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Fatty liver disease is a growing health problem. Over the years, it’s been known by a few different names. You may still see the older terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). These terms are outdated. It’s now called metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH, a type of MASLD).
If you’ve been diagnosed with MASLD or MASH, you may need treatment. Fortunately, there are medications that can help. Here’s how to use your insurance or other programs to help pay for them.
Currently, FDA-approved medications are available for a specific group of people — those with MASH (the more severe form of fatty liver disease) who have fibrosis (moderate-to-advanced liver scarring) and do not have cirrhosis. If you already have cirrhosis or severe liver damage, your treatment plan may be different, and in some cases, a liver transplant may be discussed.
The medication resmetirom (Rezdiffra) is FDA-approved for certain people with MASH who do not have cirrhosis but do have fibrosis. It’s used along with diet and exercise, and it may help improve liver scarring in some people.
Your doctor may also prescribe medications for fatty liver disease like:
These are often grouped together as glucagon-like peptide 1 (GLP-1) medications. Many of them work by targeting GLP-1. The exception is tirzepatide, which targets two hormones (GLP-1 and GIP).
One brand of semaglutide, Wegovy, is FDA-approved to treat MASH with moderate-to-advanced liver scarring in people without cirrhosis. Right now, it’s the only GLP-1-type medicine with that exact MASH approval.
Sometimes, doctors prescribe medications for conditions that are not FDA-approved to treat. When this happens, it’s called off-label use.
Some of the medications listed above may sometimes be used off-label for fatty liver disease, but insurance is usually more likely to cover them when they’re prescribed for what they’re officially approved for (such as type 2 diabetes, obesity, or, in Zepbound’s case, obstructive sleep apnea). You may have a harder time getting your insurance to pay for medications that aren’t approved specifically for MASH, though coverage rules vary a lot by plan.
Insurance plans can be complicated. But the key to getting anything covered is learning how your plan works. Understanding premiums (monthly payments), coverage limits (restrictions on how much the insurance company will pay), and other considerations like prior authorization (permission from the insurance company before they will cover something) can help you better navigate the system and avoid surprises.
It’s important to stay up to date on your plan details. Your coverage may change from year to year, even if you keep the same plan. Be sure to do your research before selecting your plan, so you know what to expect.
You usually start by paying premiums, which are the regular monthly payments that keep your insurance active. Think of premiums like a subscription fee. You pay premiums whether or not you use healthcare that month. Once you’re enrolled, your plan determines your coverage for different services, meaning what types of care, medications, or providers the insurance will help pay for.
When you need care, a healthcare professional — such as a doctor, nurse practitioner, or physician assistant — acts as your prescriber. The prescriber decides what treatments, tests, or medications are medically appropriate for you. Your insurance coverage outlines how much of those costs the insurance will pay and what portion you’re responsible for, such as copays or deductibles.
Sometimes, insurance companies require prior authorization before they agree to cover certain services or medications. This means your prescriber must submit information explaining why the treatment is necessary. The insurance company then reviews the request and decides whether it meets its coverage rules.
You can call your insurance company and speak with a representative who should take the time to help you navigate your plan. Check the back of your insurance card for a Member Services phone number to call. You can also log in to your plan online and review your prescription drug prices through the company’s portal.
Your healthcare provider can partner with you on understanding your coverage. They can also submit appeals for you if coverage is denied. Your doctor can schedule a peer-to-peer with your insurance provider to discuss your coverage and help you access the treatment you need. Advocating for yourself and reaching out for help from your plan and your healthcare provider can help you get the answers you need.
Whether your fatty liver disease medication is covered depends on your specific insurance plan. You’ll need to check for yourself to find out the cost of resmetirom and other medications for a MASH diagnosis. When it comes to GLP-1s, research suggests that most people still end up paying some of the costs out-of-pocket, regardless of their coverage. This may change with time.
But just because your insurance plan won’t fully cover MASH treatment doesn’t mean you always have to pay full price. When it’s time to renew your plan, you can shop around for one that covers these medications. Otherwise, you can look for drugmakers’ coupons and discount programs for help.
Drug manufacturer coupons are a common way to lower the high cost of prescription medications, especially brand-name drugs. These coupons are typically offered by the drug’s manufacturer and can reduce your copay or out-of-pocket cost at the pharmacy.
To use a manufacturer’s coupon, your prescriber writes the prescription as usual. You present the coupon, which is often a printable card or digital code, when you pick up your medication. The pharmacy applies the coupon, if allowed, along with your insurance to discount the price. Keep in mind that manufacturer coupons usually can’t be used with government insurance plans like Medicare or Medicaid.
Prescription drug savings programs are services that anyone can use, whether they have insurance or not. The most popular of these services in the United States is GoodRx. In many cases, these programs make it possible for you to get medications for less than you would pay with insurance. You can search for your medication on their website and see what deals are available.
On MyObesityTeam, people share their experiences with obesity, get advice, and find support from others who understand.
Does your insurance cover the cost of your fatty liver disease medication? Let others know in the comments below.
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