Insurance Won't Cover Wegovy: A Guide to Your Options

Insurance companies often don't cover Wegovy, a popular weight loss medication, due to its high cost.

The average monthly cost of Wegovy is around $1,300, which can be a significant financial burden for many individuals.

If you're struggling to afford Wegovy, there are alternative options to consider.

You can try reaching out to your insurance provider to see if they offer any discounts or financial assistance programs for prescription medications.

Insurance companies often consider weight loss medication a cosmetic treatment rather than a medical one, which can lead to denials for Wegovy coverage.

Many insurers aim to control costs using pre-authorization (PA) requirements, making it difficult for doctors to predict the success of an approval for Wegovy.

Some common reasons for Wegovy denial include:

Insurance companies may deny Wegovy even if your doctor determines it's medically necessary, leaving you to appeal the decision.

Appealing an insurance denial can be a good idea if starting or continuing treatment with Wegovy will improve your health, and research shows that around 49% of healthcare-related denial appeals are successful.

You have the right to appeal if your insurance plan was created after March 2010, and you should take the following steps to consider an appeal.

Make sure your appeal department and policy number are correct, as this is crucial information that needs to be included in your appeal letter.

State the denial reason and your request, and detail your weight loss history to provide context for your appeal.

Explain why Wegovy is an effective medical treatment for obesity, and mention the complications you may have an increased risk for without treatment, such as heart disease.

You can also use clinical studies in your argument to support your appeal, and be sure to submit your appeal within 6 months of receiving notice of your claim being denied.

Here are some key steps to consider when writing an appeal letter:

Meeting PA criteria isn't enough for an insurance company to approve Wegovy. Insurance companies may consider weight loss medication a cosmetic treatment rather than a medical one, and many don't cover Wegovy.

If your insurance company does cover weight loss medications, they may still deny a request for Wegovy, even if your doctor determines it's medically necessary. Researchers and medical professionals often disagree with this stance, as obesity leads to severe health problems like high blood pressure and stroke.

You can collect a prescription for Wegovy from your local pharmacy or through online services, but the cost is typically higher without insurance than with insurance.

If you're looking to get Wegovy without insurance, be aware that the cost is typically higher without coverage.

You can visit Optum Perks to get price estimates for Wegovy and use their coupons to save money. These coupons aren't valid with insurance copays or benefits.

The drug manufacturer website is also a good resource for information on savings options.

Meeting PA criteria isn't enough for an insurance company to approve Wegovy, as they often consider weight loss medication a cosmetic treatment rather than a medical one.

Many insurers deny coverage for Wegovy, even if your doctor determines it's medically necessary, making it difficult for patients to access this life-changing drug.

Insurance companies aim to control costs using PAs, making it hard for doctors to predict the success of an approval for Wegovy, even if it's an important part of your treatment.

Wegovy is often expensive, with insurance companies using PAs to control costs, which can lead to denial of coverage, even for patients who need it.

Medicare covers the drug semaglutide (Ozempic) for diabetes treatment, but not yet for weight loss medications like Wegovy.

Khoury tried to stay on Wegovy but her new insurance company said no because she doesn't meet the criteria for diabetes.

She considered taking part-time jobs to afford the out-of-pocket cost, but it was tough with four kids.

Some people have turned to compounding pharmacies to buy custom-made versions of their weight loss medications, like Khoury did.

The US FDA allowed some pharmacies to compound versions of semaglutide and tirzepatide, but warned about reports of adverse events in people who used compounded semaglutide.

Khoury's out-of-pocket costs rose from $20 a month to $350 per month after she switched to a compounding pharmacy.

The FDA says the active ingredients in compounded versions may not be the same as in the approved versions of the drugs.

She hopes one day the drug won't take such a big bite out of the family's budget.