Let’s take a closer look at insurance coverage for Wegovy and some ways you may be able to reduce the cost of your monthly prescription for Wegovy.
In 2021 Wegovy (semaglutide) was approved by the FDA for weight loss. However, while clinically proven effective, Wegovy can be an expensive solution. Since coming into the market, the average cost of Wegovy without insurance has been about $1600 for a 28-day supply.
That cost could be reduced if you have insurance and your carrier is willing to provide coverage for Wegovy. However, in the past, health insurance companies were not inclined to cover obesity drugs. That situation improved somewhat in 2013 when the American Medical Association recognized obesity as a disease “worthy of the full scope of medical care.”
And yet, despite that assessment, many health insurance plans still don’t cover weight-loss treatments. In fact, the makers of Wegovy, Novo Nordisk, say that only about 40% of private insurers cover their similar weight loss drug Saxenda.
Even if you can secure coverage for Wegovy, you could still face high out-of-pocket copay costs. However, the drug manufacturers’ assistance program could offset these if you qualify.
Does insurance cover Wegovy?
Wegovy for weight loss may or may not be covered by insurance. Before covering an obesity drug, some health insurers ask that you provide evidence that other weight loss strategies, such as exercise or dietary changes, have been tried and not worked before you were prescribed a weight loss drug.
Some have also required that the drug be given as part of a coinciding and overall medical weight-loss program that includes counseling and behavioral modification before insurance coverage is provided.
The version of semaglutide that is prescribed for diabetes, Ozempic, is almost always covered by insurance. Wegovy, the version approved for weight loss -which is the same drug at a different dose – may or may not be covered by your insurance company.
To qualify for Wegovy for weight loss, you must have a BMI of 30 or higher. Alternatively, if your BMI is 27 or higher, you may qualify if you have weight-related health conditions like type 2 diabetes, high blood pressure, or high cholesterol.
Whether Wegovy is covered by insurance depends on several factors, including the specific insurance plan and its coverage policies. Insurance coverage can vary widely from one plan to another, even within the same insurance provider. Some insurance plans may cover Wegovy partially, while others may cover it fully, and some may not cover it at all.
To find out if Wegovy is covered by insurance, it’s best to check with the insurance provider directly or review the policy documents provided by the insurance company.
You can also consult with your healthcare provider or pharmacist, as they may have experience dealing with various insurance plans and can provide information about potential coverage options.
If you are unsure if your insurance will cover a prescription for Wegovy, it is best to check with them. Even if it seems in your plan’s literature that your particular insurer does not cover obesity drugs like Wegovy, you might still be able to obtain coverage.
How to get Wegovy Covered by Insurance
Currently, insurance coverage for Wegovy is kind of a mixed bag, with few, if any, commercial insurance plans providing full coverage for the groundbreaking drug. However, that does not mean that you cannot afford to take Wegovy.
If your insurer doesn’t pay for Wegovy, inquire about a Wegovy Savings Copay Card with Novo Nordisk. You can also request coverage by printing a sample letter and asking your healthcare provider to send it on your behalf.
It is always best to check with your insurance company to learn if you are eligible for an upgrade or an add-on to your plan to cover Wegovy’s class of drugs for weight loss.
Remember that insurance coverage can change over time, so staying up-to-date with the latest information from your insurance provider and relevant healthcare professionals is essential.
Suppose your insurance or coverage does not cover Wegovy, which is limited. In that case, you may explore other options, such as patient assistance programs or discount cards offered by the manufacturer or other organizations, to help offset the cost.
What insurance covers Wegovy?
Several medical insurance sources may offer some degree of insurance for a Wegovy prescription.
Medicare does not offer any coverage for Wegovy at this time.
VA health benefits provide coverage for Wegovy, such as those participating in the MOVE! program may qualify for coverage.
Tricare insurance provides some coverage for Wegovy. For example, Tricare Prime and Tricare Select plans may offer coverage if it’s determined to be a medically necessary treatment of obesity.
Private insurance may or may not cover Wegovy. Many do, 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 giving coverage approval. Check with your providers, such as Kaiser, Aetna, Anthem, Blue Cross Blue Shield, etc., to see if they cover Wegovy and their requirements.
How Much Can Wegovy Cost With Insurance
Depending on your coverage, it is possible that you could pay as little as $25 per 28-day month for Wegovy with insurance.
The drug’s manufacturer, Novo Nordisk, offers a $25 copay card to help significantly lower the cost of Wegovy. Still, it is only issued to patients with insurance covering Wegovy and meeting certain other requirements.
If your usual copay is more than $25, you’d be saving money by using the copay card at a participating retail pharmacy. According to Wegovy’s manufacturer, This discount card is only available to commercially insured people with coverage for Wegovy and a valid prescription.
You must live in the US. People covered by public programs such as Medicaid, Medicare, TRICARE, or VA benefits aren’t eligible.
To determine the cost of Wegovy with insurance, it’s best to contact your health insurance provider directly. They can provide specific details about your coverage, co-payments, deductibles, and any other costs of obtaining Wegovy.
Additionally, your doctor or pharmacist might be able to offer information about potential costs and assistance programs that could help reduce the out-of-pocket expenses for the medication.
How much is Wegovy without insurance?
The cost of Wegovy without insurance can vary based on factors such as the dosage, the quantity of medication prescribed, and the location of the pharmacy. Additionally, drug prices are subject to change over time, so it’s essential to check for the most up-to-date pricing.
Currently, the cash price for Wegovy for those without insurance averages about $1620 per month. This price could be higher or lower depending on the factors mentioned earlier. It’s crucial to inquire about discounts, manufacturer coupons, or patient assistance programs that may help reduce your out-of-pocket cost.
Can I buy Wegovy in Mexico?
Many people who live on or near the border will travel to Mexico for prescription drugs. While we do not endorse such practices, many prescription medications are available in Mexican “farmacias” without a prescription.
While you can save a significant amount of money buying prescription medications like Wegovy in Mexico, there is no guarantee of the safety or authenticity of such medications, and purchasing Wegovy in Mexico or anywhere without a prescription to save money should be discouraged.
Using this or any prescription medication without a doctor’s supervision could be hazardous.
Are there Wegovy alternatives for weight loss?
Since Wegovy is a newly approved drug for weight loss, it is patented, and there will not be a generic version available for quite some time. Current law states that a pharmaceutical patent lasts for 20 years.
Other prescription medications contain semaglutide – the active ingredient in Wegovy — however, these drugs are not FDA-approved for weight loss. Two such drugs are Ozempic and Rybelsus; both are drugs that are forms of semaglutide for blood sugar control for patients with Type 2 diabetes.
There are some other weight loss drugs whose monthly costs are less than Wegovy, such as Contrave, Xenical, or Qsymia. Still, these are different classes of drugs entirely and may or may not be as effective for your situation, especially if you meet the prescribing criterion for Wegovy.