{"id":5268,"date":"2024-10-30T20:31:30","date_gmt":"2024-12-10T03:46:33","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/?p=5268"},"modified":"2024-12-10T03:46:33","modified_gmt":"2024-12-10T03:46:33","slug":"hmn-is-wegovy-covered-by-blue-cross-blue-shield-in-2025","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-is-wegovy-covered-by-blue-cross-blue-shield-in-2025\/","title":{"rendered":"HMN: Is Wegovy covered by Blue Cross Blue Shield in 2025?"},"content":{"rendered":"<p>\n<br \/>Do you know:  Is Wegovy covered by Blue Cross Blue Shield? in 2025<\/p>\n<p>\n                                    It\u2019s likely that you\u2019ll get Wegovy covered by Blue Cross Blue Shield if you meet eligibility criteria, but it ultimately depends on the details of your plan.&#13;\n                                <\/p>\n<div id=\"main-content\">\n<section class=\"table-of-contents\">\n<div class=\"anchorLinks\">\n<div class=\"mobile-only\">\n<div class=\"dropdownLists\">\n<div class=\"dropdownBtn\"><span class=\"listsIcon\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/union.svg\" width=\"14\" height=\"20\"\/><\/span><br \/>\n\t\t\t\t\t\t\t<label><\/label><br \/>\n\t\t\t\t\t\t\t<span class=\"downArrow\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/dropDownArrow.svg\" width=\"24\" height=\"24\"\/><br \/>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<p><span style=\"font-weight: 400;\">Wegovy is the first weight loss medication <\/span><a href=\"https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-approves-new-drug-treatment-chronic-weight-management-first-2014\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">approved by the Food and Drug Administration<\/span><\/a><span style=\"font-weight: 400;\"> since 2014. It is a weekly injection that contains semaglutide as the active ingredient and is in a class of medications called <\/span><span style=\"font-weight: 400;\">GLP-1 (glucagon-like peptide) agonists<\/span><span style=\"font-weight: 400;\"> that stimulate the production of insulin to reduce blood sugar and slow the digestion process. They\u2019re also believed to interact with parts of the brain that reduce appetite and signal fullness. Most major insurance plans cover Wegovy for patients who meet coverage requirements.<\/span><\/p>\n<p><span data-sheets-root=\"1\" data-sheets-value=\"{\" data-sheets-userformat=\"{\" data-sheets-formula=\"=CONCATENATE(R[0]C[-2],R[0]C[-3],R[0]C[-1])\"><\/p>\n<section class=\"compass-ads-new\" data-compass-id=\"628437\">\n<aside class=\"top-section no-isi\">\n<figure class=\"col-1\">\n<div class=\"banner-heading\">\n<p><h3>\n\t\t\t\t\t\t\tPrescription Weight Loss Program\t\t\t\t\t\t<\/h3>\n<\/p><\/div>\n<\/figure>\n<figure class=\"col-2\">\n<\/figure>\n<figure class=\"col-3 no-supplimental-links-alt-layout no-client-approval-code\">\n<\/figure>\n<\/aside>\n<\/section>\n<p><\/span><\/p>\n<h2 id=\"does-blue-cross-blue-shield-cover-wegovy\"><span style=\"font-weight: 400;\">Does Blue Cross Blue Shield cover Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Many 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. Wegovy\u2019s manufacturer, Novo Nordisk, also provides a tool on its website that allows you to <\/span><a href=\"https:\/\/bsp.novocare.com\/selfservice\/s\/verification\/wegovy-bv?condition=obesity&amp;product=wegovy\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">check your insurance coverage<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cWeight loss drugs are expensive and are covered by some insurance plans, but most people get insurance through their employers, so it\u2019s a question of whether employers opted in or out of weight loss benefits,\u201d says <\/span><a href=\"https:\/\/www.primeinstitute.us\/michelle-pearlman-md\/\"><span style=\"font-weight: 400;\">Michelle Pearlman, MD<\/span><\/a><span style=\"font-weight: 400;\">, CEO and co-founder of Prime Institute and ByteMD, who is board certified in internal medicine, gastroenterology, and obesity medicine.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Even if a BCBS plan does offer coverage for Wegovy, patients have to meet specific criteria. Patients 12 and older are approved for Wegovy if they either:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have a BMI of 30 or above<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have a body mass index (BMI) of 27 or greater and at least one weight-related health condition, such as heart disease, diabetes, high blood pressure, or sleep apnea<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">In addition, patients must go through a comprehensive medical evaluation that includes lab tests and a full medical history.<\/span><\/p>\n<h2 id=\"how-much-does-wegovy-cost\"><span style=\"font-weight: 400;\">How much does Wegovy cost?