Does Insurance Cover Wegovy? Understanding the specifics of your insurance plan can help determine whether Wegovy is covered. However, since it’s a newer medication, not all insurance providers include it in their formularies.
Also, coverage can depend on factors like your health plan, the reason for the prescription, and whether prior authorization is required. In this blog post, we’ll enlighten you on all you need to know about insurance coverage for Wegovy.
What is Wegovy?
Wegovy is a prescription medicine used to help adults who are overweight or obese lose weight. It contains semaglutide, a drug that makes you feel less hungry, helping you eat less and lose weight over time.
Doctors usually prescribe Wegovy along with a healthy diet and exercise plan. It’s meant for people with a high body mass index (BMI) of 30 or more, or those with a BMI of 27 or more who also have health problems like high blood pressure or type 2 diabetes.
How Do I Know If My Insurance Cover Wegovy?
To find out if your insurance covers Wegovy, start by checking your plan’s drug formulary. This is a list of medications your insurance covers, and you can usually find it online or in your plan documents. If Wegovy isn’t listed, call your insurance company to ask directly.
They can tell you if it’s covered and if there are any conditions, like needing prior authorization or meeting certain health criteria.
You can also ask your doctor or pharmacist for help. They can tell you if there’s Wegovy in your insurance and guide you through the necessary steps like filling out paper works and submitting additional information to your insurance provider.
may know if Wegovy is covered and guide you through any steps required, like filling out paperwork or submitting additional information to your insurance provider.
Who Is Eligible For Wegovy?
Wegovy is approved for both adults and adolescents aged 12 and older to help with long-term weight management.
To be eligible, adults must have a body mass index (BMI) of 30 or higher. This means they are considered obese.
Adults with a BMI of 27 or higher who also have at least one weight-related health problem like high blood pressure, type 2 diabetes, or high cholesterol may also qualify.
Wegovy is also used to lower the risk of heart attack, stroke, and death in adults with heart disease who are overweight or obese.
For adolescents, eligibility is based on their BMI being at or above the 95th percentile for their age and sex, according to growth charts that doctors use.
You are to take Wegovy once a week as a self-injection under the skin, and it mimics a hormone that controls appetite.
How Much Is Wegovy Without Insurance?
Without insurance, Wegovy can be quite expensive. The current list price for a 28-day supply, which includes four pens, is about $1,349.02. However, the actual amount you pay might vary slightly depending on the pharmacy.
When starting Wegovy, your healthcare provider will usually prescribe a low dose of 0.25 milligrams (mg) per week for the first four weeks. The dose will then increase each month until you reach a maintenance dose of either 1.7 mg or 2.4 mg per week. This gradual increase in dosage helps manage your treatment more effectively.
How Much Is Wegovy With Insurance?
With your insurance cover wegovy, the cost can be significantly lower. According to Novo Nordisk, the manufacturer of Wegovy, about 80% of insured patients pay less than $25 a month.
However, how much you pay depends on your specific insurance plan. Some health insurance plans may not cover medications for treating obesity. So it’s important to check with your insurer to understand your coverage details.
Does Medicare And Medicaid Cover Wegovy?
Generally, Medicare Part D (prescription drug coverage) may not cover Wegovy for weight loss purposes. This is because it often excludes medications used primarily for obesity treatment. Coverage can depend on specific plan details and the reason for prescribing the medication.
While for Medicaid, coverage for Wegovy varies by state. Some state Medicaid programs may cover it if prescribed for certain health conditions or if specific criteria are met. It’s best to check with your state’s Medicaid program to get accurate information on coverage.
In both cases, contacting your Medicare or Medicaid provider directly will give you the most accurate information on whether Wegovy is covered under your plan and under what conditions.
Bottom Line
Insurance coverage for Wegovy can vary. To find out if your plan covers it, start by checking your insurance list or call your insurance company directly.
Wegovy is usually prescribed for adults with a BMI of 30 or more, or 27 or more if they have weight-related health issues. Additionally, it is also for teens with a BMI at or above the 95th percentile.
Without insurance, Wegovy costs about $1,349 for a 28-day supply. However, with insurance, most people pay less than $25 a month. On the other hand, Medicare often doesn’t cover Wegovy for weight loss, and Medicaid coverage depends on your state. Therefore, it’s best to contact your insurance provider to get the most accurate information.