Is there insurance coverage for Wegovy?

Popular weight loss medication Wegovy (semaglutide) is pricey without insurance. If you’re thinking about asking your healthcare provider about taking it, or have been prescribed it, you may wonder if there’s insurance coverage for Wegovy. Read on to find out — and learn about Wegovy’s costs and how to get your insurance plan to cover it. 

If you’re ready to lose weight, find a provider on Klarity today to help manage your journey to a healthier you. 

Does insurance cover Wegovy?

Insurance coverage for Wegovy depends on your insurance company and specific plan. You may also need to meet certain requirements set by your healthcare insurance company.

Which insurance plans do and don’t cover Wegovy

If you have a government insurance plan, such as Medicare, Medicaid, or Tricare, you’re unlikely to get coverage for Wegovy for weight loss. Though there are some exceptions. Tricare covers Wegovy in some situations. It may also be covered if you have Medicare Part D or if you have Medicare and are prescribed Wegovy to reduce your risk of cardiovascular issues if you’re overweight or have obesity. 

You can check your cost and coverage details for Wegovy on its website on the Check Your Cost and Coverage page. Most private insurance plans offer coverage, including Aetna, Blue Cross Blue Shield, United Healthcare, and Cigna — but only if you meet certain requirements. For information specific to your plan, including any Wegovy requirements for coverage, reach out to your insurance company by calling the number on the back of your member ID card. 

Wegovy requirements for insurance coverage

To get insurance coverage for Wegovy, you first need a prescription from a board-certified, licensed healthcare provider. It’s U.S. Food and Drug Administration (FDA)-approved for adults and children 12 and older with obesity, or adults with overweight and at least 1 weight-related health condition. It can also reduce the risk of heart attack, stroke, or death in adults who are overweight or obese with known cardiovascular disease. If you meet any of these requirements, your provider can prescribe Wegovy for you. 

Once you have a prescription, you likely need prior authorization from your insurance company before they’ll cover it. This is a process insurers use to make sure a prescribed medication is medically necessary and to lower their costs. To get prior authorization for Wegovy, your healthcare provider will submit a request that includes relevant information from your medical records. You can find a provider on Klarity to help you navigate this process and get your Wegovy prescription covered by insurance. Your provider can also show you how to appeal a prior authorization denial if needed.   

How to get your insurance company to cover Wegovy?

If you have a health insurance plan that doesn’t cover Wegovy, you can submit a request for coverage. Just give this sample coverage request letter from Novo Nordisk to your healthcare provider. It reads: 

“To Whom It May Concern, 

I am writing this letter on behalf of my patient, Patient’s Name, to express a concern. My patient is in need of prescription weight loss medication that is currently not covered by your insurance plan. 

It is well recognized that obesity is a chronic illness associated with many related diseases, such as dyslipidemia and hypertension. Obesity deserves the same treatment and attention as any other chronic illness. Please contact your health plan or pharmacy benefit manager to pursue coverage for either this individual employee or for the company at large. 

Sincerely,
Healthcare Provider’s Signature
Healthcare Provider’s Name”

Your provider will write a similar one specific to your situation and give it to you to submit to your employee benefits coordinator. Your benefits coordinator will work with your insurance plan to determine if Wegovy’s covered in your case.

How much is Wegovy with insurance?

If you have insurance coverage for Wegovy, you’ll likely pay less than the retail price — or not. Following is how to better understand what Wegovy costs with insurance. 

Understanding insurance drug coverage

Insurance plans have a formulary, or preferred drug list (PDL), that shows which drugs are covered by that plan. It also provides guidelines on how the cost of the drug is split between you and your insurer — in other words, what your drug copay is. Each formulary is divided into tiers (typically 3 or 4) based on cost, so your copay for Wegovy depends on the tier it’s in on your plan’s specific formulary. 

Understanding Wegovy insurance coverage

FDA-approved in 2021, Wegovy is considered a newer medication with less post-market data than others, meaning there isn’t as much real-world safety information as older medications. And with a retail price of more than $1,400 per month, it’s expensive. These are the things insurance companies consider when they decide how much of the cost of a medication they’ll cover — and your copay. 

Cigna lists Wegovy as a tier 2 drug in their standard 3-tier insurance plans. In Wegovy reviews, Reddit users who get insurance coverage for it from Cigna often say their copay is $25 or $40 per month. Some even get it for free. It just depends on which plan you have. 

Blue Cross Blue Shield (BCBS) considers Wegovy “non-formulary” — they don’t cover it without an exception, meaning you need prior authorization. If you get prior authorization approval for Wegovy, it’s covered at tier 4. Reddit users with various BCBS insurance plans say they pay anywhere from $25 to more than $1,000 for a 1-month supply of Wegovy. 

Check your plan’s formulary or call your insurance company for your cost details. 