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Wegovy is one of the most expensive weight loss medications, with a <\/span><a href=\"https:\/\/www.novocare.com\/obesity\/products\/wegovy\/let-us-help\/explaining-list-price.html\"><span style=\"font-weight: 400;\">list price<\/span><\/a><span style=\"font-weight: 400;\"> of $1,349.02. For people with insurance, the cost depends on the specific plan.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are, however, <\/span><span style=\"font-weight: 400;\">ways to save on Wegovy<\/span><span style=\"font-weight: 400;\"> if you do not have insurance:\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\t\t<\/p>\n<div class=\"singlecare-dynamic-newsletter-wrapper sin-newsletter-wrapper\">\n\t\t\t<span class=\"heading\">Get our weight management newsletter<\/span><\/p><\/div>\n<p>\t<\/span><\/p>\n<h2 id=\"how-to-check-whether-your-bcbs-plan-covers-wegovy\"><span style=\"font-weight: 400;\">How to check whether your BCBS plan covers Wegovy<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Even if you first use the Novo Nordisk website to check BCBS coverage of the cost of Wegovy, it is a good idea to contact your insurance company for verification since they\u2019re 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. If your prescription coverage is separate from your medical insurance, you\u2019ll want to call the number on the back of your prescription card.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Once you find out if your BCBS plan covers Wegovy, here are some questions to ask:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do I need prior authorization?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have I met my deductible for the year?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Once I meet my deductible and out-of-pocket requirements for the year, how much will my copay be for Wegovy for the rest of that year?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Does my plan have an out-of-pocket limit or maximum? Once I reach that, how much will my copay be for Wegovy?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">What can I do to get the best price? For example, will a 90-day supply be cheaper?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If I am turned down, what do I need to do to appeal?<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">If an employer-sponsored healthcare plan does not cover Wegovy, you can ask your healthcare provider to prove why you need it covered. Wegovy has a <\/span><a href=\"https:\/\/www.wegovy.com\/content\/dam\/obesity\/wegovy\/images\/pdf\/Wegovy_Patient_Coverage_Request_Sample_Letter.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">sample letter<\/span><\/a><span style=\"font-weight: 400;\"> that healthcare providers can use as a template. You can then submit the letter to your insurance company to see if they\u2019ll consider covering the cost. If your insurance company still does not cover Wegovy, you can consider enrolling in a <\/span><a href=\"https:\/\/www.clinicaltrials.gov\/search?cond=obesity&amp;term=wegovy\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">clinical trial<\/span><\/a><span style=\"font-weight: 400;\"> to get low-cost or free Wegovy if you qualify.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Keep in mind that there are other prescription weight loss medications, like <\/span><span style=\"font-weight: 400;\">Saxenda<\/span><span style=\"font-weight: 400;\">, that your health insurance plan may cover if it doesn\u2019t cover Wegovy. Some medications, like <\/span><span style=\"font-weight: 400;\">Mounjaro<\/span><span style=\"font-weight: 400;\">, are approved for managing blood sugar levels in adults with Type 2 diabetes but are sometimes prescribed off-label for weight loss. Your healthcare provider can help determine which medication is most suitable for you if Wegovy isn\u2019t an affordable option.<\/span><\/p>\n<p><svg style=\"display:none\">\n  <g id=\"facebook\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M19.51 9.32003H21.39V6.14003C20.4798 6.04538 19.5652 5.99865 18.65 6.00003C15.93 6.00003 14.07 7.66003 14.07 10.7V13.32H11V16.88H14.07V26H17.75V16.88H20.81L21.27 13.32H17.75V11.05C17.75 10 18.03 9.32003 19.51 9.32003Z\"\/>\n  <\/g>\n  <g id=\"twitter\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M26 9.9506C25.2483 10.2767 24.4534 10.4923 23.64 10.5906C24.4982 10.0779 25.1413 9.27138 25.45 8.3206C24.6436 8.80066 23.7608 9.1389 22.84 9.3206C22.2245 8.65317 21.405 8.2089 20.5098 8.05745C19.6147 7.90601 18.6945 8.05596 17.8938 8.48379C17.093 8.91162 16.4569 9.59313 16.0852 10.4214C15.7135 11.2497 15.6273 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