What Weight Loss Medications Are Approved by Express Scripts in 2025?

If you’re trying to lose weight and wondering whether your insurance covers any of the newer weight loss medications, you’re not alone. Express Scripts, one of the largest pharmacy benefit managers in the U.S., covers several FDA-approved weight loss drugs - but not all of them. And coverage isn’t automatic. It depends on your plan, your medical history, and whether your doctor meets their requirements.

Which Weight Loss Medications Does Express Scripts Cover?

As of 2025, Express Scripts includes the following FDA-approved weight loss medications in its formulary for most commercial and Medicare Advantage plans:

• Wegovy (semaglutide) - approved for chronic weight management in adults with obesity or overweight with at least one weight-related condition
• Saxenda (liraglutide) - approved for long-term weight management in adults with BMI ≥30 or ≥27 with weight-related comorbidities
• Qsymia (phentermine/topiramate) - a combination drug for adults with BMI ≥30 or ≥27 with related health issues
• Contrave (naltrexone/bupropion) - approved for chronic weight management in adults with obesity or overweight with weight-related conditions
• Orlistat (Xenical, Alli) - available over-the-counter and prescription, covered under some plans for BMI ≥30

These drugs are not covered for cosmetic use. Express Scripts requires documented evidence of obesity-related health risks - like high blood pressure, type 2 diabetes, or sleep apnea - before approving coverage. Many patients are denied at first because their provider didn’t submit enough clinical documentation.

How Does Express Scripts Decide What to Cover?

Express Scripts doesn’t just follow FDA approvals. They use a tiered formulary system that ranks drugs by cost, effectiveness, and safety. Weight loss medications are often placed on Tier 3 or Tier 4, meaning higher out-of-pocket costs unless you qualify for a prior authorization exception.

For example, Wegovy is a high-cost drug - around $1,300 per month without insurance. Express Scripts may require you to try and fail at least three lifestyle interventions (like a 6-month medically supervised diet program) before approving it. Some plans also require a BMI over 35, not just 30.

They also favor drugs with long-term safety data. That’s why Ozempic (semaglutide) is covered for diabetes but not always for weight loss - even though it’s the same active ingredient as Wegovy. Express Scripts treats them as separate drugs with separate indications.

What’s Not Covered?

Several newer or less proven weight loss drugs are excluded from Express Scripts’ formulary as of 2025:

• Zepbound (tirzepatide) - approved by the FDA in late 2023, but not yet added to most Express Scripts formularies due to high cost and limited real-world data
• Plenity - a medical device, not a drug, so it’s rarely covered
• GLP-1 drugs used off-label - like semaglutide or tirzepatide prescribed for weight loss without FDA approval for that use
• Over-the-counter supplements - like Garcinia cambogia, green tea extract, or appetite suppressants sold online - are never covered

Some patients try to get Zepbound covered by asking their doctor to prescribe it as a diabetes medication first. But Express Scripts has strict rules: if you don’t have type 2 diabetes, they won’t pay for it for weight loss - even if your doctor says it’s medically necessary.

How to Get Your Weight Loss Medication Covered

Getting approved isn’t just about having insurance. You need to follow a clear process:

1. See your doctor and get a formal diagnosis of obesity (BMI ≥30) with at least one related condition (e.g., hypertension, prediabetes, fatty liver)
2. Document at least 6 months of lifestyle changes - keep food logs, exercise records, or a letter from a nutritionist or weight management program
3. Ask your doctor to submit a prior authorization request to Express Scripts using the correct ICD-10 codes (E66.9 for obesity, E78.5 for hyperlipidemia, etc.)
4. Call Express Scripts customer service (number on your card) to confirm your plan includes weight loss meds and ask for the formulary list
5. If denied, appeal with additional lab results, progress notes, or specialist letters

Many people give up after the first denial. But Express Scripts approves nearly 60% of appeals when patients submit complete documentation. Keep copies of everything.

What If Your Plan Doesn’t Cover It?

If Express Scripts won’t cover your medication, you still have options:

• Use manufacturer coupons - Novo Nordisk offers Wegovy savings cards that can reduce cost to $25/month for eligible patients
• Try generic alternatives - orlistat (Alli) is available OTC for under $40/month
• Switch to a different insurance plan during open enrollment - some Medicare Advantage plans now include weight loss meds as a standard benefit
• Use a health savings account (HSA) or flexible spending account (FSA) to pay for prescriptions tax-free

Some patients use mail-order pharmacies like Express Scripts’ own pharmacy to get a 90-day supply at a lower cost than retail. Always compare prices - a 30-day supply of Saxenda might cost $1,100 at CVS but $850 through Express Scripts’ mail service.

Common Mistakes That Lead to Denial

Here’s what most people get wrong:

• Assuming FDA approval = insurance coverage - it doesn’t
• Not documenting lifestyle efforts - insurers want proof you tried diet and exercise first
• Using the wrong diagnosis code - BMI alone isn’t enough; you need a comorbidity
• Trying to get Ozempic for weight loss - Express Scripts treats it as a diabetes drug only
• Waiting until the last minute - prior auth can take 7-14 days

One patient in Texas was denied Wegovy because her doctor coded her condition as "overweight" instead of "obesity." She resubmitted with a BMI of 34 and a diagnosis of prediabetes - and got approved within 48 hours.

What’s Changing in 2025?

Express Scripts is updating its formulary in early 2025 to include more weight loss medications due to rising demand and new clinical evidence. Zepbound is expected to be added by Q2 2025, but only for patients with BMI ≥35 and type 2 diabetes.

Some employers are now offering weight loss meds as part of their wellness programs, bypassing traditional formulary restrictions. If your company partners with Express Scripts for health benefits, ask HR if you qualify for an exception.

Also, Medicare Advantage plans are expanding coverage. As of January 2025, over 80% of Medicare Advantage plans now include at least one weight loss drug - up from just 35% in 2023.

Bottom Line

Express Scripts does cover real, science-backed weight loss medications - but only if you meet strict criteria. It’s not a free pass. You need medical proof, documentation, and persistence. The drugs work - but insurance won’t pay unless you jump through the right hoops.

Start with your doctor. Get your numbers right. Submit the paperwork. And don’t give up if you’re denied the first time. The system is designed to make it hard - but it’s not impossible.