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Is Wegovy Covered By Insurance? Coverage Options Explained

When considering taking Wegovy for weight loss, it's essential to understand insurance coverage options. This article outlines various coverage for Wegovy so you can make an informed decision about your weight loss journey. We'll discuss Wegovy's cost with insurance and the eligibility criteria. Explore options and coverage eligibility for Wegovy so you can begin the weight loss process.

What is Wegovy used for?

Wegovy has been shown to be effective in helping individuals lose weight. Clinical trials resulted in some individuals losing up to 15% of their body weight. Wegovy helps regulate appetite and blood sugar levels. The medication is typically used with a reduced-calorie diet and increased physical activity.

The medication is available in a pre-filled pen injected once a week, making it a convenient option for those who may have trouble remembering to take daily medication. It's important to note that Wegovy is not a standalone solution for weight loss. Wegovy should be combined with lifestyle changes such as making good nutrition choices and increased activity. If you're considering Wegovy to help you achieve your weight loss goals, it's essential to talk to your doctor to determine if it's the right option for you.

What insurance covers Wegovy?

The coverage options for Wegovy depend on your health insurance plan. Check with your provider (e.g. Kaiser, Aetna, Anthem, Blue Cross Blue Shield, etc.) to see if they cover Wegovy and the requirements. If you're interested in taking Wegovy and your insurance doesn't cover it, consider exploring other options, such as applying for financial assistance from the drug manufacturer or looking into discount programs.

If your insurance does cover Wegovy, you may still be responsible for paying a portion of the cost, such as a copay or coinsurance. Review your insurance plan's benefits and coverage details to understand any out-of-pocket costs.

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How to get Wegovy covered by insurance

If you're interested in getting Wegovy covered by your insurance, several steps you can take are:

  1. Talking to your doctor about whether Wegovy is suitable for you based on your medical needs.
  2. Checking with your insurance provider to see if they cover Wegovy and coverage requirements.
  3. Checking with your insurance provider to determine if you meet the eligibility requirements for Wegovy.
  4. Checking with your insurance provider to see if doctor preauthorization is required.

Private insurance providers

Many private insurance providers cover Wegovy, but coverage may vary depending on your plan. Some insurance providers may require preauthorization, from your doctor before you can start the medication. Other insurance providers may require you to meet specific eligibility criteria before coverage approval is given.

Medicare

Medicare does not cover medicines for obesity. Some select Medigap and Medicare Advantage plans for retirees, however, do cover medicines for obesity. If you have one of these plans, please check with its administrator.

Medicaid

In addition to Medicare, Medicaid covers Wegovy for eligible beneficiaries. Typically, Medicaid covers Wegovy for individuals with a BMI of 30 or higher or a BMI of 27 or higher with at least one weight-related medical condition. However, the eligibility criteria may vary depending on the state of residence. Check with your state's Medicaid program for eligibility requirements and coverage options. If you meet the criteria, Medicaid may cover some or all of the cost.

Tricare

Tricare may cover Wegovy under certain medical conditions. To determine when coverage is available, your doctor can request a coverage review. Please contact your Military Treatment Facility or Tricare Network provider to discuss.

Employer-sponsored health insurance

Many employer-sponsored health insurance plans cover Wegovy but check with your plan provider to confirm coverage and requirements. Some plans may require preauthorization or eligibility criteria before they cover the cost. If your plan does cover Wegovy, you may still have a copay. Understanding the costs associated with Wegovy under your specific plan is important to avoid surprises.

How much does Wegovy cost with insurance?

The cost of Wegovy with insurance varies, depending on your health insurance plan. Some providers may cover the entire cost of the medication. In contrast, others may require a copay or deductible. Depending on the plan, Medicare and Medicaid beneficiaries may also have different out-of-pocket costs. Check with your insurance provider to determine your specific costs.

In addition, the cost of Wegovy may also depend on the dosage and the required number of doses. For example, a higher dosage or longer treatment may lead to a higher cost. Some patients may have high out-of-pocket costs for Wegovy even with insurance coverage. Patients can use manufacturer discounts or patient assistance programs to reduce costs in such cases.

