{"id":5348,"date":"2024-10-22T20:31:30","date_gmt":"2024-12-10T03:34:52","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/?p=5348"},"modified":"2024-12-10T03:34:52","modified_gmt":"2024-12-10T03:34:52","slug":"hmn-how-to-get-wegovy-covered-by-insurance-in-2025","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-how-to-get-wegovy-covered-by-insurance-in-2025\/","title":{"rendered":"HMN: How to get Wegovy covered by insurance in 2025"},"content":{"rendered":"<p>\n<br \/>Do you know:  How to get Wegovy covered by insurance in 2025<\/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;\">We have finally entered an age where physicians, public health advocates, and insurers recognize that obesity is a disease that requires medical treatment. According to the <\/span><a href=\"https:\/\/www.cdc.gov\/obesity\/data\/adult.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Centers for Disease Control and Prevention<\/span><\/a><span style=\"font-weight: 400;\">, between 2017 and March 2020, 41.9% of Americans had obesity. What\u2019s more, medical costs for adults with obesity were $1,861 higher than for people with a healthy weight. Obesity is a serious health issue associated with many leading causes of death, including heart disease, stroke, diabetes, and certain types of cancer.\u00a0<\/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<p><span style=\"font-weight: 400;\">\u201cObesity is truly a disease that is associated with many health conditions such as diabetes, heart disease, high blood pressure, and sleep apnea,\u201d says <\/span><a href=\"https:\/\/www.primeinstitute.us\/michelle-pearlman-md\/\" target=\"_blank\" rel=\"noopener\"><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. \u201cMost people are not able to lose weight with diet and exercise alone, and we need to treat the underlying metabolic issues. \u201c\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Wegovy is an injectible weight loss medication approved by the U.S. Food and Drug Administration (FDA). But is it possible to get Wegovy covered by insurance? The short answer is \u201csometimes.\u201d<\/span><\/p>\n<h2 id=\"when-insurance-might-cover-wegovy\"><span style=\"font-weight: 400;\">When insurance might cover Wegovy<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Several insurance companies, including Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare, cover Wegovy in some form or another. However, major insurance companies tend to offer several different types of plans, whether employer-sponsored or individually obtained. Coverage can vary greatly between plans, even if they\u2019re offered by the same insurance company, so it is important to verify coverage before starting Wegovy. This is especially important because the drug\u2019s high cost has some employers ending or limiting coverage of weight loss medications, including Wegovy.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Even if your insurance plan covers Wegovy, you need to meet its eligibility requirements. Insurance plans that cover Wegovy require that patients meet the following criteria:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Adults must have an initial body mass index (BMI) of 30 or higher; or<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">An initial BMI of 27 or higher (overweight) with at least one weight-related health condition, such as:<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Heart disease<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">High cholesterol\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Type 2 diabetes<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">High blood pressure<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Sleep apnea<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pediatric patients ages 12 years and older must have an initial BMI at the 95th percentile or higher for age and sex.<\/span><\/li>\n<\/ul>\n<h2 id=\"how-to-get-wegovy-covered-by-insurance\"><span style=\"font-weight: 400;\">How to get Wegovy covered by insurance<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Getting Wegovy covered by insurance starts with a visit to your healthcare provider, who will determine whether you qualify for Wegovy. If you do, they\u2019ll write you a prescription. You can either have your healthcare provider send the prescription to the pharmacy or rake it there yourself, where your pharmacist can check your coverage.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Alternatively, you can call your insurance company (the phone number is listed on the back of most insurance cards and prescription drug cards) to find out if your plan covers the cost of Wegovy before having the prescription sent to your pharmacy. You may want to also ask whether you need prior authorization. If so, your healthcare provider will have to contact your insurance company for approval before your prescription can be filled. If you are turned down, ask what you need to do to appeal.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cPeople need to be more well-informed,\u201d Dr. Pearlman says. If you are turned down, ask why. \u201cDid you not meet the criteria, or has your employer opted out of weight loss benefits?\u201d If so, your healthcare provider can submit a request to the employer asking them to reconsider benefits or send an appeal to the insurance company to show that you meet the FDA requirements for the medication. \u201cIf you are having trouble getting medication covered, find a provider with experience with these medications who will be an advocate,\u201d Dr. Perlman says.<\/span><\/p>\n<h2 id=\"what-insurance-covers-wegovy\"><span style=\"font-weight: 400;\">What insurance covers Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Most major insurance plans cover Wegovy, including Blue Cross Blue Shield, Aetna, Cigna, and United Health Care, but coverage may vary with each plan. Benefits offered by employer plans also vary, and coverage is often based on what employers are willing to cover.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Novo Nordisk, the manufacturer of Wegovy, sponsors NovoCare, a website with resources that help people <\/span><a href=\"https:\/\/www.novocare.com\/obesity\/products\/wegovy\/cost-navigator.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">check insurance coverage<\/span><\/a><span style=\"font-weight: 400;\">, manage the cost of medication, and more.\u00a0<\/span><\/p>\n<h2 id=\"does-medicare-cover-wegovy\"><span style=\"font-weight: 400;\">Does Medicare cover Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicare does not cover weight loss medications and does not let people use manufacturer\u2019s coupons in combination with their Part D plan. The ban on coverage for weight-loss treatments was instituted in 2003, partly due to concerns over the safety of fen-phen (the combination of fenfluramine and phentermine), the popular weight loss medication at the time. Fen-phen was associated with life-threatening hypertension and heart valve issues.