Do you want to lose weight through Wegovy treatment, but you have no idea whether your insurance company will pay for it or not? Now you don’t need to worry. Here, I have answered all the questions, including eligibility, cost, how to get covered, how to save money, etc.
What is wegovy?
Wegovy is a medication used for weight loss. It is an FDA-approved prescription. It is a semaglutide injection, which is an injectable prescription medicine that may help adults and children with obesity (BMI ≥30 for adults, BMI≥95 percentile for children, and teens of the same age and sex) or some adults who are overweight (BMI 27) and have weight-related medical problems.
This treatment should be taken only after a doctor’s advice.
Wegovy should be used with a combination of a low-calorie diet and increased physical activity. Wegovy works by decreasing thirst and boosting feelings of satisfaction, which results in weight loss.
Who is eligible for Wegovy?
Individuals, both adults and children, with obesity denoted by BMI (body mass index). BMI ≥30 for adults and BMI ≥95 percentile for children and teens of the same age and sex)
- Adults and children with obesity (BMI ≥30 for adults, BMI ≥95 percentile for children, and teens of the same age and sex)
- Overweight adults (BMI 27) with weight-related medical problems
Note: If you have any other medical conditions or are taking any medications, you must share the information with your doctor before using Wegovy.
What insurance companies cover Wegovy?
Weight-loss treatment is not commonly covered by insurance in the US, but some companies offer it.
Wegovy is covered by some of the following insurance companies:
- Blue Cross Blue Shield
- UnitedHealthcare
- Cigna
- Aetna, etc
It is extremely important to remember that coverage varies between insurance plans, so you must confirm the details of Wegovy coverage by contacting your insurance provider.
You can call your insurance company to find out how much it will cost and what your copay, deductible, and coinsurance will be. Because insurance may cover all or some of the cost. You may have to pay for things that are not included in the coverage.
Is wegovy covered by private or commercial health insurance?
Yes, but not all. To know the coverage, you can personally contact your insurance provider by giving them the necessary information. Some insurance providers may require preauthorization from your doctor before you can start the medication.
Is Medicare and medigap covers?
Unfortunately, Medicare does not cover obesity medications, despite the fact that they have recently begun to offer free counseling sessions. Wegovy is not covered by Medicare, but some Medigap and Medicare Advantage plans for retirees are covered by this plan. Please contact the provider of any of these plans, if you have any.
is semaglutide (wegovy) covered by medicaid?
Yes, Medicaid covers Wegovy but is not covered in all states of the US. For Medicaid, it will be better if you contact your insurance company personally. It is important to note that you should contact your provider for the latest update.
List of states which covers wegovy
- California’s
- Delaware’s
- Georgia’s
- Hawaii ( some plan)
- Kansas
- Michigan
- Minnesota’s
- Mississippi’s
- New Hampshire
- Pennsylvania
- Rhode Island ( some plan)
- Tennessee’s
- Virginia’s
- Wisconsin’s
Is wegovy covered by Tricare ?
In certain circumstances, your plan will cover this medication. Your doctor may arrange for a coverage review to find out when coverage is available. For further details, please get in touch with your Tricare Network provider or military treatment facility.
Is wegovy covered by VA coverage?
Yes, it covers the treatment of obesity. For more information about obesity medication options, contact your local Veterans Health Administration provider.
How much does it cost with insurance?
The cost of WeGovy can vary depending on your plan or company. The best way to know the cost, copay, and deductibles, or coinsurance, is to call your insurance provider and ask all these things.
The cost is always low as compared to without insurance wegovy treatment if your insurance plan makes it eligible for wegovy.
Certain providers may pay the full cost of the medication. On the other hand, some might demand copays, deductibles, and coinsurance, which means out-of-pocket costs. You may need to pay a deductible first, and then your insurance begins to pay for Wegovy. You may still have co-pays or coinsurance after the deductible is fulfilled.
Likewise, the dosage and number of doses also affect the cost of Wegovy. For example, a longer duration of treatment may create a higher cost.
Even with insurance coverage, some patients may have high out-of-pocket expenses for Wegovy. In such circumstances, patients can lower costs by utilizing patient assistance programs or manufacturer discounts.
How much does it cost without insurance?
A package of Wegovy contains four pens. single pen used once a week. Four pens get used in a month. At present, one package of Wegovy costs around $1,349.02. Depending on the drugstore you visit, the price may change. If we break it into smaller digits, it would be about $269 for one week and 16,188 for one year. Overall, it is an expensive treatment.
But listen, even without health insurance, there are many ways to save money on Wegovy and bring down the cost of Wegovy.
How do I save money?
- Novo Nordisk: offers a money-saving program. Individuals with private or commercial insurance can take advantage of Wegovy’s savings card, Wegovy®. If your insurance covers the medication, Novo Nordisk offers a savings card for Wegovy that allows you to pay $0 for a 28-day supply (1 box) of Wegovy, reducing the monthly copay by up to $225 for a 28-day supply of 12 fills. If your insurance plan does not cover it, you can save up to $500 per 28-day supply (1 box) of wegovy.
- For more information, call NovoCare at 1-888-793-1218 (Monday-Friday) during working hours.
- You can also visit their website by searching on Google: Novocare, Open First Website.
- Pharmacies and clinics may offer discounts or coupons.
