Will Insurance Companies Pay for Wegovy?

Key Takeaways

Insurance providers may or may not pay for prescription medications designed to help you lose weight. It depends on the insurance company, your specific plan, and if you meet certain criteria.
The average out-of-pocket cost for Wegovy with insurance coverage depends on your insurance company and your specific health insurance plan. With insurance coverage, you can also use the Wegovy savings card from Novo Nordisk.

The U.S. Food and Drug Administration (FDA) approved Wegovy (semaglutide) for chronic weight management. It is a relatively new medication approved in 2021 and can be used to support your weight loss journey. But the cost of Wegovy can be nearly $1,350 a month without insurance, and Wegovy may not be covered by insurance for everyone.

Please continue reading to learn more about which insurance providers cover Wegovy and how Wegovy works as a weight loss drug.

How much does Wegovy cost without health insurance?

The list price of Wegovy is $1,349.02 per package (28-day supply). Each package contains 4 Wegovy pens, one for each week. Therefore, the out-of-pocket costs of Wegovy are $1,349.02 for a 28-day (1-month) supply if your insurance plan does not cover weight loss drugs.

Note: The list price is not necessarily the final price you will pay for Wegovy if you don’t have health insurance coverage.

The drug manufacturer for Wegovy, Novo Nordisk, also offers financial assistance programs for both insured and uninsured individuals.

If you don’t have insurance, you can save up to $500 per box of Wegovy (28-day supply) through the manufacturer’s savings offer called WeGoTogether.

Check out our blog for a complete overview of how much prescription weight loss injections cost.

What is the average out-of-pocket cost for Wegovy with insurance coverage?

The average out-of-pocket cost for Wegovy with insurance coverage depends on your insurance company and your specific health insurance plan.

It can range from $0 if you have a full coverage plan to higher amounts if you have a partial coverage plan or are required to meet a deductible before your insurance provider will pay for weight loss drugs.

A formulary is a list of drugs covered by the health plan. Prior authorizations require submitting or communicating specific documents to the insurance plan by your healthcare providers.

The process of prior authorizations ensures that healthcare providers get approvals from the health plan before prescribing the medication. If Wegovy is in your plan’s formulary, your health plan may require prior authorization.

The co-pay of Wegovy may vary depending on the health plan and the type of coverage provided.

People who have insurance coverage can take advantage of the Wegovy savings card from Novo Nordisk. The WeGoTogether program can result in savings of $225 per 28-day supply for up to 12 refills if you have insurance coverage for Wegovy.

Do insurance companies pay for weight loss medications?

Insurance providers may or may not pay for prescription medications designed to help you lose weight. It depends on the insurance company and your specific plan.

Insurance plans from private insurance companies: These include plans offered by employers. Contact your insurance provider directly to check if Wegovy is covered. You can also check your plan’s formulary (list of medications that are covered) and eligibility requirements for Wegovy (semaglutide injection).
Medicare coverage: Medicare generally does not cover prescription medications for treating obesity. However, Wegovy may be covered by some Medigap and Medicare Advantage Plans.
Medicaid coverage: Coverage by Medicaid for weight loss medications varies by state. Contact your insurance provider to find out if Wegovy is covered in your plan.
Tricare coverage: You may be able to get Wegovy covered by Tricare. Talk to your Tricare network provider or military treatment facility to find out if your Tricare insurance covers Wegovy.

Note: Certain medications contain the same active ingredient but are not approved to treat severe obesity. For example, Ozempic, which also contains semaglutide, is approved to treat diabetes type 2. Insurance may not cover medicines that are used off-label (non-FDA-approved use), for example, taking semaglutide (Ozempic) for weight loss alone.

Which insurance provider pays for Wegovy?

The coverage options for Wegovy depend on the specific insurance provider and health plan. For example, Cigna requires that eligible patients undergo a medical necessity review for semaglutide injection (Wegovy).

