If you’re one of the lucky ones who has access to diet pills for weight loss that actually works, you may find yourself quite perplexed by the question: What insurance covers Wegovy? However, it is such a high cost and without insurance, so it is important to understand the way insurance coverage works for Wegovy if you think this is a treatment option for you. Read on as we discuss how insurance plans are billed for Wegovy, how to get the medication covered if you don’t have insurance, and all of its costs with and without insurance.
What is Wegovy?
Wegovy® (semaglutide) is indicated as an adjunct to a reduced-calorie diet and increased physical activity, for chronic weight management in adults with obesity or overweight, including those with weight-related malignancies. Combined with a balanced diet and regular exercise, this works by helping to control hunger, slow gastric emptying, and reduce cravings and helps with weight loss. But because it’s a fairly new medication, not a lot of people know if the insurance covers it.
Does Insurance Cover Wegovy?
How much or little your insurance pays for Wegovy will vary based on your insurance company and plan. Formularies are a list of medications that an insurance company has to specifically cover. The list of drugs found in this formulary are a range of these drugs that are able to be reimbursed, but importantly, not all drugs will be automatically included. Coverage for Wegovy can vary for some plans, and for many insurers, they may need to have some criteria met before they will pay for it.
The Issues of Insurance Coverage and Eligibility Criteria
Your insurance company may make you meet some criteria in order to be able to have Wegovy covered, like having a Body Mass Index (BMI) of 30 or higher, or with a BMI of 27 or higher plus a medical condition such as high blood pressure or high cholesterol. Your insurance provider sets these eligibility requirements and may also require your healthcare provider to provide documentation that Wegovy is appropriate treatment for you.
Many times a healthcare professional, such as those at Form Health, can lead you through the process. If you can, there are these professionals who can help submit necessary paperwork, like prior authorizations, to your insurance company in an attempt to get approval. However, this won’t be decided by us – it’s up to the insurance providers, and there’s no guarantee they’ll cover Wegovy.
Wegovy Without Insurance
It is an expensive medication, especially if you don’t have insurance. Wegovy’s list price for a 28-day supply is $1,349.02 as of now. On the other hand, this is quite expensive for a lot of people.
But those people on no insurance still have options to cut costs. Some pharmacies may have ways to get you to pay less for Wegovy, and there’s a Wegovy savings card. Depending on whom you ask, you could save up to $500 a month with this savings card, especially if you don’t have insurance.
How Much Does Wegovy Cost with Insurance?
Wegovy will cost less for those with insurance coverage; the exact amount will depend on what your plan covers. The full cost of Wegovy may be covered by some insurance providers and a portion of the cost — such as copayment or deductible — by others. Wegovy is often a reduced price for those with insurance due to their plan’s coverage.
Also, if your insurance includes Wegovy and you still need to pay a copay, your Wegovy savings card can cut your cost down even further: by up to $225. But this is an important factor — one to look at when considering your overall out-of-pocket expenses.
Wegovy: How to Find Insurance That Covers It
Insurance for Wegovy may not be easy to find, but it isn’t impossible. Most, but not all, insurance companies cover Wegovy. How much your cards cover is determined by the insurance plan you have — through your employer, your government benefits, or another source. So make sure to check your plan’s formulary to make sure that Wegovy is, in fact, on your plan.
It’s important to note, however, that if you are covered by Medicare, Medicare generally doesn’t cover medications used for weight management, including Wegovy. But some Medigap and Medicare Advantage plans cover Wegovy. Depending on your state, Medicaid may not cover everything, and it’s best to call your insurance provider directly for questions regarding coverage.
Can You Get a Generic Version of Wegovy?
Right now, there is no generic version of Wegovy available. However, Wegovy is still fairly new to the market, so it’s under patent protection. Some people may be thinking of compounded semaglutide as cheaper, but this is not FDA-approved and may not be as safe and effective as Wegovy.
If you want to save, continue to use the approved Wegovy and take advantage of services available, including the Wegovy savings card and from your healthcare provider.
Wegovy Coverage: How Form Health Can Help
Getting Wegovy by insurance can become a complex process, but it doesn’t have to be so if you work with Form Health. With Form Health, you have a complete approach to weight management, with medical providers who have strong experience completing prior authorizations for weight loss medications like Wegovy. If your insurance provider first denies you coverage, Form Health can help you to explore alternative medications or low-cost options.
Understanding that Form Health does not impact the cost of Wegovy is important. Form Health prescribes the medications, and your pharmacy fills it with your preferred pharmacy, and Wegovy’s cost is insurance covered. But Form Health has experience with the insurance paperwork and can be an asset to secure coverage or find a more affordable alternative.
Eligibility for Wegovy
To determine if you are eligible for Wegovy, your doctor will consider several factors, including:
- Body Mass Index (BMI): If you have a BMI of more than 30 (obesity) or if you have a BMI of more than 27 with a related condition, you may be eligible.
- Previous Weight Loss Attempts: Wegovy may be an option if you’ve failed to lose weight through diet and exercise for three months or more.
But that doesn’t mean Wegovy will be automatically prescribed. Before a final decision on your eligibility for Wegovy, your doctor will review your medical history, medications, and insurance coverage.
Conclusion
Getting insurance coverage these days can be a complicated journey, but it isn’t impossible. The insurance coverage for Wegovy varies from person to person because of how your insurance works, your insurance plan specifics, and even if you qualify for it. If your insurance doesn’t cover Wegovy, you still have less expensive ways to reduce the costs, such as taking advantage of the Wegovy savings card or partnering with solid healthcare providers like Form Health.
Finding some options for your insurance, being very close with your doctor, and using what you can to get Wegovy covered can improve your chances exponentially of getting it covered. For the most accurate and up-to-date information on coverage and costs, always consult your insurance provider.
