Is Wegovy Covered by Insurance?

Since it entered the market in 2021 as an obesity medication, Wegovy has become a popular option for those seeking pharmacotherapy for weight management. It works by regulating your appetite, making it easier to follow a balanced eating plan.

However, not all insurance plans cover Wegovy, and the out-of-pocket cost is high (well over a thousand dollars per month). Insurance coverage for Wegovy will depend on your specific plan. If you can’t use insurance, there are some ways to reduce the cost of the medication, such as through manufacturer coupons. 

Continue reading to learn more about Wegovy, its costs, and how to get it covered by insurance. 

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What is Wegovy?

Wegovy is a once-weekly injectable medication approved by the FDA in 2021 for treating people with overweight or obesity. It’s a GLP-1 receptor agonist, which means it works by regulating your appetite and food intake. Wegovy also helps your body produce more insulin while releasing less glucagon, resulting in lower blood sugar levels. 

In a 68-week clinical trial on the effectiveness of Wegovy combined with a weight management eating and exercise plan, participants lost an average of 15% of their body weight or 35 pounds. Though everyone responds to the medication differently, 83% of the people in the study lost at least 5% of their starting weight. 

Who can Take Wegovy?

Wegovy is approved for doses ranging from 0.25 to 2.4 milligrams in people who meet specific criteria. 

• Adults with BMI >30. 
• Adults with BMI >27 with at least one comorbidity, like high blood pressure or type 2 diabetes.
• Children over 12 years old with BMI >95 percentile.

Wegovy is not recommended for individuals with a personal or family history of thyroid cancer. 

What are the Side Effects of Wegovy?

Part of how Wegovy helps manage hunger is by slowing the rate your stomach empties. This can result in digestive side effects, with the most common being:

• Nausea and vomiting. 
• Diarrhea. 
• Constipation. 
• Abdominal pain.

Experts recommend a balanced diet and regular exercise routine to maximize the effectiveness of Wegovy.

Is Wegovy Covered By Insurance?

Though the Affordable Care Act (ACA) requires insurance companies to include treatment for obesity in their plans, the coverage of weight management medications greatly varies from state to state. 

Approximately 40% of Americans with private insurance have coverage for weight loss drugs. Some government insurance programs, like Medicare, do not cover these medications at all. Medicaid coverage varies by state, with 78% of programs covering Wegovy. Depending on their medical history, people with health insurance through the Veteran’s Administration (VA) or Tricare may also qualify. 

Check your specific insurance plan to find out if weight management medications like Wegovy are covered.

Cost of Wegovy with Insurance

If your insurance covers Wegovy, it’s important to understand how much you’ll be responsible for paying. This varies significantly by plan and location. You may need to hit your annual deductible before your insurance kicks in, or you might be responsible for a copayment or coinsurance fee. 

Cost of Wegovy Without Insurance

If you don’t have insurance coverage for Wegovy, a 28-day supply costs an average of $1,718.50 out of pocket. Depending on where you live and the pharmacy you choose, you may be able to get your cost down closer to $1,300.   

Unfortunately, there is no generic version of Wegovy at a more affordable price. This is because Wegovy was approved in 2021, and it can take many years for generic medications to become available for new drugs. 

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Getting Insurance Coverage for Wegovy

It may be possible to get coverage for Wegovy even if your insurance does not directly cover it. If you pay for your plan individually (not through an employer), you may have the option to upgrade your insurance plan to include additional services, like obesity medications. 

If your health insurance plan is through your employer, you may be able to appeal the decision if Wegovy gets denied. You can also have your doctor fill out a letter to your insurance requesting medication coverage. This letter will go to your employer’s benefits manager or to human resources to be passed along to your insurance.   

Getting a Prior Authorization

Some insurance plans require prior authorization before covering medications. A prior authorization is a form your doctor fills out for your insurance explaining why a specific treatment is medically necessary for you. You can request this directly from your doctor’s office if your provider has prescribed Wegovy and your insurance plan needs prior authorization.

Ways to Lower the Cost of My Wegovy Prescription?

If your insurance does not cover Wegovy and you will be paying out-of-pocket, there are a few strategies you can consider to help lower the cost of your prescription. 

Manufacturer Coupon

Drug manufacturers often have coupons on their websites to help reduce out-of-pocket costs. Novo Nordisk, the maker of Wegovy, has a savings program for people starting on the medication. You can apply the discount by registering online, then presenting the coupon to your pharmacy along with your active prescription for Wegovy. 

These coupons typically have restrictions and specific criteria for who can use them, and the savings or offers may change over time. It’s important to review the terms and conditions to determine if you qualify and how long it will help reduce your costs of Wegovy. 

Third-Party Coupons

If you don’t qualify for a manufacturer coupon, you may be able to use third-party programs like GoodRx to save on the cost of Wegovy. GoodRx helps you compare the price of medications across different pharmacies and offers coupons to help you find the best possible discount. 

Fill a 90-Day Supply

Filling a 90-day supply of Wegovy instead of the traditional 30-day supply may save you money. You can do this by asking your doctor for a new prescription reflecting a 90-day refill. The greater quantity may also allow you to utilize your insurance plan’s mail-order pharmacy, which is sometimes more affordable than physical pharmacy locations.  

Takeaway

Wegovy is a GLP-1 medication that is approved for weight management purposes. It works by slowing gastric emptying, improving blood sugar, and regulating appetite. Though effective, many people have to pay out of pocket due to a lack of insurance coverage. 

If your insurance covers Wegovy, copayments and coinsurance fees vary by plan, and you may need a prior authorization. Without insurance coverage, it can cost over $1,700 per month, but tricks like utilizing manufacturer coupons, ordering a 90-day supply, and finding third-party discounts can bring the cost down. 

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Managing Weight Loss with an RD 

Wegovy is a tool to assist with weight management. It’s important to set a healthy foundation of balanced eating and regular exercise to help the medication work the best. A registered dietitian can create an eating plan with you based on your food preferences, health goals, and medical history. 

If you’re not sure where to start, consider trying Nourish. We’ll connect you with a top-rate weight loss nutritionist. For your convenience, visits are conducted online, and we work with you to maximize insurance coverage of your appointments.