From understanding how to get Wegovy insurance coverage to communicating with your healthcare provider and insurance company, we will provide practical insights and tips to navigate the process successfully.
Wegovy (semaglutide) is a novel prescription weight-loss medication approved by the United States Food and Drug Administration (FDA).
Many people are interested in incorporating Wegovy into their weight management journey due to its remarkable efficacy in assisting weight loss.
However, the cost of medication can be an issue for some people, prompting them to look into insurance coverage options. We will walk you through the steps to get Wegovy covered by insurance in this comprehensive guide.
By following these guidelines, you can improve your chances of obtaining Wegovy insurance coverage and gaining access to this innovative weight loss treatment without incurring undue financial burdens.
Is Wegovy Covered by Insurance?
To find out if Wegovy is covered by your insurance plan, contact them and ask if this medication is already covered and what the cost (or tier) is.
A tier is the dollar amount of copay you may be expected to pay, which varies between insurance companies.
If you do not have insurance, call Novo Nordisk at 1-888-809-3942 (Monday-Friday, 8:00 a.m.-8:00 p.m. ET) to see if you are eligible for a Wegovy Savings Copay Card or a patient financial assistance program.
You can also fill out an online form and they will check your insurance for you.
Weight-loss medication insurance coverage is not widely available in the United States, but you may be eligible for financial medical assistance.
How Much is Wegovy with Insurance?
If your insurance covers some or all of the cost of Wegovy, the price will be determined by how Wegovy is classified by your insurance and the level or tier of your benefit. You can call your insurance company to find out how much it will cost and what your copay will be.
If you have commercial insurance and your doctor prescribes this medication, a Wegovy Savings Copay Card provided by Novo Nordisk, the manufacturer, maybe more affordable.
Patients with commercial insurance who are eligible may pay as little as $25 for a 28-day supply (1 box of injectable pens), with a maximum savings of $200 per prescription fill.
Patients with government-sponsored insurance, such as Medicare, Medicaid, or Tricare, are typically ineligible for copay cards.
If you have a yearly insurance deductible, you may need to meet it before your insurance will cover any portion of your medication.
Inquire with your insurance company if you have any out-of-pocket expenses before your medications are covered. Once your yearly out-of-pocket expenses have been met, your insurance should cover some or all of your medication.
How Much is Wegovy without Insurance?
Wegovy subcutaneous solution costs around $1,430 for a supply of four injectable pens containing a month’s supply of medicine.
The cost varies depending on the pharmacy. Prices are only valid for cash-paying customers and do not apply to insurance plans.
If you pay cash for your prescriptions or your commercial insurance does not cover the cost of Wegovy, you may be able to save up to $500 by calling NovoCare at 1-888-793-1218 (Monday-Friday, 8:00 a.m.-8:00 p.m. ET).
If your insurance does not cover Wegovy and you have exhausted all other options, consider the following:
- You can check with your insurance company to see if any other weight loss maintenance products are covered. Discuss these various options with your doctor to see if any of them are a viable alternative to Wegovy.
- Call NovoCare at 1-888-793-1218 (Monday-Friday, 8:00 a.m.-8:00 p.m. ET) to find out if you qualify for any financial assistance programs.
- The Wegovy price guide is based on the use of the Drugs.com discount card, which is accepted at the majority of pharmacies in the United States and may help you save money.
What Insurance Companies Cover Wegovy?
You can also call Novo Nordisk or check your coverage immediately online by filling out a form. Call NovoCare at 1-888-809-3942 (Monday-Friday, 8:00 a.m.-8:00 p.m. ET) for more information.
Does Wegovy Require Prior Authorization?
- As part of the insurance approval process, your insurance company may require a “prior authorization form” to be completed by your doctor and submitted to the insurance company.
- Prior authorization may be required for certain medications if you have not tried other “first-line” options, either because these medications are more expensive or because they raise certain safety concerns.
- After receiving the form, your insurance company will determine your eligibility and contact you.
Is Wegovy Generic Yet?
Wegovy is only available as a brand-name medication; there is no generic version. A generic option is not expected until around 2026 to 2031, depending on patent restrictions.
Who is Eligible for Wegovy?
Wegovy (semaglutide) injection is approved for chronic weight management in adults and adolescents 12 years of age and older when combined with a low-calorie diet and increased physical activity.
- Adults must have an initial BMI of 30 kg/m2 or greater (obesity) or 27 kg/m2 or greater (overweight) and at least one weight-related comorbid condition, such as hypertension (high blood pressure), type 2 diabetes mellitus, or high cholesterol (hyperlipidemia).
- In adolescents aged 12 and up, eligible patients should have an initial BMI that is at or above the 95th percentile for age and gender (as determined by your doctor’s growth charts).
- Wegovy is a glucagon-like peptide-1 (GLP-1) receptor agonist that is administered once weekly as a self-administered subcutaneous (under the skin) injection.
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This is not all of the information you need to know about Wegovy for safe and effective use, and it does not replace the advice of your doctor.
Examine the full Wegovy information and discuss it with your doctor or other health care provider, as well as any questions you may have.
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