Losing weight and keeping it off is no easy feat. You’ve tried every diet and exercise plan with little long-term success. The numbers on the scale won’t budge. Excess weight is impacting your health and quality of life. What if there was a medication that could help? A drug that curbs your appetite so you eat less without constant hunger or willpower?
Enter Wegovy: the first FDA-approved drug for chronic weight management in adults who are overweight or obese. This injectable prescription medication helps you feel full and satisfied with less food. In clinical trials, most patients lost significant weight with Wegovy compared to diet and exercise alone. Even better – the pounds stayed off for over a year.
But there’s a catch. Wegovy is expensive without insurance, costing over $1,300 out of pocket for a one-month supply. That’s where health insurance becomes key to affordability. The good news is many major insurers do cover Wegovy, but with requirements. This guide will walk you through everything you need to know about getting insurance coverage for Wegovy. You’ll learn how to confirm your plan’s coverage, meet criteria for approval, submit documentation, and even appeal denials.
With the right information and perseverance, you can get Wegovy covered and finally achieve the weight loss you’ve been striving for. Let’s get started.
Table of Contents
What is Wegovy?
Wegovy (semaglutide) is an injectable prescription medication used for chronic weight management. It works by mimicking a hormone called GLP-1 that sends signals to your brain telling you that you’re full. By activating receptors in your brain, Wegovy curbs your appetite, so you eat less food and consume fewer calories.
In clinical trials, people taking Wegovy lost an average of 15% of their body weight over 68 weeks. It’s the first obesity drug approved for long-term use along with diet and exercise.
Why Choose Wegovy for Weight Loss
There are several reasons why Wegovy is an appealing weight-loss option:
- It’s highly effective: In studies, nearly all participants lost significant weight with Wegovy compared to diet and exercise alone.
- Long-lasting results: Wegovy helps you maintain weight loss long-term, keeping the pounds off.
- Convenient dosing: It’s a once-weekly injection you can administer yourself at home.
- Improves health: Losing excess weight can lower blood pressure, cholesterol, and blood sugar and reduce other obesity-related conditions.
However, there are some downsides to consider as well:
- Side effects: Like nausea, vomiting, diarrhea that are most common when starting.
- Weekly injections: You have to be diligent about the weekly shots.
- Cost – The medication is expensive without coverage, around $1,300 for a month’s supply.
That’s why having insurance cover Wegovy makes weight loss more accessible for most people.
Insurance Coverage for Wegovy
The big question is what insurance covers Wegovy? Here are some tips on getting coverage:
- Commercial plans – Many commercial insurers like Aetna, Cigna, and UnitedHealthcare cover Wegovy with prior authorization. You’ll need to meet certain criteria like having a BMI over 30 or at least one weight-related health issue.
- Medicare Part D – Original Medicare does not cover prescription weight loss drugs, but Medicare Part D plans may cover Wegovy with prior authorization and step therapy requirements. Look for Part D plans that include it on their formularies.
- Medicaid – Medicaid coverage varies by state. Some Medicaid programs cover anti-obesity meds like Wegovy with limitations and PA requirements. Check your state’s coverage policies.
- Discounts – Novo Nordisk offers a savings card that can lower your out-of-pocket costs for Wegovy. It provides up to $200 off per prescription fill. There are also copay cards available that can save you money if your insurance has high cost-sharing.
How to Check Your Insurance Coverage
Don’t assume Wegovy is covered or not covered. Verify with your health insurer first. Here are some tips:
- Call the number on the back of your insurance card and ask if Wegovy is covered. If so, find out the specific requirements.
- Check your plan’s prescription drug formulary to see if Wegovy is listed. Formularies often have tier info and utilization rules.
- Search the plan documents for details on weight loss medication coverage. Look for exclusions too.
- Ask your doctor to run a prior authorization to confirm coverage criteria are met. This is required by most insurers.
- If denied, appeal the decision if it makes sense in your case. Provide medical documentation that shows you meet the criteria.
Tips for Getting Insurance Approval
If your insurer doesn’t cover Wegovy at first, don’t give up. You can take steps to get approval:
- Meet BMI requirements – Most plans require your BMI to be 30 or higher to cover weight loss medications. If you’re close, losing a few pounds first may help.
- Try step therapy – Some insurers make you try other weight loss medications before Wegovy. Following the step therapy rules can help move the process along.