Cost of Wegovy without insurance

A one-month supply typically costs around $1,300. However, the manufacturer, Novo Nordisk, offers a savings program to help eligible patients save money. The program provides a maximum savings of up to $600 per prescription.

While the cost of Wegovy may seem high, the drug is effective in helping with weight loss and improving health outcomes. Additionally, some pharmacies and clinics may offer discounts or payment plans for uninsured patients. Talk with your healthcare provider about alternative medications or weight loss programs that may be more affordable. The decision to take Wegovy should be made in consultation with your healthcare provider based on your needs and circumstances.

Eligibility criteria for Wegovy

  • To be eligible you must have a BMI of 30 or higher or a BMI of 27 or higher with at least one weight-related medical condition, such as high blood pressure or type 2 diabetes. Your doctor will also evaluate your overall health and medical history to determine whether Wegovy is safe and appropriate.
  • Coverage for Wegovy depends on your health insurance coverage. If you don't have insurance, Wegovy can be costly, but the manufacturer offers a savings program to help eligible patients save money. Ultimately, the decision to take Wegovy should be made in consultation with your doctor, who can help you determine if it's safe and appropriate.

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Comments

Jacqueline Black
prefix 25 days ago
I have Medicare and Medicaid do it cover it or how can I get it covered?
David M Hoffman
prefix 30 days ago
I am a 64-year-old male weight of 187 With high blood pressure and hypertension. I am currently on Medicaid till 12-25-2024 Then I'll be switched to Medicare. Trying to get my primary care Doctor to submit BMI over 30 I also have high blood pressure. They should cover it. If I cannot get it covered what options are available to me for discounted rate?
kin
prefix 3 months ago
even with my pre authorization form my insurance refuses to cover wegovy
Melissa Howard
prefix 3 months ago
I have been on diet, after diet, continuous exercise and dealing with hormones for almost my entire life trying to get some weight off. My doctor put me on Wegovy for 6 months and lost almost 40 pounds. While it wasn't a walk in the park, I have never been happier in my life. My clothes fit, I felt good about myself, my bp and cholesterol were great, and I had stopped taking my anti-depressant medication. Then boom, November 2023, my insurance company stopped covering it without an explanation and I am gaining my weight back. I am absolutely sick that this is happening, and that medication is not available to people who need it for Obesity. When will the FDA, and insurance companies realize that Obesity is a Disease?? I didn't ask for this, I can't help that I can't get this weight off and I don't sit around on the couch eating bon-bons. Obesity is a health risk problem and medications need to be made available to patients who need them. Afterall, insurance isn't cheap, but I have it so why can't I use it for medications that are prescribed to me by my doctor?
Alexis
prefix 1 month ago
I have lost 80 lbs on my own without any medications. It is possible but it is hard work. Exercise and eating healthy is the best way to go. I have many comorbidities so I do know and understand the struggles of losing weight.
Denise
prefix 1 month ago
Have you contacted the manufacturer and explained the situation to them? They may cover the cost considering your circumstances. Good luck😁
Lisa
prefix 3 months ago
I have high blood pressure, high cholesterol and had a stroke 4 years ago. I began Wegovy in March 2023 and was having good success. My BP and cholesterol was lower than it has been in years. That all changed in November 2023 when my insurance company suddenly stopped covering me (United Healthcare). Now, in 6 weeks, I'm back to where I started in March. Sooooo upset this is happening to me!!!!
Theodora Micheletos
prefix 4 months ago
Does my insurance cover this medication?
CBB
prefix 7 months ago
My expensive BCBS insurance & Express Scripts has stopped covering ALL weight loss meds...Wegovy, Saxenda, all of them. I've been on Wegovy with good success. Blood work improving, joint pain better. Now I can't get it anymore. If I was infertile or impotent, I could get medical help. But not for this. So disappointing.
Chasity
prefix 6 months ago
For what we pay a month EVERYTHING should be paid by insurance!!! I will be dropping my BCBS insurance.
Terry Leigh Hlavaty
prefix 7 months ago
How do I find a Medigap or Medicare Advantage plan that will cover Wegovy