- Wegovy discount cards or coupons can be obtained from companies such as GoodRx and SingleCare. For example, GoodRx provides free Wegovy coupons that can be used at a variety of pharmacies, including Safeway, Rite Aid, Walgreens, Walmart, etc., allowing people to save money. Additionally, you can ask the pharmacist about any prescription discount cards.
- Depending on where you live, Optum Perks provides Wegovy coupons to those who don’t have insurance. You can also visit Optum Perk to find out an estimate of the cost of Wegovy.
- Note: You can’t use Optum Perks coupons with insurance benefits or copays.
- Compare the costs at different pharmacies, including your local pharmacy; the cost of prescription drugs can differ between them. Explore alternates for more affordability by comparing costs and other important aspects.
- Talk with your healthcare provider: Talk with your healthcare provider about alternative medications or weight-loss programs that may be more convenient and affordable. You can share your financial concern; they might be able to provide you with information or resources that will enable you to get Wegovy for a lower cost.
- Consider insurance, which pays for the majority of the cost of prescription medication. In this scenario, the out-of-pocket cost is very low.
- Consider mail-order pharmacies: Some mail-order pharmacies provide medication discounts, particularly if you order in bulk or for a longer-term supply.
- Request a 90-day supply: If your healthcare provider believes that you need Wegovy for a longer period of time, you can request a prescription for a 90-day supply. This can often prove to be a more cost-effective choice compared to obtaining a 30-day supply multiple times.
- Explore government assistance initiatives: Depending on your income level and your specific healthcare requirements, you might be eligible for government support programs such as Medicaid or Medicare, which can provide financial assistance for covering the expenses associated with Wegovy.”
Is Wegovy covered by insurance? how to get covered?
Weight-loss medication coverage through insurance in the United States is not widely available, but some of them provide coverage.
- Review your insurance policy. Carefully review your policy documents and check the part that focuses on prescription drug coverage. Look for weight-loss medications or specific drugs, for example, Wegovy.
- Contact insurance company: If you already have a health insurance plan and want to know the coverage for Wegovy, call the insurance company directly and ask them whether Wegovy is covered by your plan or not by giving them the necessary data. You can usually find the phone number on the official site of the company or on the back of your insurance card. If your plan covers it, ask about deductibles, copays, coinsurance, and out-of-pocket costs.
- Talk with your healthcare provider: Before checking insurance coverage for Wegovy, confirm that the medication is right for you. Discuss with your doctor whether Wegovy is a good option for you according to your past medical conditions and weight management needs. You can look into insurance coverage once you have a prescription for Wegovy or another weight-loss medication. Thereafter, you can discuss this with your healthcare provider. They will help you get the claim.
- Prior authorization: Some insurance plans may require prior authorization for certain medications, including Wegovy. In such cases, your healthcare provider will need to submit a formal request (prior authorization) to your insurance company, explaining the medical necessity of this specific medication. If your insurance plan mandates prior authorization, you can take the initiative by reaching out to your healthcare provider’s office and telling them to initiate the prior authorization process.
- Appeal if necessary: If your insurance company denies your coverage request, you can appeal their decision.” Your healthcare provider is available to help you navigate the appeals process and provide additional information to strengthen your case.
- Work with your insurance company: Work together with your insurance company. They might have certain rules you need to follow to get coverage.
- Check out tips for saving money
- Don’t give up: If your insurance plan doesn’t cover Wegovy, you might have options with the assistance of your healthcare provider (doctor). Novo Nordisk provides a template letter that your doctor can use to request coverage. If you don’t have insurance, you can contact Novo Nordisk, the manufacturer, at 1-888-809-3942, if you qualify for a Wegovy Savings Copay Card or a patient financial assistance program, then you can save your money. They also offer an online form that you can complete, and they will check your insurance for you, which reduces the cost of wegovy.
- Consider a different insurance plan: If your current insurance plan does not cover Wegovy, you can check other insurance plans that do cover the medication.
Note: The process of getting insurance coverage for any medications can be complex, so it needs patience and persistence.
Conclusion
Contact your healthcare provider and provide all details, including what drugs you are currently taking, which diseases you have, etc., to confirm whether WeGovy is right for you or not; if they suggest you for WeGovy, then only start the journey of WeGovy after a prescription. You can check out our savings tips, costs, and steps for getting coverage.
FAQ
There is no generic version of Wegovy available at this time.
Q. does bcbs cover wegovy for weight loss?
yes.
“Your insurance plan may request a ‘prior authorization form’ to be completed by your healthcare provider and submitted to the insurance company as a part of the approval process.
After receiving the completed form, your insurance company will assess your eligibility and reach out to you with their decision.”
Insurance benefits verification is the procedure for confirming a patient’s current medical coverage with their health insurance provider, which helps avoid billing complications.
Q. is wegovy covered by cigna insurance?
Yes.
With insurance, it can vary depending on the plan and company, but you have to pay as little as possible compared to without insurance. whereas without insurance, one package of Wegovy costs around $1,349.02, which contains four pens and a single pen used once a week. and 4 pens require 1 month.
Q. does anthem cover wegovy?
yes.
If you don’t have insurance, then you can’t get this for free. But if you have insurance and if you are eligible for WeGovy, then you only need to pay very little.
$1,349.02 for 1 pack of wegovy and 1 pack contains 4 pens.