This means you need to meet certain eligibility criteria for initial approval and continued treatment with semaglutide (Wegovy) for weight loss.

This drug is considered medically necessary if an adult 18 years of age or older has tried behavioral modification (a reduced calorie diet and exercise) for at least 3 months, has a body mass index (BMI) of at least 30 kg/m2, has a BMI of at least 27 kg/m2 and weight-related medical conditions such as cardiovascular disease, high cholesterol, hypertension, impaired glucose tolerance, type 2 diabetes, or obstructive sleep apnea, and if they will use Wegovy along with diet and exercise.

Other insurance providers such as Humana, Kaiser Permanente, Aetna, United Health, Anthem, Blue Cross Blue Shield, and others have their own eligibility criteria for Wegovy. Check with your plan administrator for a coverage review.

What are the requirements to qualify for Wegovy?

Wegovy is a once-weekly injectable prescription drug that is approved to treat obesity in adults and children 12 years of age and older. In adults, the requirements to qualify for Wegovy are:

A body mass index (BMI) of 30 kg/m2 or higher.
A BMI of 27 kg/m2 or higher and a medical history of at least one weight-related medical condition such as high blood pressure, high cholesterol, or diabetes.

In children ages 12 years and older, the requirements to qualify for Wegovy are a BMI at or above the 95th percentile for age and sex. Check out our blog on who should not take Wegovy.

What is the dosing schedule for Wegovy?

Wegovy comes in 5 different strengths for once-weekly subcutaneous injection.

0.25 mg once a week for weeks 1-4.
0.5 mg once a week for weeks 5-8.
1 mg once a week for weeks 9-12.
1.7 mg once a week for weeks 13-16.
2.4 mg once a week (maintenance dosage) week 17 onwards.

The recommended maintenance dose (or target dose) of Wegovy for weight loss is 2.4 mg once a week, although some people cannot tolerate more than 1.7 mg weekly.

One Wegovy package containing 4 Wegovy pens (one for each week). You can get a 28-day supply (one package or box of Wegovy) for the 0.25 mg, 0.5 mg, and 1 mg strengths. You can get either 28-day (1-month) or 84-day (3-month) supplies for the 1.7 mg and 2.4 mg strengths.

Is there a generic version for Wegovy?

Currently, there is no lower-cost generic version for Wegovy.

How to get Wegovy for weight loss?

The best way to get Wegovy is to work with your healthcare provider to determine if Wegovy is right for you as part of an overall weight loss plan. Your provider will discuss the benefits as well as the safety concerns of Wegovy with you.

As mentioned, coverage will vary depending on your insurance provider’s health policy and your specific plan. If your doctor prescribes Wegovy, they can submit the required paperwork to your insurance company’s plan administrator, including obtaining prior authorizations and requesting coverage.

Can I substitute Wegovy for another product during the ongoing drug shortage?

While some weight loss medications may act similarly, they are not interchangeable.

Due to drastically increased demand, the ongoing shortage of weight loss medications makes it challenging for people to start and continue Wegovy.

This drug shortage created opportunities for critical organizations to sell counterfeit drug products that could lead to dangerously harmful consequences.

Working closely with your doctor to determine the most optimal approach for your weight loss journey is always highly recommended.

Check out our blog to learn more about Wegovy’s uses and side effects.

How much weight can you lose on Wegovy?

Clinical trials have shown that Wegovy can result in significant weight loss. People who took Wegovy achieved an average -15% reduction in body weight (35 lbs if the starting weight was 232 lbs) over a period of 68 weeks. Learn about what happens when you stop taking Wegovy.

Note: Wegovy works best when used with a low-calorie diet and increased exercise. By helping you lose weight, Wegovy can have wide-ranging health benefits, including a reduced risk of obesity-associated health conditions such as high blood pressure, diabetes, high cholesterol, heart disease, and cardiovascular events like heart attack and stroke.

Learn more about how prescription weight loss medications work.

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