a refill, or get help with an existing prescription. There’s no monthly membership needed — all you’ll pay is $39 for the appointment plus the cost of the medication.

With this service, you can submit an online form answering a few questions about your condition, and a licensed healthcare professional will respond soon after, without the need to make an in-person appointment.

Next steps

If you’re considering a GLP-1:

1. Talk with your doctor about your goals and medical history.
2. Check insurance coverage and explore cost-saving options.
3. Start with lifestyle changes to see if they’re enough.
4. Discuss alternatives if GLP-1s aren’t suitable, such as bariatric surgery or other medications like metformin or phentermine.

—————

Download the free Optum Perks Discount Card to save up to 80% on many prescription medications. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.