- Highlight health issues – Have your doctor note any obesity-related conditions you have like diabetes, hypertension, sleep apnea, etc. This shows medical necessity.
- Provide documentation – Submit records proving you’ve tried diet and exercise alone unsuccessfully. Insurers want to see you’ve made an effort.
- Use an in-network provider – Getting your Wegovy prescription from an in-network doctor or weight loss clinic gives you the best shot at approval.
- Appeal denials – If your claim gets rejected, resubmit information and appeal it. Be persistent.
What are the possible side effects of Wegovy®?
Like all medications, Wegovy may cause side effects in some people. The most common side effects reported in clinical trials were:
- Nausea
- Diarrhea
- Vomiting
- Constipation
- Abdominal pain
- Headache
- Fatigue
- Dyspepsia
- Dizziness
- Abdominal distension
Most gastrointestinal side effects are mild to moderate and typically subside within a few weeks of treatment. Taking Wegovy with food may help reduce nausea.
More serious side effects of Wegovy may include:
- Gallbladder problems – Wegovy may increase your risk of gallstones or gallbladder inflammation. Contact your doctor if you experience abdominal pain, fever, chills, yellowing of skin or eyes.
- Hypoglycemia – Wegovy can lower blood sugar levels. Those with diabetes are at higher risk of low blood glucose. Monitor glucose closely and adjust medications as needed.
- Kidney problems – There have been rare reports of kidney injury and impairment. Your doctor will check your kidney function before and during Wegovy treatment.
- Allergic reactions – Seek immediate medical care if you have signs of serious allergic reaction like rash, swelling, difficulty breathing.
- Pancreatitis – Severe abdominal pain that radiates to the back along with vomiting may signal pancreatitis. This requires prompt evaluation.
Always talk to your healthcare provider about any side effects you experience with Wegovy. They can help determine if it’s related to the medication and recommend solutions to help manage symptoms.
The Bottom Line
Wegovy can be pricey if you pay full retail cost. But many major medical insurances offer coverage if you meet plan requirements. Check with your insurer, submit any required information, and appeal denials when necessary. With persistence, most people can get Wegovy approved and start losing weight with this highly effective medication.
FAQs
1. Does BCBS cover Wegovy for weight loss?
Blue Cross Blue Shield health plans often cover Wegovy with prior authorization. You’ll likely need a BMI of 30 or higher and have at least one obesity-related health issue like diabetes or hypertension. Plans may require you to try other medications first under step therapy rules.
2. How to get Wegovy covered by insurance?
- Check that your health plan includes anti-obesity drugs like Wegovy on their formulary.
- Confirm you meet all coverage criteria like BMI requirements.
- Have your doctor submit a prior authorization request along with documented proof of medical necessity.
- Appeal any denials and resubmit information. Be persistent.
3. Does Novo Nordisk offers a Wegovy coupon?
Yes, Novo Nordisk offers a Wegovy savings card that can save you up to $200 off per prescription fill. There are also copay cards available that lower your out-of-pocket costs if you have insurance. These can make Wegovy more affordable.
4. How much is Wegovy without insurance?
The retail price for Wegovy is around $1,300 for a one month supply. It’s an expensive medication without health insurance. Getting coverage lowers your costs significantly through lower copays or coinsurance rates.
5. Is semaglutide covered by Medicaid?
Semaglutide products like Wegovy may be covered by Medicaid plans if considered medically necessary. Requirements vary by state Medicaid program. Some have BMI limits, step therapy rules, or exclude weight loss drug coverage. Check your state’s Medicaid formulary.
6. Is Wegovy covered by Medicare?
No, original Medicare does not cover weight loss medications. But Medicare Part D prescription drug plans may include Wegovy on their formularies. You’d need to enroll in a Part D or Medicare Advantage Plan that covers it with authorization rules.
7. How to get $25 Wegovy?
The Novo Nordisk savings card provides up to $200 off per month. So using the card would lower your out-of-pocket cost to around $25 for a month’s supply if you don’t have insurance. You can sign up for the card online at Wegovy.com.
8. How to get insurance to cover Ozempic for weight loss?
The process is similar. Check your plan’s pharmacy coverage details, submit a prior authorization request, meet BMI and medical necessity requirements, and appeal any denials. Providing documentation of failed weight loss with diet and exercise alone can help gain approval.
