Does BCBS Cover Wegovy and Understanding Your Coverage?

If you're considering using Wegovy for weight loss, it's essential to understand your BCBS coverage options. BCBS may cover Wegovy, but the specifics can vary depending on your plan and location.

According to Blue Cross Blue Shield's (BCBS) coverage policies, Wegovy is considered a prescription medication, so it's subject to the same coverage rules as other prescription drugs.

BCBS plans may cover Wegovy with a copayment or coinsurance, which could be a flat fee or a percentage of the medication's cost.

The cost of Wegovy can vary depending on your insurance coverage. If you have a good insurance plan, you could pay as little as $25 per month. However, costs can be higher if your plan doesn't cover Wegovy or if you pay cash for your prescription.

The list price of Wegovy is $1,349, but you can save over $100 per month with a SingleCare Prescription Discount Card. The manufacturer's coupon can also save you up to $500 per month for a 28-day supply.

If you have insurance, the cost of Wegovy depends on your plan's rates and how it classifies Wegovy. If your plan says Wegovy is a preferred brand drug (tier 2), you'll likely pay less. For example, you could have a low copay of just $25 per month.

Here's a breakdown of the estimated costs of Wegovy with insurance:

Keep in mind that the cost of Wegovy can vary widely depending on your insurance plan and coverage. It's a good idea to check with your insurance provider or a pharmacist to get a more accurate estimate of the costs.

If you're wondering whether your BCBS plan covers Wegovy, it's a good idea to contact your insurance company for verification, as they're more familiar with the details of your specific plan. You can typically do this by calling the phone number on the back of your insurance card.

To get your BCBS plan to cover Wegovy, you'll need to meet certain requirements, such as having a BMI of 30 or above, or a BMI of 27 or greater and at least one weight-related health condition. Your healthcare provider will submit a request for prior authorization, which includes relevant information from your medical records.

If your BCBS plan does offer coverage for Wegovy, patients have to meet specific criteria, including going through a comprehensive medical evaluation that includes lab tests and a full medical history. Your healthcare provider will write a similar letter to the one provided by Novo Nordisk, and give it to you to submit to your employee benefits coordinator.

To increase your likelihood of acceptance by your insurance provider, it's essential to maintain complete compliance with the standards outlined in the medical policy. This means following visits in consecutive calendar months, and not spacing diets under medical supervision for too long.

Here's a summary of the requirements you may need to meet to get your BCBS plan to cover Wegovy:

Most Blue Cross Blue Shield (BCBS) plans cover Wegovy, but coverage depends on the plan. To verify whether your BCBS plan will cover Wegovy, check with your insurance company or your employer if you have employer-sponsored coverage.

You can use the Novo Nordisk website to check BCBS coverage of the cost of Wegovy, but it's a good idea to contact your insurance company for verification since they're more familiar with the details of your specific plan.

If your BCBS plan does offer coverage for Wegovy, patients have to meet specific criteria, including having a BMI of 30 or above, or a BMI of 27 or greater and at least one weight-related health condition.

To check whether your BCBS plan covers Wegovy, you can call the phone number on the back of your insurance card. You should also ask questions like: Do I need prior authorization? Have I met my deductible for the year? What can I do to get the best price?

If your employer-sponsored healthcare plan does not cover Wegovy, you can ask your healthcare provider to prove why you need it covered. Your healthcare provider can use a sample letter from Novo Nordisk as a template.

There are other prescription weight loss medications, like Saxenda, that your health insurance plan may cover if it doesn't cover Wegovy. Your healthcare provider can help determine which medication is most suitable for you.

If Blue Cross Blue Shield does not cover your medication, you may get other options for more affordable medication coverage. Unfortunately, medications like Wegovy and Ozempic will typically still cost $700 or more.

Here are some common issues with insurance coverage for Wegovy:

It's usually easier to get insurance to cover Wegovy to lose weight rather than to maintain your weight loss. For example, if Wegovy successfully helped you to lose weight, you may no longer be eligible for coverage if your BMI has fallen below the FDA requirements for the drug.

If you're considering Blue Cross Blue Shield (BCBS) for weight loss medication coverage, it's essential to know the specifics. BCBS may cover weight loss drugs like Wegovy before your deductible, but it's not a guarantee.

BCBS offers a large set of healthy living programs, including apps, coaching, nutrition counseling, and fitness tools, which can be a great resource for those looking to lose weight. Some plans even offer free WeightWatchers.

To get BCBS to cover Wegovy, you may need to show that you've tried to lose weight through diet and exercise. This is a common requirement for many insurance plans. You may also need to try cheaper drugs before plans will cover more expensive drugs like Wegovy.

If you have a government insurance plan like Medicare, Medicaid, or Tricare, you're unlikely to get coverage for Wegovy for weight loss. However, there are some exceptions, such as Tricare covering Wegovy in certain situations.

Here's a summary of the insurance plans that cover Wegovy:

It's worth noting that BCBS is phasing out coverage for large employer plans in Michigan. If you're in this situation, it's essential to check with your insurance company for specific details on your plan's coverage.