How to ask your employer to cover GLP-1, HRT, or menopause care

Step 1: Find out what your plan actually covers

• Check your formulary: Most insurers post the drug formulary online. Search for "Wegovy," "Zepbound," "Mounjaro," "Ozempic," "estradiol." Note tier and any prior auth requirements.
• Call member services: Ask specifically: is [medication] on formulary? That is the prior auth criteria? What\'s the copay tier? Step therapy required?
• Review your SPD (Summary Plan Description): Self-funded employer plans may explicitly exclude certain conditions. Check for "weight management exclusion" or "anti-obesity medication exclusion."
• Identify the specific gap:Is it coverage exclusion (plan says no)? Or prior auth denial (plan covers but you didn't meet criteria)? Different gaps need different approaches.

Step 2: Build your case

Employers add coverage when (a) employees ask, (b) the case is data-backed, and (c) peer companies have already done it. Bring all three:

• Peer benchmarking: Walmart, Microsoft, Costco, Salesforce have publicly added GLP-1 weight-loss coverage 2024-2026. Use these names.
• Productivity argument: Untreated obesity and menopause symptoms are linked to ~$1,500-3,000/year per affected employee in lost productivity (Mercer Health Survey data).
• Retention argument: Women aged 45-55 leave workforce at higher rates than men. Menopause-supportive benefits are increasingly cited as retention factor.
• Long-term ROI: Weight loss treatment reduces downstream cardiovascular and diabetes costs. Many employers see net-neutral or positive 5-year economics.

Step 3: Send the email

Edit the template below with your specifics. Send to your HR Benefits lead, not to your direct manager. CC your union rep if applicable.

Subject: Request to evaluate adding [Wegovy / Zepbound / Menopause care] coverage to our benefits

Hi [HR/Benefits Lead name],

I'd like to request a review of our current benefits coverage for [GLP-1 medications / hormone replacement therapy / menopause care]. Here's my brief case:

CURRENT GAP:
[Brief description of what isn't covered — e.g., "Our plan currently excludes Wegovy and Zepbound for weight management, only covering them for type 2 diabetes."]

WHY IT MATTERS:
- Obesity and perimenopause-related conditions affect [X%] of women employees per CDC data
- Evidence-based treatment is now available and professional society guidelines support coverage
- Coverage cost is often offset by reduced absenteeism, lower long-term cardiovascular costs, and improved retention
- Several Fortune 500 peers added coverage in 2024-2025 (Walmart, Microsoft, Costco have publicly announced GLP-1 weight loss coverage)

WHAT I'M ASKING:
Could the benefits team review our 2026/2027 plan year coverage decisions and consider adding [specific coverage]?

I'd be happy to share more information or join a benefits committee meeting to discuss. Many of my colleagues would benefit from this coverage if added.

Thanks for considering,
[Your name]
[Your role]

Step 4: What if the answer is no?

• Request a formal appeal: If a prior auth was denied, your insurance must allow an appeal. Use our appeal letter generator.
• Use HSA / FSA: GLP-1 prescribed for diagnosed obesity (BMI ≥30, or ≥27 with comorbidities) is HSA/FSA eligible. Pre-tax dollars effectively reduce cost ~25-30%.
• Consider cash-pay alternatives: Compounded GLP-1 ($200-400/mo) is dramatically cheaper than branded cash ($1,000-1,350/mo). Compare cash-pay brands.
• Document for next open enrollment: Save your request and any response. Benefits decisions are usually made annually. Re-request annually until coverage changes.

Resources

• Generate an insurance appeal letter (auto-filled by denial reason)
• Full guide to GLP-1 insurance coverage
• Brands that accept HSA/FSA payment
• Fact-check claims about HRT, GLP-1, menopause care