The rising popularity of weight loss injections, particularly those containing semaglutide (Ozempic, Wegovy, Rybelsus), has led many to wonder if they can use their Health Savings Account (HSA) or Flexible Spending Account (FSA) to cover the costs. With the average retail price of these drugs potentially exceeding $1,300 per month, understanding HSA/FSA eligibility is crucial. This article explores the possibilities, requirements, and limitations of using these accounts for weight loss injections and related expenses.
Understanding HSAs and FSAs
Flexible spending accounts (FSAs) and health savings accounts (HSAs) allow you to set aside pre-tax money to use on certain eligible out-of-pocket medical care costs. If your doctor recommends weight loss for a specific condition (including but not limited to obesity, hypertension, or heart disease) the Internal Revenue Service (IRS) may allow you to use funds from your pre-tax accounts such as your FSA or HSA to pay with tax-free dollars.
Health Savings Accounts (HSAs)
To be eligible for an HSA, you must have a high-deductible health plan. In 2024, individuals with a qualifying health plan can contribute up to $4,150 to their HSA. For those with family coverage, the maximum contribution limit is $8,300 per year. HSA contributions are made with pretax dollars, and withdrawals for qualified medical expenses are tax-free as well. Moreover, HSA dollars can earn interest, just like a regular savings account, and once your HSA balance reaches a certain threshold, you can invest in mutual funds to potentially grow your savings, similar to a 401(k) or other retirement account.
Flexible Spending Accounts (FSAs)
In order to qualify for an FSA, you need to be enrolled in an employer-sponsored plan that offers it as part of your benefits package. Employees receive the full amount of their annual contributions at the start of their plan year, even before they’ve contributed the full amount via paycheck deductions, giving them access to the full election amount at the beginning of the year. Unlike HSAs, FSA funds typically have a “use-it-or-lose-it” policy, meaning you may lose your funds if you don’t use them by the end of the year or the end of your employer’s grace period if they offer one.
Semaglutide and Weight Loss
Semaglutide is part of a class of drugs that mimics a natural hormone in the body that helps regulate blood sugar. By stimulating insulin production and slowing digestion, it lowers blood glucose levels in people with Type 2 diabetes. The drug also reduces appetite, which is what piqued interest in its potential for weight loss.
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Semaglutide Medications
Semaglutide is the active ingredient in three major drugs:
- Ozempic
- Wegovy
- Rybelsus
While all three drugs contain semaglutide, their dosage and intended uses vary. Ozempic is an injection that is prescribed to help lower blood sugar levels in people with type 2 diabetes, and can lower the risk of cardiovascular events for people with type 2 diabetes and heart disease. Wegovy is also administered via injection and is used for chronic weight management and to lower the risk of heart attack, stroke, and cardiovascular death. The primary difference between Ozempic and Wegovy is the dosage. Rybelsus offers an oral version for diabetes treatment.
Effectiveness and Usage
Semaglutide has been highly effective for weight loss. Several studies have shown that patients lose between 15-16% of their total body weight over the course of the treatment (typically about 16 months). Of course, this varies depending on individual factors like lifestyle and existing medical conditions.
Semaglutide is typically prescribed to adults with a BMI of 30 or higher (the BMI category that is considered obese) or those with a BMI of 27 or higher who also have weight-related health conditions like high blood pressure or type 2 diabetes. It is not for people with a BMI lower than 30 (unless they have comorbidities) and isn’t recommended for short-term weight loss or cosmetic purposes. It's also not suitable for anyone with a personal or family history of thyroid cancer.
How Semaglutide Works
Semaglutide works by regulating appetite and slowing digestion, leading to reduced calorie intake. It triggers the brain’s satiety centers, helping people feel fuller faster and for longer. According to the FDA, semaglutide was the first new drug approved for chronic weight management since 2014, making it quite a breakthrough in obesity treatment.