How to lower your cost for Wegovy with insurance

There are ways to lower your cost for Wegovy if your insurance copay is high. The manufacturer, Novo Nordisk, offers a savings card program that lets you get Wegovy for free, or at least at a discount, if you’re eligible. It has a maximum savings limit of $250 per 1-month supply. So, if your copay is $350, you’ll only pay $150 for Wegovy when you use the savings card. 

You can also lower your cost for Wegovy if you have a health savings account (HSA) or flexible spending account (FSA). These accounts are employee benefits that, if offered by your employer, let you set aside pre-tax dollars to use for eligible healthcare expenses. Reach out to your benefits coordinator or account administrator to verify whether you can use FSA or HSA weight loss funds to pay for Wegovy. You likely need to submit a letter of medical necessity from your healthcare provider to use either type of account.

Wegovy coupons from prescription discount sites, like drugs.com, GoodRx, NeedyMeds, or Optum Perks,  may also help you save if your copay is higher than the discounted coupon price. Print or download your coupon and present it to a pharmacy that has Wegovy in stock for savings — with or without insurance. 

How much is Wegovy without insurance?

Without insurance or other savings, Wegovy is expensive. According to drugs.com with its discount card applied, a 1-month supply of Wegovy costs around $1,430. 

To save on Wegovy without insurance, use coupons from discount sites. You can save anywhere from 3% to 80% depending on the discount and site you choose. 

You can also use the Wegovy Savings Card without insurance. If you’re eligible, you can expect to pay $650 per month for your prescription.

Key takeaway

Most health insurance plans cover Wegovy if you meet certain requirements. If they don’t, you can submit a request for coverage. If you have a government insurance plan, like Medicare, you likely won’t get coverage for Wegovy, but there are exceptions.

What you pay for Wegovy with insurance depends on your specific plan. Your drug copay could cover some or all of the cost. Use the Wegovy Savings Card to lower your cost with insurance. You can also use your HSA or FSA to cover your copay and anything you would pay with the savings card. 

Without insurance, a 1-month supply of Wegovy costs more than $1,400. Coupons can lower your cost. You can also save with the Wegovy Savings Card if you’re eligible.

Talk to a weight loss specialist about Wegovy in as little as 24 hours

If you’re ready for a lighter, healthier you, look no further. A provider on Klarity can assess your weight loss needs and prescribe Wegovy, or another medication, if it’s right for you. Find a provider today and have an online appointment for weight loss whenever it’s convenient for you.

Sources

Accreditation Council for Medical Affairs, What is Prior Authorization?, Amanda DeMarzo, Dec. 2020, https://www.priorauthtraining.org/prior-authorization/

Aetna, Wegovy PA Policy, https://www.aetna.com/products/rxnonmedicare/data/2023/Wegovy_PA_Policy_4774-A_08-2022_v2.html

Blue Cross Blue Shield of California, Drug Details: Weight Loss Agents, https://blueshieldca.adaptiverx.com/webSearch/index?key=8F02B26A288102C27BAC82D14C006C6FC54D480F80409B68651080F44A11E57C

Blue Cross Blue Shield of Massachusetts, Pharmacy Medical Policy: Drugs for weight loss, https://www.bluecrossma.org/medical-policies/sites/g/files/csphws2091/files/acquiadam-assets/572%20Drugs%20for%20Weight%20Loss%20prn.pdf

Cigna, Drug and Biologic Coverage Policy: Weight Loss- Semaglutide (Wegovy), https://static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/ip_0521_coveragepositioncriteria_semaglutide_wegovy.pdf

Cigna, Prescription Drug List and Coverage, https://www.cigna.com/individuals-families/member-guide/offered-by-employers-drug-list

DailyMed, Label: Wegovy- semaglutide injection solution, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b

drugs.com, Wegovy Price Guide, https://www.drugs.com/price-guide/wegovy

Forbes, FSA vs. HSA: What’s the difference?, https://www.forbes.com/advisor/health-insurance/difference-between-fsa-and-hsa/

HSA Store, Weight Loss Programs: HSA Eligibility, https://hsastore.com/hsa-eligibility-list/w/weight-loss-programs

Novo Nordisk, Wegovy – Check Your Cost and Coverage, https://www.wegovy.com/coverage-and-savings/check-your-cost-and-coverage.html

Novo Nordisk, Wegovy Savings Card, https://www.wegovy.com/coverage-and-savings/save-on-wegovy.html

Novo Nordisk, Wegovy: Ways to Gain Coverage, https://www.wegovy.com/coverage-and-savings/wegovy-coverage-options.html

Own Your Health, Understanding Prescription Coverage, https://www.ownyourhealthwa.org/selecting-a-health-plan/understanding-prescription-coverage/

Reddit, WegovyWeightLoss, https://www.reddit.com/r/WegovyWeightLoss/

United Healthcare, Clinical Pharmacy Programs: Prior Authorization Notification, https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/drugs-pharmacy/commercial/r-z/PA-Notification-Weight-Loss.pdf

The information provided in this article is for educational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health.

How we reviewed this article: This article goes through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author.