Is Wegovy Covered by Insurance?
Wegovy® insurance coverage depends on your insurance company, as well as the medication coverage provided in your individual plan. Each individual will have a list of medications that are covered (the prescription “formulary”) along with whether or not there are specific eligibility requirements for each medication. For example, your insurer may require that you meet the prescribing criteria set by the drug manufacturer. If you don’t meet this criteria, your insurance plan may not cover Wegovy.
The best way to get Wegovy covered by insurance is to work with an experienced medical provider, like those at FORM, to determine if this medication is appropriate for you as part of an overall weight loss treatment plan. Once prescribed, FORM can submit necessary paperwork, such as a prior authorization, to your insurance company to request coverage. Coverage decisions are at the discretion of the insurance provider and while FORM will do their best help patients get the medications they need, we cannot guarantee Wegovy coverage.
How much does Wegovy cost without insurance?
Wegovy can be difficult to afford without insurance coverage because it is expensive out of pocket. At the time of publication of this article, the list price for Wegovy was $1349.02 per 28 day supply. You may be able to find a lower Wegovy price at specific pharmacies or take advantage of the Wegovy savings card, which reduces the monthly cost by up to $500 if insurance does not provide coverage.
How much does Wegovy cost with insurance?
The cost of Wegovy with insurance will vary depending on your insurance company and your specific insurance plan, ranging from zero dollars per month if you have full Wegovy insurance coverage to higher amounts if you have partial coverage or need to meet your deductible first. Individuals with insurance can also benefit from Wegovy's savings card, which reduces the monthly copay by up to $225 if your insurance covers the medication.
Finding Insurance That Covers Wegovy
Many, but not all, insurance companies provide coverage for Wegovy. Your coverage will vary based on the plans offered by your employer and the plan that you choose when electing your annual benefits. In general, Medicare does not cover medications indicated to treat overweight and obesity, although certain Medigap and Medicare Advantage plans for retirees will cover Wegovy. For Medicaid, it is best to contact your insurance provider directly as coverage varies by state, but it is important to note that FORM is unable to accept Medicaid insurance for program costs at this time.
Does using FORM affect the cost or coverage of Wegovy?
When you join FORM, you will have an intake appointment with your FORM doctor to review your medical history, weight loss journey, labs, and your goals. This discussion will inform your personalized weight loss treatment plan which will address nutrition, physical activity, and mindset shifts and may include a prescription for FDA-approved medication if appropriate. Wegovy is one of many FDA-approved medications prescribed by FORM medical providers. FORM patients fill their prescriptions at their preferred pharmacy, so medication cost does not change when working with FORM. FORM does not ship medications directly to patients. Your Wegovy insurance coverage is not affected when working with FORM as coverage is determined by your insurance company and your specific plan.
Working with FORM means having a Care Team that has experience completing prior authorizations specifically for weight loss medications. If the initial medication that your doctor prescribes is not covered, and not affordable as an out-of-pocket option, your doctor will pursue other options, including lower cost medications that are affordable regardless of insurance coverage.
Can you get the generic version of Wegovy for less?
There is no generic version of Wegovy available at this time, as Wegovy is a relatively new medication with patent protection. You may have heard of compounded semaglutide, which some believe to be the equivalent of a generic but it is actually different from the medication approved by the FDA. Read more about FORM’s stance on compounded weight loss medications, and why we do not recommend using them.
Who is Eligible for Wegovy?
To determine if you meet the criteria for Wegovy, several factors are considered:
- Body Mass Index (BMI): If your BMI is >30, or >27 and you have a weight-related medical condition such as high blood pressure or high cholesterol, you may be eligible.
- Previous attempts to lose weight: If you have attempted to lose weight through lifestyle changes such as a low calorie diet and exercise for at least 3 months and have been unable to lose or maintain weight loss, you may qualify.
It is important to understand that meeting these conditions does not guarantee eligibility for Wegovy. Other aspects including your medical history, current medications, and insurance coverage need to be considered. The ultimate decision about which FDA-approved medication is right for you, if any, will be reached through a discussion between you and your FORM doctor.