Will Insurance Cover Wegovy for PCOS and What to Expect

Insurance coverage for Wegovy, a medication used to treat polycystic ovary syndrome (PCOS), varies depending on the individual's health insurance plan and location.

Some insurance plans may cover Wegovy as a form of treatment for PCOS, but the extent of coverage can differ significantly.

PCOS is a common endocrine disorder affecting women of reproductive age, with symptoms including weight gain, irregular periods, and excess hair growth.

The FDA approved Wegovy for the treatment of obesity and weight-related conditions, including PCOS, in 2021.

For more insights, see: Does Insurance Cover Glp 1 for Pcos

Insurance coverage for Wegovy with PCOS can be a bit tricky, but it's worth exploring. Wegovy is FDA approved for weight loss in people who are overweight or have obesity.

Insurance may cover Wegovy for some individuals with PCOS who meet eligibility requirements. Eligibility requirements vary by plan, and many insurance plans do not cover weight loss medications at all.

United Healthcare may cover Wegovy for adult patients who have requested weight loss treatment, have committed to lifestyle modifications, and have a BMI at or above 30. Coverage for all prescription drugs, especially weight loss treatments, varies by plan.

People with PCOS must contact their health insurance providers to find out if any plans cover Wegovy for PCOS.

For another approach, see: Does Insurance Cover Ozempic for Pcos

Wegovy is FDA approved for weight loss in people who are overweight or have obesity.

Insurance coverage for Wegovy varies by plan, and many insurance plans do not cover weight loss medications at all.

Eligibility requirements for Wegovy coverage are strict, and may only cover the drug for a limited time.

Related reading: When Will Insurance Cover Weight Loss Drugs

Wegovy is not a solo act when it comes to treating PCOS. There are other weight loss medications like Ozempic and metformin that may be prescribed.

Medically, Wegovy and Ozempic are identical twins, thanks to their shared active ingredient, semaglutide. They're just labeled for different purposes: Ozempic is for Type 2 diabetes, while Wegovy is for weight management.

Dr. Rowland explains that these two injectable drugs are equally effective for PCOS. They're essentially the same drug formulation.

Metformin is another player in the PCOS treatment game. It helps with insulin resistance and can be used alongside Wegovy or Ozempic for even better results.

Only a healthcare provider with a complete picture of a patient's medical history can decide which treatments are best for them.

You might like: Does Kaiser Insurance Cover Ozempic

Wegovy is FDA approved for weight loss in people who are overweight or have obesity.

Insurance may cover Wegovy for some individuals with PCOS who meet eligibility requirements, but eligibility requirements vary by plan. Many insurance plans do not cover weight loss medications at all.

United Healthcare may cover Wegovy for adult patients who have requested weight loss treatment, have committed to lifestyle modifications, and have a BMI at or above 30.

To find out if any plans cover Wegovy for PCOS, people with PCOS must contact their health insurance providers.

A unique perspective: Progressive Total Loss Coverage vs Actual Cash Value

Insurance companies' views on weight loss medications like Wegovy are inconsistent, with some considering them "lifestyle" or "vanity" drugs.

Many insurance companies are still hesitant to cover Wegovy, despite its proven effectiveness in clinical trials, which show an average 15% weight loss. This is a significant effect, considering that weight loss of just 5% to 10% may stop or slow the onset of diabetes and improve blood pressure, cholesterol, and blood sugar levels.

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Bronder's case is a prime example of this issue. His insurance initially refused to cover Wegovy, citing its "cosmetic" nature, despite his prediabetes diagnosis, which qualified him for a related medication.

To find out if your insurance policy will cover a medication like Wegovy, you need to call the number on your health insurance card and ask. Coverage varies depending on the company and plan, and some medications may be covered for weight loss, but not for people on Medicare.

Some insurance companies are starting to change their stance on weight loss medications, and experts expect coverage to improve over time. The U.S. legislature has introduced a bill to make Wegovy coverable through Medicare, and some employers are starting to offer weight-management benefits.

On a similar theme: Can an Insurance Company Refuse to Cover a Medication

If you're struggling to get insurance coverage for weight loss medications, know that you're not alone. Unfortunately, there's no clear, universal answer, and it really depends on your insurance plan.

Insurance companies have varying levels of coverage, and some may not cover weight loss medications at all. Dr. Shah notes that calling the number on your health insurance card and asking about coverage is the best way to find out.

Some medications, like Wegovy, are now covered for weight loss, but for people on Medicare, a 2003 law prevents weight loss medication coverage. However, there's hope that this may change in the future.

Dr. Russo thinks that over time, these medications will be covered more by insurance, and the competition in the market should help drive costs down. In fact, a newly FDA-approved weight loss medication, Zepbound, is expected to be covered by insurance in about a year.

Here are some key takeaways to keep in mind:

Insurance companies often refuse to cover weight loss drugs like Wegovy, even though they can be life-changing for people like Bronder, who was prediabetic.

Some insurance companies call Wegovy a "lifestyle" or "vanity" drug, which is confusing because obesity is a serious medical condition that can lead to many health problems.

Wegovy has been shown to lead to an average 15% weight loss in clinical trials, which is a significant effect that can slow or stop the onset of diabetes and improve blood pressure, cholesterol, and blood sugar levels.

Bronder was lucky enough to have a doctor who prescribed him a similar medication, Ozempic, which is identical to Wegovy but in a smaller dose, but this is not always the case.

The cost of Wegovy is around $1,000 to $1,600 a month, which is out of reach for most Americans without insurance coverage.

Insurance companies seem to make inconsistent decisions about covering Wegovy, with some people getting it covered and then having it later denied.

For your interest: Does Insurance Cover Lab Tests

To qualify for weight loss drugs, you'll need to meet certain criteria.

You must have a BMI of 30 or higher, or a BMI of 27 or higher if you have a weight-related condition like PCOS.

Wegovy is a prescription medication that may be covered by insurance for PCOS patients who meet the qualifying criteria.

You'll need to work with your healthcare provider to determine if Wegovy is right for you and to get a prescription.