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In July 2023, a bipartisan group in Congress reintroduced the <\/span><a href=\"https:\/\/www.obesityaction.org\/troa\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Treat and Reduce Obesity Act (TROA)<\/span><\/a><span style=\"font-weight: 400;\">, which would work to prevent diseases associated with obesity, including heart disease, stroke, Type 2 diabetes, and certain cancers that are leading causes of preventable death. The expansion of Medicare coverage for weight-loss medications would increase their availability for many older adults who cannot afford them and have a \u201cmultiplier effect\u201d because private insurers often follow Medicare\u2019s lead. This is only introduced legislation and is not yet a law.<\/span><\/p>\n<h2 id=\"does-medicaid-cover-wegovy\"><span style=\"font-weight: 400;\">Does Medicaid cover Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Every state decides what prescription drugs to cover through Medicaid, so coverage for Wegovy depends on where you live. As of July 2023, <\/span><a href=\"https:\/\/news.bloomberglaw.com\/health-law-and-business\/next-gen-weight-loss-drugs-receive-tentative-embrace-by-medicaid\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">nine states<\/span><\/a><span style=\"font-weight: 400;\">\u2014California, Connecticut, Delaware, Michigan, Minnesota, Pennsylvania, Rhode Island, Virginia, and Wisconsin\u2014have added Wegovy to Medicaid preferred drug lists that allow patients to receive coverage without undergoing \u201cstep therapy,\u201d where they are required to try less expensive drugs first.\u00a0\u00a0<\/span><\/p>\n<h2 id=\"does-the-va-cover-wegovy\"><span style=\"font-weight: 400;\">Does the VA cover Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The Veterans Administration (VA) covers obesity management for eligible veterans, but whether it will cover the cost of Wegovy varies. Wegovy is <\/span><a href=\"https:\/\/www.va.gov\/formularyadvisor\/drugs\/4040576-SEMAGLUTIDE-INJ-SOLN\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">not on the VA national formulary<\/span><\/a><span style=\"font-weight: 400;\"> and requires a nonformulary drug request and prior approval. See your local VA office to discuss your options.<\/span><\/p>\n<h2 id=\"wegovy-cost-with-insurance\"><span style=\"font-weight: 400;\">Wegovy cost with insurance<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The cost of Wegovy with insurance depends on many factors, including the specifics of the plan, drug copays, and limits on coverage. In November 2023, Novo Nordisk told Reuters that <\/span><a href=\"https:\/\/www.reuters.com\/business\/healthcare-pharmaceuticals\/novo-nordisk-80-us-wegovy-patients-with-insurance-paying-less-than-25month-2023-11-02\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">80% of insured patients pay less than $25 a month for Wegovy<\/span><\/a><span style=\"font-weight: 400;\">.\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=\"wegovy-cost-without-insurance\"><span style=\"font-weight: 400;\">Wegovy cost without insurance<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The typical cash price of a one-month supply of <\/span><span style=\"font-weight: 400;\">Wegovy<\/span><span style=\"font-weight: 400;\"> is $1,803.46, but that cost varies by pharmacy.\u00a0 Although it\u2019s expensive, there are <\/span><span style=\"font-weight: 400;\">ways to save on Wegovy<\/span><span style=\"font-weight: 400;\">. With a <\/span><span style=\"font-weight: 400;\"> prescription discount card<\/span><span style=\"font-weight: 400;\">, you\u2019ll pay an average of $1,234 for a month\u2019s supply of Wegovy, depending on your preferred pharmacy. If insurance does not cover Wegovy, or if you pay cash for your prescriptions, you may be able to use a NovoCare <\/span><a href=\"https:\/\/www.novocare.com\/obesity\/products\/wegovy\/savings-offer.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">manufacturer\u2019s coupon<\/span><\/a><span style=\"font-weight: 400;\"> for up to $500 in savings for a 28-day supply.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Wegovy coupons<\/span><\/p>\n<h2 id=\"a-new-indication-possible-changes-in-coverage\"><span style=\"font-weight: 400;\">A new indication\u2014possible changes in coverage?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">On March 8, 2024, the <\/span><a href=\"https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">FDA approved a new indication<\/span><\/a><span style=\"font-weight: 400;\"> for Wegovy. This indication is to lower the risk of heart-related death, heart attack, and stroke in adults with heart disease and obesity and in adults with heart disease who are overweight. This new approval makes Wegovy the first weight-loss medicine that is also FDA approved to prevent heart events. This new indication may help prompt insurance companies to provide better coverage of Wegovy, but information on insurance coverage for this indication is not yet available.\u00a0<\/span><\/p>\n<h2 id=\"bottom-line\"><span style=\"font-weight: 400;\">Bottom line<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Many insurance plans cover Wegovy for patients who fit the criteria once someone has met their deductible, but this can vary by policy. Although weight loss medication can help, it\u2019s not a quick fix for obesity.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cWhen we speak about obesity, we\u2019re looking at a multi-disciplinary approach that includes behavioral interventions, lifestyle modifications, and pharmacology, \u201c says <\/span><a href=\"https:\/\/www.sleepadvisor.org\/dr-rajkumar\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Raj Dasgupta, MD<\/span><\/a><span style=\"font-weight: 400;\">, a board-certified physician and associate professor of clinical medicine at the University of Southern California in Los Angeles. \u201cIt is especially important to realize that even when you are on medications, you need to continue with lifestyle modifications that include diet and exercise because when people stop these medications, they gain the weight back.\u201d\u00a0<\/span><\/p>\n<p>\u00a0<\/p>\n<p><span style=\"font-weight: 400;\">Lea este art\u00edculo en espa\u00f1ol 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According to the Centers for Disease Control and Prevention, between 2017 and March 2020, 41.9% of Americans had obesity. 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