(Oona Zenda/KFF Health News)
A professional in-home caregiver lost her coverage for Zepbound. She soon realized getting it back was not straightforward.
“I was like: ‘What am I going to do? Hopefully I can just continue keeping this weight off.’”
— Deborah Finley, 50, of Lodi, California
Deborah Finley, 50, of Lodi, California, said her weight started to worry her during the early days of covid. That’s when she noticed a lot of the people who were on ventilators or dying had something in common: obesity.
“It was a scary time,” she said. As a single mom, she was afraid “that I wouldn’t be here for my daughter.”
Finley had been diagnosed with sleep apnea and nonalcoholic fatty liver disease, and she was prediabetic. Her pulmonologist suggested bariatric surgery but couldn’t get Finley’s insurer to cover it.
She exercised and watched what she ate, but she wasn’t losing weight and her mental health suffered.
She remembers telling her doctor: “Look, I’m at 223 pounds. I feel like I’m hitting this wall. I don’t know what else I can do.” That’s when he suggested Zepbound, a GLP-1 drug for obesity.
Finley said she still had to put in a lot of work to get healthy. But the drug helped. Her sleep apnea improved dramatically. She lost weight.
Then her insurance plan stopped covering Zepbound for weight loss at the end of last year. That’s become common because GLP-1 drugs are expensive for health plans and the employers that pay for them.
“They started sending out notices to all the patients,” Finley said. “And they said: ‘Look, we’re pulling this medication. We’re giving you 90 days’ notice to figure out what you want to do.”
From 2025 to 2026, 12 million people were on plans that dropped coverage for Zepbound and 12 million had plans that dropped Wegovy, another GLP-1, according to research by GoodRx, a website that helps patients find discounts on prescription drugs.
If you find yourself in this situation, these tips can help.
1. Read the fine print on coverage.
While many plans don’t cover GLP-1 drugs for weight loss alone, they may make exceptions if you have other conditions.
That was Finley’s situation. She learned that her insurer would cover Zepbound if it was used to treat obstructive sleep apnea, or MASH, a fatty liver disease. GLP-1s are also covered for people with Type 2 diabetes.
You can work with your doctors to screen for qualifying conditions, said Caleb Alexander, a professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health.
Undiagnosed diabetes, he said, is “the most likely scenario that would allow for someone to go from not being qualified to being qualified.”
Since Finley had sleep apnea and testing showing that the drug helped, she learned it could still be covered with a prior authorization — that’s when you have to get approval from your health insurance before it w …