Wegovy Insurance Coverage: Everything You Need to Know

Wegovy is an FDA-approved injectable drug that helps with weight management. It is a high-dose version of the diabetes drug semaglutide that helps individuals lose weight by reducing appetite and increasing feelings of fullness. This medication has become increasingly popular as a weight loss treatment, but many people wonder if it is covered by insurance. In this journal article, we will discuss everything you need to know about Wegovy insurance coverage.

What is Wegovy?

Wegovy is a medication that has been approved by the FDA for weight loss treatment. It contains the active ingredient semaglutide, which is a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 is a hormone that is released in response to food intake, and it helps regulate appetite and blood sugar levels. By activating the GLP-1 receptor, Wegovy reduces appetite and increases feelings of fullness, thereby leading to weight loss.

Wegovy is administered as a once-weekly injection that can be self-administered under the skin of the abdomen, thigh, or upper arm. The recommended dosage is 2.4 mg per week, which is higher than the dosage used for diabetes treatment with semaglutide.

Does Insurance Cover Wegovy?

Insurance coverage for Wegovy varies depending on the insurance company and the specific plan. Some insurance plans may cover the cost of Wegovy, while others may not. It is important to check with your insurance company to determine if Wegovy is covered under your plan.

If Wegovy is covered under your insurance plan, you may be responsible for a copay or coinsurance. The amount of the copay or coinsurance will depend on your specific plan and insurance company. Some insurance companies may also require prior authorization for Wegovy before it is covered.

If Wegovy is not covered under your insurance plan, you may be able to appeal the insurance company’s decision. Your healthcare provider can help you with the appeals process and provide supporting documentation to demonstrate the medical necessity of Wegovy for your weight loss treatment.

How Much Does Wegovy Cost Without Insurance?

If Wegovy is not covered under your insurance plan, the cost can be quite high. The list price for a four-week supply of Wegovy is around $1,300. This means that the cost for a year’s worth of treatment would be over $16,000.

However, there are ways to reduce the cost of Wegovy if you are paying out of pocket. The manufacturer of Wegovy, Novo Nordisk, offers a savings card that can help reduce the cost of the medication. With the savings card, eligible patients may be able to pay as little as $25 per prescription fill.

Which Insurance Companies Cover Wegovy?

As mentioned earlier, insurance coverage for Wegovy varies by insurance company and plan. However, some insurance companies that currently cover Wegovy are:

This is not an exhaustive list, and it is important to check with your insurance company to determine if they cover Wegovy under your specific plan.

FAQ

1. Is Wegovy covered by Medicare?

Yes, Wegovy is covered under Medicare Part D drug coverage. However, the cost of Wegovy may vary depending on your specific plan and whether or not you have reached the coverage gap or “donut hole” in your plan.

2. What is the savings card offered by Novo Nordisk?

The savings card offered by Novo Nordisk is called the Wegovy Savings Card. It can be used by eligible patients to reduce the cost of the medication. With the savings card, eligible patients may be able to pay as little as $25 per prescription fill.

3. Can I appeal an insurance company’s decision to not cover Wegovy?

Yes, if Wegovy is not covered under your insurance plan, you may be able to appeal the insurance company’s decision. Your healthcare provider can help you with the appeals process and provide supporting documentation to demonstrate the medical necessity of Wegovy for your weight loss treatment.

4. How long does it take for Wegovy to start working?

Wegovy starts working immediately after the first injection, but it may take several weeks to see noticeable weight loss. Clinical studies have shown that individuals taking Wegovy can lose up to 15% of their body weight within 16-20 weeks of treatment.

5. Are there any side effects of Wegovy?

Like any medication, Wegovy can cause side effects. The most common side effects of Wegovy are gastrointestinal side effects, such as nausea, vomiting, diarrhea, and constipation. Other potential side effects include headache, fatigue, and injection site reactions. It is important to talk to your healthcare provider if you experience any side effects while taking Wegovy.

Conclusion

Wegovy is an effective weight loss treatment that has become increasingly popular in recent years. While insurance coverage for Wegovy varies depending on the insurance company and plan, there are options available to help reduce the cost of the medication. If you are considering Wegovy as a weight loss treatment, it is important to talk to your healthcare provider and insurance company to determine if it is covered under your plan.