Does Insurance Cover Wegovy and Other Weight Loss Medications?

Wegovy and other weight loss medications can be costly, but insurance coverage can help make them more affordable. Many insurance plans cover Wegovy and other medications in their formulary.

The cost of Wegovy without insurance can be around $1,300 per month, which is a significant financial burden for many people. However, with insurance, the out-of-pocket cost can be significantly reduced.

Insurance coverage for Wegovy and other weight loss medications varies depending on the insurance plan and the specific medication. Some plans may require a prior authorization or step therapy before covering the medication.

Insurance coverage for Wegovy can be complex, but here's the bottom line: it depends on your insurance plan. About 43% of employers provide coverage for Wegovy in 2024, but that means 57% of workers will have to pay for it themselves.

If you have Medicare, you may be in luck - it now covers Wegovy for patients at risk for heart disease who meet weight requirements. However, Medicare won't cover Wegovy for weight loss alone, as a 2003 rule specifically prevents it.

Here's a breakdown of insurance coverage for Wegovy:

It's worth noting that insurance coverage for Wegovy can vary depending on the specific medication, with some insurers covering Wegovy but not Ozempic, for example.

Semaglutide is a medication that's often prescribed for weight loss, but its costs can be a significant barrier for many people. Generic semaglutide costs about $300 per month through a compounding pharmacy.

The FDA has issued a warning about compounded semaglutide, as the drugs you receive could contain wrong ingredients, incorrect amounts of semaglutide, or harmful additives. This highlights the importance of only using approved and FDA-regulated sources for medication.

Semaglutide is also available under the brand name Ozempic, which has a list price of $968.52 for a 28-day supply. However, with the Ozempic Savings Card, the price can be reduced to as little as $25 for those with private or commercial insurance coverage.

Novo Nordisk, the manufacturer of Ozempic, also offers a cheaper alternative called Wegovy, but its cost is still quite high. Compounded semaglutide, on the other hand, can be a cheaper option, costing $194 for the first month and $399 monthly through the Body membership.

It's worth noting that insurance coverage for semaglutide varies widely depending on the insurer and the specific plan. Some insurers may cover Wegovy but not Ozempic, even though both medications contain the same active ingredient, semaglutide.

Here's a comparison of the costs of semaglutide medications:

Keep in mind that these costs are subject to change and may not reflect your specific insurance coverage or circumstances. It's essential to consult with your healthcare provider and insurance company to determine the best course of action for your weight loss journey.

About 43% of employers offer coverage for Wegovy in 2024, but you'll have to pay for it yourself if you work at the other 57% of companies.

Wegovy is now covered by Medicare Part D and Medicare Advantage plans that include prescription benefits, but only if you're at risk for heart disease and meet the weight requirements.

Medicaid covers Wegovy in all states if you're at risk of heart disease and meet the weight requirements, with some states also covering it for weight loss.

Some marketplace health insurance plans cover Wegovy, but it varies, so be sure to shop around during health insurance open enrollment.

The cost of Wegovy without insurance is $1,349.02 per month, but insurance, coupons, and manufacturer savings cards can reduce the price.

With insurance, Wegovy can cost as little as $0, depending on the level of coverage.

You can save between 7-34% off the retail price of Wegovy by using free coupons available on sites like GoodRx.

Here are some prices for Wegovy at different pharmacies without insurance:

The cost of medications can be overwhelming, especially when it comes to weight loss treatments like Wegovy. Without insurance, Wegovy costs $1,349 per month or $16,188 per year.

However, if you have insurance, the cost can be significantly lower. In fact, the drug maker estimates that most people with insurance pay less than $25 per month.

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

Keep in mind that the cost with insurance will depend on the rates set by your insurance plan and how your plan classifies Wegovy.

Mounjaro costs $1,069 per month without insurance, which is a significant expense.

If you have health insurance but your plan won't cover Mounjaro, you can use a Mounjaro coupon from the drug maker to lower your costs to $596 per month.

Ozempic, on the other hand, costs $969 per month without insurance, but with insurance, the cost drops to $291 per month.

Wegovy is the most expensive of the three, costing $1,349 per month without insurance. However, with insurance, the cost can be as low as $25 per month, depending on your plan's classification of the drug.

Here's a rough breakdown of the costs for each medication without insurance:

Rybelsus can be a pricey medication without insurance, costing as much as $936 per month.

If you have insurance, however, Rybelsus becomes much more affordable, with a monthly cost of just $281.

You can also get the medication for as little as $10 per month if you have insurance and use the Rybelsus coupon, which offers a maximum savings of $300 per month.

Here's a breakdown of the costs with and without insurance:

This is significantly cheaper than other weight loss medications, which often have a manufacturer discount of $150 to $225 per month after insurance benefits.

Wegovy can be quite expensive, with a list price of $1,349.02 per month.

Fortunately, there are cheaper alternatives to Wegovy. Other injections and oral medications for weight loss are available.

One such alternative is Saxenda (liraglutide), which also has a list price of $1,349.02. However, with insurance, Saxenda can be a cheaper option.

Contrave (naltrexone/bupropion) is an oral medication for weight loss that's cheaper than Wegovy. Without insurance, it costs around $690-$750 for a monthly supply, according to GoodRx.

