{"id":7269,"date":"2025-02-04T08:14:26","date_gmt":"2025-02-04T08:14:26","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/hmn-does-medicaid-cover-wegovy-in-2025\/"},"modified":"2025-02-04T08:14:26","modified_gmt":"2025-02-04T08:14:26","slug":"hmn-does-medicaid-cover-wegovy-in-2025","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-does-medicaid-cover-wegovy-in-2025\/","title":{"rendered":"HMN: Does Medicaid cover Wegovy? in 2025"},"content":{"rendered":"<p>\n<br \/>Do you know:  Does Medicaid cover Wegovy? 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;\">Wegovy is the first weight loss drug approved by the <\/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;\">Food and Drug Administration (FDA)<\/span><\/a><span style=\"font-weight: 400;\"> since 2014. This weekly injection is one of the new weight loss drugs that contains semaglutide, part of a class of medications called <\/span><span style=\"font-weight: 400;\">glucagon-like peptide-1<\/span><span style=\"font-weight: 400;\"> (GLP-1) receptor agonists. These medications mirror the GLP-1 hormone that is released in the gastrointestinal tract in response to eating. They not only stimulate the production of insulin to reduce blood sugar but also decrease appetite and slow the emptying of the stomach.\u00a0<\/span><\/p>\n<p><span data-sheets-root=\"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;\">The FDA approved Wegovy for weight loss for adults with a body max index (BMI) of 30 or higher and for adults with a BMI of 27 or higher with at least one weight-related health condition, such as heart disease). It is also approved for weight loss in children ages 12 and older whose weight is above the 95 percentile for their age and gender. Many insurance plans cover Wegovy for weight loss for patients who meet the criteria, but coverage may vary within each insurance plan, so it is important to check with your provider. Furthermore, Medicaid coverage for Wegovy depends upon where you live since every state decides what prescription drugs to cover through Medicaid.<\/span><\/p>\n<h2 id=\"does-medicaid-cover-wegovy\"><span style=\"font-weight: 400;\">Does Medicaid cover Wegovy\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">In 1990, the <\/span><a href=\"https:\/\/www.medicaid.gov\/medicaid\/prescription-drugs\/medicaid-drug-rebate-program\/index.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Federal Medicaid Drug Rebate Program (MDRP)<\/span><\/a><span style=\"font-weight: 400;\"> allowed the exclusion of certain classes of medication, including weight-loss drugs, from Medicaid coverage. 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. Other states may offer limited coverage, requiring beneficiaries to pay out of pocket for a portion of the cost. Within Medicaid in most states, beneficiaries may have to choose a managed care plan\u2014each with a different formulary. So even if Medicaid covers Wegovy in a certain state for weight loss, you\u2019ll have to ensure your plan covers it, too.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The increasing number of states offering Medicaid coverage for weight loss drugs reflects the growing opinion among lawmakers that obesity is a disease requiring medical treatment. Because <\/span><a href=\"https:\/\/journals.lww.com\/md-journal\/fulltext\/2020\/07020\/the_association_of_obesity_with_health_insurance.101.aspx\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">the prevalence of obesity among Medicaid beneficiaries is about 44%<\/span><\/a><span style=\"font-weight: 400;\">, more states may follow as they look for ways to reduce the cost of caring for patients with obesity-related comorbidities. Most states that include Wegovy on the preferred drug list require prior authorization and qualified patients who meet the FDA criteria for BMI. But each state has its own rules. For example, Virginia prohibits access to Wegovy for people under 18.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">To find out if your state\u2019s Medicaid covers Wegovy or other medicines for obesity and weight loss management, visit the <\/span><a href=\"https:\/\/www.wegovy.com\/coverage-and-savings\/wegovy-coverage-options.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Wegovy website<\/span><\/a><span style=\"font-weight: 400;\"> or <\/span><a href=\"https:\/\/www.medicaid.gov\/state-overviews\/index.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">contact your state\u2019s Medicaid office<\/span><\/a><span style=\"font-weight: 400;\">.<\/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;\">The cost of Wegovy depends on many factors. For those on Medicaid, coverage, and cost will depend upon the state in which they live and the Medicaid plan in which they are enrolled. For those with insurance, the cost will be determined by the specifics of each plan, each person\u2019s deductible, copay, and any limits on coverage. The typical cash price for Wegovy for people who are not insured is $1,811.35 for four weekly injections.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are a few ways to <\/span><span style=\"font-weight: 400;\">save on Wegovy<\/span><span style=\"font-weight: 400;\"> if your insurance does not cover the medication. One is to use your <\/span><span style=\"font-weight: 400;\"> Prescription Discount Card<\/span><span style=\"font-weight: 400;\"> to pay $1,234 for a month\u2019s supply of <\/span><span style=\"font-weight: 400;\">Wegovy<\/span><span style=\"font-weight: 400;\">. If insurance does not cover Wegovy, or if you pay cash for your prescriptions, Novo Care also offers a <\/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<h2 id=\"how-to-check-whether-your-medicaid-plan-covers-wegovy\"><span style=\"font-weight: 400;\">How to check whether your Medicaid plan covers Wegovy<\/span><\/h2>\n<p><a href=\"https:\/\/www.kff.org\/policy-watch\/medicaid-coverage-of-and-spending-on-new-drugs-used-for-weight-loss\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Medicaid coverage<\/span><\/a><span style=\"font-weight: 400;\"> of Wegovy, which is currently approved solely for weight loss, is limited and depends on where you live. Every state decides what prescription drugs to cover through Medicaid. As of July 2023, California, Connecticut, Delaware, Michigan, Minnesota, Pennsylvania, Rhode Island, Virginia, and Wisconsin are the only states that cover Wegovy without requiring Medicaid beneficiaries to try less expensive drugs first. An additional six states offer limited coverage. The best way to find out if Wegovy is covered by your state, or whether you\u2019ll have to pay a copay is to contact <\/span><a href=\"https:\/\/www.medicaid.gov\/about-us\/contact-us\/index.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">your state\u2019s Medicaid agency<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/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 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This weekly injection is one of the new weight loss drugs that contains semaglutide, part of a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. These medications mirror [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7269","post","type-post","status-publish","format-standard","hentry","category-health-news"],"blocksy_meta":[],"_links":{"self":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/7269","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/comments?post=7269"}],"version-history":[{"count":0,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/7269\/revisions"}],"wp:attachment":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/media?parent=7269"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/categories?post=7269"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/tags?post=7269"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}