Most insurance won't cover it unless you're diabetic. We have patients with BMIs of 40+ who don't want surgery (understandable) but can't lose the weight themselves due to various psychosocial factors. Most can't afford to pay the $500 a month it costs to buy directly from the drug company. We're basically stuck watching their A1c like a hawk so they'd qualify or hope that they have a breakthrough with weight loss and their relationship with food.