What is ‘prior authorization’ for Wegovy (Semaglutide) insurance coverage
Prior authorization is paperwork requested by your insurance carrier to justify the use of Wegovy®. Some insurance plans will require a prior authorization to be completed in order to cover the cost of Wegovy. Your healthcare provider will complete the paperwork. Unfortunately, this is not a guarantee of coverage.
Different insurance plans and providers may have different criteria as to what is needed for prior authorization of Wegovy, which can include:
- Proof that the medication is working (patient lost at least 5% of their body weight within the first 3 months of taking Wegovy)
- Proof that the patient has – and follows – a lifestyle & diet plan in addition to taking Wegovy
- Proof that the patient made lifestyle changes prior to starting Wegovy
Many doctors have the authority to prescribe medication such as Wegovy. However, without following a standardized treatment schedule and laying out a treatment plan, the prescription may not pass the authorization for coverage.
At FORM, we always recommend working with reputable doctors that will construct a holistic lifestyle and health improvement plan for you as opposed to just giving you a prescription. In turn, this will also help your case if your insurance plan requests prior authorization paperwork.