Wegovy is a weight loss drug approved for people with obesity or overweight people who also have medical problems related to their weight.
Wegovy has been proven effective in research to help with chronic weight management, but it may cause unwanted side effects and risks for people with certain health conditions.
Every health insurance plan is different. Contact your health insurance to determine whether your plan covers Wegovy and, if so, how much it costs. If your insurer does not cover Wegovy, you can take other steps to access your prescription.
Obesity is associated with a number of adverse health outcomes, such as an increased risk of diabetes and heart disease. In people with obesity, or a body mass index of 30 or higher, medical providers may recommend a prescription drug such as Wegovy.
Wegovy, an injectable drug, has been shown in clinical trials to help people with obesity lose weight, which can lower their risk for diseases. While Wegovy can be an effective drug, it’s important to understand the associated costs, especially if you don’t have insurance coverage.
Read on to learn more about what Wegovy is, how much it costs, and how to get Wegovy covered by insurance. guide for how to get Wegovy covered by insurance.
What is Wegovy?
Wegovy is a prescription medication used to help people with obesity lose weight and keep it off, in conjunction with a healthy lifestyle that includes a nutritious, reduced-calorie diet and increased physical activity. It works by helping decrease a person’s appetite, which may result in eating less/fewer calories.
Wegovy’s active ingredient, semaglutide, is a human glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 is a hormone naturally produced by your body that helps regulate appetite and affects how quickly your stomach empties. This can result in feeling full for longer periods of time. Wegovy mimics these actions, which can result in weight loss.
Wegovy is given as a once-weekly injection under the skin. It can cause unwanted side effects, such as nausea, diarrhea or constipation, and fatigue. It’s currently approved by the Food and Drug Administration for weight loss in people 12 years of age and older.
Cost of Wegovy with Insurance
Using health insurance to cover medication is one way to reduce prescription costs. While many insurance plans cover weight loss medications like Wegovy, every insurance plan is different.
Your plan may cover the entire cost of Wegovy or only part of it. The cost ultimately depends on your insurance provider and the type of benefits you have, along with the pharmacy you use.
Wegovy’s manufacturer, Novo Nordisk, offers a Wegovy Savings Copay Card. If you have private health insurance, the copay card can greatly reduce the cost. Some patients pay as little as $25 for one box of injectable pens (a 28-day supply). Unfortunately, people with Medicare or Medicaid usually are not eligible for copay cards.
How To Get Wegovy Covered By Insurance
Call your health insurance plan to ask if Wegovy is covered and, if so, the cost. Currently, Wegovy is not typically fully covered by commercial health insurance companies. But that doesn’t mean you can’t take Wegovy.
Private insurance companies
Ask your insurance provider if your plan has any out-of-pocket costs before it will cover Wegovy. Some health insurance plans require you to meet a deductible before they pay anything for medicine.
If your insurer won’t pay for Wegovy, inquire with Novo Nordisk about a Wegovy Savings Copay Card. You can also request coverage by printing out a sample letter and asking your health care provider to send it on your behalf.
Did You Know
When you’re a K Health member, your care team helps you through the process of getting your weight loss prescriptions covered by your insurance. Learn more.
Medicaid or Medicare
Most Medicare plans do not cover Wegovy or other medicines for obesity, with the exception of some Medigap and Medicare Advantage plans for retired people. Contact your insurance provider to learn more about what’s covered and what’s not.
Medicaid plans are different in every state. If you have state health insurance, contact your provider directly to learn more about your benefits.
Does Wegovy require prior authorization?
Every health insurance plan is different. If your doctor prescribes you Wegovy, your insurer might require prior authorization, a process used to determine whether a less costly option could achieve the same result. If your insurance refuses to cover a medication, your doctor may be able to appeal the denial.
Getting Wegovy Without Insurance
If you don’t have health insurance, you can try contacting the drug’s manufacturer, Novo Nordisk, at 1-888-809-3942. You may qualify for a Wegovy Savings Copay Card or another patient financial assistance program.
Eligibility for Wegovy
Not everyone is eligible for Wegovy. The FDA approved Wegovy for people with obesity, or those with a body mass index (BMI) of 30 kg/m2 or greater. It’s also approved for overweight people, or those with a BMI of 27 or greater, who also have a medical condition caused by their weight. Examples include type 2 diabetes, high cholesterol, and high blood pressure.
Your medical provider can help you determine if Wegovy is a good choice for you. Your medical history may make Wegovy an unsafe medication for you. For example, Wegovy is not recommended for those who have a personal or family history of a type of thyroid cancer called medullary thyroid carcinoma or an endocrine disease called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
See if You Qualify for Wegovy with K Health
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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.