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While you might notice the short-term effects within the initial 4 weeks, patients typically start seeing meaningful results within the first 4-8 weeks, although weight loss may continue for several months. Long-term effects appear after 20 weeks of use. Semaglutide is meant for long-term use, and stopping the medication may result in regaining the lost weight, which makes it crucial to incorporate lifestyle changes, such as exercise and a healthy diet, alongside the treatment.
Side Effects and Risks
As beneficial as it can be, semaglutide is not completely harmless. Common side effects include:
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Constipation
More serious risks include pancreatitis, gallbladder issues, and the potential for thyroid tumors. You should not take semaglutide if you have a personal or family history of medullary thyroid carcinoma (MTC) or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Be cautious about overdosing, as the FDA has warned of serious complications.
HSA/FSA Eligibility for Weight Loss Injections
General Eligibility
If your doctor prescribes Wegovy, then you can use your HSA or FSA to pay for it. Your health insurance may also cover the drug, but all plans are different when it comes to weight-management medications, so you’ll want to review the specifics of your plan. Since Semaglutide is an FDA-approved medication, it qualifies as a medical expense under both HSAs and FSAs.
Requirements
To use HSA funds for weight loss medication, you need a letter of medical necessity from your healthcare provider. This documentation outlines your medical condition and why weight loss is necessary to ensure your HSA distribution remains tax-free. This document outlines your specific medical conditions and the reasons why weight loss treatment is necessary. It may also include specific recommendations from your healthcare team, including weight-loss programs, nutritional counseling, or exercise equipment to aid your treatment.
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How to Purchase Semaglutide with HSA/FSA
Today, semaglutide is only available from major pharmacies and retailers like CVS, Rite Aid, and Amazon. Because prescriptions are qualified medical expenses, you can use your HSA or FSA debit card to pay for semaglutide directly at any pharmacy or retailer that accepts these cards (or you can pay out-of-pocket and submit for reimbursement).
Weight Watchers
You may be eligible for up to 100% reimbursement on your WeightWatchers membership. Any WeightWatchers membership costs, including access to the app and Workshops, and Registered dietitian visits may be eligible for reimbursement. For reimbursement of our Points and Workshops memberships, you will need a letter of medical necessity from your doctor that recommends weight loss for a specific condition (including but not limited to obesity, overweight, hypertension, or heart disease). For all other memberships, check with your provider if a letter of medical necessity is required. For all expenses, you will need to submit your WeightWatchers membership receipt.
Other Eligible Weight Loss Expenses
Beyond weight loss injections, HSAs and FSAs can cover a range of related expenses, provided they are deemed medically necessary.
Covered Services and Products
- Doctor Visits: Your HSA can be used to cover physical and mental healthcare appointments, including those with qualified medical professionals, like physicians, physician assistants/associates (PAs), nurse practitioners (NPs), dietitians, and therapists.
- Nutritional Counseling:
- Weight loss programs:
- Medication, including compound medication:
- Services for personal training
- Equipment for home gyms
- Surgical interventions, such as gastric bypass:
- Copays related to appointments for weight loss:
Ineligible Expenses
While HSA funds are used for a range of eligible healthcare expenses, some services aren’t covered.
*You can’t pay for gym memberships with an HSA account. While physical activity and exercise are part of a healthy lifestyle, gym memberships are considered wellness expenses rather than medical treatments.
*Other wellness items, such as organic food, nutritional supplements, meal prep services, or spa memberships, aren’t eligible for HSA or FSA dollars either.
Maximizing HSA/FSA Contributions
To maximize your HSA weight loss dollars, it’s important to have as much money as possible in your HSA. Here are some tips to help you maximize your HSA contributions.
- Contribute the maximum amount
- Take advantage of employer contributions
- Earn interest on your HSA balance
- Keep track of receipts and documentation Maintain proper documentation for weight-loss expenses paid for with your HSA to avoid penalties or repayment requirements.
How Flex Can Help
Flex offers a simplified way to use your HSA or FSA to purchase this medication. If an ecommerce company has partnered with Flex, they can accept HSA/FSA cards without issue. Flex works behind the scenes to auto-substantiate purchases, meaning your payment will go through without the need for additional documentation or manual claims submission.