The Contrave Coupon Savings Card Program can bring the price down to $20 for those with insurance coverage for Contrave or $199 for those with insurance but without coverage for Contrave. To qualify for the discount, you must meet certain eligibility requirements.

If you have insurance but your plan won't cover Contrave, you can use a Contrave coupon to lower your costs. The coupon can save you up to $199 per month, depending on your insurance coverage.

Contrave is a good option for those looking for a more affordable weight loss medication. With the right insurance coverage and a Contrave coupon, you can get this medication for a fraction of the original price.

Zepbound is a medication option to consider. It costs $1,060 per month without insurance.

If you have insurance, Zepbound can be more affordable, costing $318 per month after insurance coverage. However, this may not be the case for everyone, as some insurance plans may not cover Zepbound.

In such situations, you'll need to pay the full price of $1,060 per month, or take advantage of the drug maker's discount, which would bring the cost down to $597 per month.

Rybelsus is a weight loss medication that's gaining attention for its effectiveness. It costs $936 per month at full price.

Rybelsus has the same main ingredient as Ozempic and Wegovy, semaglutide. This ingredient is key to its weight loss properties.

The main difference between Rybelsus and Ozempic/Wegovy is the delivery method - Rybelsus is a pill, while Ozempic and Wegovy are at-home injections. This makes Rybelsus a more convenient option for some people.

With insurance, the cost of Rybelsus drops significantly, to $281 per month.

Qsymia (Phentermine/Topiramate) is an oral medication for weight loss.

The average cost of Qsymia without insurance is $134, which is significantly lower than some other weight loss medications.

Qsymia's cost can be further reduced with the Qsymia Savings Card, which offers additional savings for people with commercial insurance.

This makes Qsymia a more affordable option for those looking to lose weight with medication.

If you're looking for cheaper alternatives to expensive weight loss medications, there is some good news. You can get Ozempic for $25 per month if you use the Ozempic Savings Program on top of your insurance benefits.

With a list price of $1,349.02 per month, Wegovy can be quite expensive. There are cheaper alternatives to Wegovy, including other injections and oral medications for weight loss.

Saxenda (liraglutide) has a list price of $1,349.02, but with insurance, it can be a cheaper alternative to Wegovy. Depending on your insurance coverage, Saxenda might be a more affordable option.

If you're struggling to afford Wegovy, don't worry – there are several financial assistance options available.

You can use the Ozempic Savings Program on top of your insurance benefits to get Ozempic for $25 per month. However, the $25 per month rate is only available if you have great insurance benefits.

Novo Nordisk, the manufacturer of Wegovy, offers a patient assistance program for eligible patients based on income and insurance status. This program can provide Wegovy at no cost to those who qualify.

Eligible patients with private insurance may benefit from Novo Nordisk's savings card, which can significantly reduce out-of-pocket costs for Wegovy. If your insurance covers Wegovy, you can pay as little as $0 for a 28-day supply (1 box) of Wegovy and save up to $225 for a 28-day supply of Wegovy.

Some pharmacies provide discount programs that may offer reduced prices on prescriptions, including Wegovy. It's worth checking with local and online pharmacies to see what discounts might be available.

You can also explore nonprofit organizations that provide financial assistance for medications. These organizations often offer support for patients who don’t qualify for other forms of assistance but still need help affording their treatments.

Here are some additional options to consider:

Most insurance companies cover Wegovy, but the rules on how you can qualify for that coverage will be different between insurance companies, plans, and plan types.

Employer-provided insurance plans cover Wegovy in about 43% of cases, which means nearly 57% of employees will have to pay for it themselves. Access to weight loss drugs has been expanding, and nearly twice as many employers are covering Wegovy this year versus last.

If you have health insurance through your job, weight loss drug coverage will usually depend on your employer's rules, rather than the insurance company. If you buy insurance on the marketplace, Blue Cross Blue Shield is often the best company for weight loss drug coverage because sometimes you don't need to meet a deductible before the plan will pay.

Some insurance companies, like UnitedHealthcare, have coverage for most major weight loss drugs, including Wegovy, Ozempic, Mounjaro, and Rybelsus. They also offer free online health and weight loss coaching, as well as free insulin and other common drugs in some plans.

However, insurance companies are hesitant to cover weight loss medications due to their high cost, which can be over $1,000 per month without insurance. They often view weight loss treatments as short-term expenses, rather than investments in long-term health.

Here are some insurance companies that offer coverage for Wegovy:

Keep in mind that coverage for Wegovy can vary widely between insurance providers and plans, and you should check with your insurance company to see what specific requirements and coverage options are available to you.

If your insurance company denies coverage for Wegovy, don't be discouraged. Many patients have successfully secured coverage after going through the appeals process.

Insurance companies often deny coverage on the basis that the medication is not medically necessary. To challenge this, work closely with your healthcare provider to provide detailed documentation that demonstrates the drug's necessity.

Your BMI, any related health conditions, and your weight loss history are all crucial in showing that the treatment is necessary. Specifically, showing that other methods have not worked is key.

The appeal process can take time and may require multiple rounds of submissions. Persistence is key, and many patients have seen their denials reversed after submitting stronger evidence of their need for the medication.