Coverage Overview
Oscar Insurance provides coverage for weight loss medication under certain conditions. Coverage varies based on individual policies, state regulations, and whether medical necessity is established.
Covered Medications
Oscar Insurance covers FDA-approved weight loss medications, including:
- Phentermine-topiramate (Qsymia)
- Naltrexone-bupropion (Contrave)
Eligibility Requirements
To be eligible for coverage, individuals must meet specific criteria, such as:
- Body mass index (BMI) of 30 or higher with a comorbid condition like diabetes or high blood pressure
- BMI of 27 or higher with at least two weight-related concerns
- Demonstration of unsuccessful weight loss efforts through diet and exercise
Medical Necessity Determination
Oscar Insurance requires evidence of medical necessity to approve weight loss medication coverage. This may include:
- Diagnosis of obesity or a related health condition
- Documentation of previous weight loss attempts
How to Confirm Coverage
Members can confirm their coverage by:
- Reviewing their membership booklet or coverage certificate
- Contacting Oscar’s Member or Provider Services
Additional Considerations
- Specific medications covered may vary based on the individual’s health plan and formulary.
- Coverage may also be affected by state regulations.
- Oscar Insurance encourages a comprehensive approach to weight management, including healthy eating, exercise, and behavioral therapy.
- Coverage for emerging weight loss treatments, such as GLP-1 receptor agonists and SGLT2 inhibitors, is subject to future decisions.