GLP-1 Professional Medical Care and Insurance Coverage at Medallus Urgent Care

Medallus has numerous employer direct contracts for GLP-1 prescribing and patient management services, and each employer’s health plan has its own unique coverage and member cost share requirements. For more information, contact us.

The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets (less than 50 EE’s) as well as large fully insured large employers (greater than 50 EE’s) and self-insured employer plans that use the North Dakota essential health benefits (EHB) as its plan benchmark to cover the following services with no member cost-sharing:

• MD, NP or PA medical patient counseling for obesity, nutritional and diabetes
• Registered Dietician counseling about diet, exercise or both together with behavioral interventions aimed at skill development, motivation and support strategies produce modest, sustained weight loss in adults who are obese.

North Dakota EHB changes coming in 2025, requires non-grandfathered health plans in the individual and small group markets (less than 50 EE’s) as well as large, fully insured large employers (greater than 50 EE’s) and self-insured employer plans that use the North Dakota essential health benefits (EHB) as its plan benchmark to cover the following services:

• Weight loss drugs: Coverage for the use of drugs like glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) for the prevention of diabetes and treatment of insulin resistance, metabolic syndrome, or morbid obesity.
• Nutritional benefits: Includes up to 12 sessions per policy year if deemed medically necessary as determined by the insured’s physician for dietary or nutritional screening, counseling, and therapy for obesity, diabetes related diagnosis or chronic illness or conditions that could be managed through nutritional or weight loss programs.

Your Health Plan Coverage or Medallus Employer Direct Contracts: Medallus has many employer direct contracts for GLP-1 prescribing and patient management services and each employer’s health plan has its own unique coverage and member cost share requirements, We would advise that you contact your employer’s HR department for the specifics of your GLP-1 health plan professional care coverage and member cost share requirements or Medallus GLP-1 employer direct care services and member cost share requirements.