Wegovy has a hefty out-of-pocket cost when paying full price, leaving many wondering if Wegovy is covered by insurance. Find out here if your insurer will cover this weight loss medication and your alternatives if not.
Wegovy is a household name at this point. It’s a prescription weight loss medication, but it’s also a celebrity. Videos with the #wegovy hashtag on TikTok have more than 185 million views as of February 2023.
The reasons behind Wegovy’s popularity are its effectiveness—in one clinical trial published in 2022, patients lost an average of 15.8 percent of their body weight in 68 weeks—and the upsetting shortage that left many patients without their medication.
Wegovy (semaglutide) is part of the medication class called glucagon-like peptide-1receptoragonists (GLP-1s). It’s a once-weekly injection approved by the U.S. Food and Drug Administration (FDA) to treat overweight and obesity in 2021. Novo Nordisk manufactures Wegovy; it also makes other popular GLP-1 drugs Ozempic, which shares the same active ingredient as Wegovy, and Saxenda (liraglutide).
Additionally, Wegovy is prescribed for patients with weight-related conditions like high blood pressure and a body mass index (BMI) of ≥27 or obesity and a BMI of ≥30. When prescribed Wegovy for weight loss, you should combine it with behavioral changes like a reduced-calorie diet and exercise.
If you’re aware of Wegovy and qualify for a prescription but want to know if Wegovy is covered by insurance, you’ve come to the right place. Here’s what we know.
Wegovy has a list price of $1,349 per package (about a month’s supply) without health insurance, according to Novo Nordisk.
With insurance, the co-pay for a 28-day supply of Wegovy can be as little as $25, but it depends on where you live, how much it costs there, and what your insurance is.
When does insurance cover Wegovy? That depends on a couple of factors: What kind of insurance coverage you have, who your insurance provider is, and if you’re eligible.
Not all insurances—employer-provided or private—cover obesity or weight loss medications for chronic weight management. In fact, only about 40 percent of private insurers cover the similar weight loss drug Saxenda, a Novo Nordisk executive told NPR in 2021.
In addition, Medicare and Medicaid typically don’t cover obesity medication, so your expenses will most likely be out-of-pocket (meaning you’d pay the full price).
Novo Nordisk has a helpful cost estimator set up on their site to see if your insurance covers the cost for Wegovy (or Saxenda) and how much of it.
And you may have the option of speaking with a benefits advisor at your company to find out if your plan covers medication to treat obesity. But, if you find out your employer’s insurance doesn’t cover any of the cost, you can use this template to send to your human resources team to get them on board to help treat obesity as precisely what it is—a chronic illness.
The Wegovy cost right now is high, but the silver lining is it’s a relatively new drug. As it travels through more health care providers and insurance companies, they’ll realize just how necessary it is to treat the obesity epidemic.
Novo Nordisk has NovoCare, a patient assistance program (PAP) that includes a Wegovy Savings Offer. NovoCare says savings can be significant if you have private or commercial insurance that covers part of Wegovy—asserting some will pay nothing for a 28-day supply when they use the card at the pharmacy.
The savings can be up to $500 for a 28-day supply if your commercial insurance doesn’t cover the medication or if you pay cash for your prescriptions. So it’s worth looking into when getting your prescription filled.
However, the terms and conditions state a patient isn’t eligible to use the Wegovy Savings Offer if they have “Medicaid, Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program.” So again, check to see what coverage your insurance offers.
Unfortunately not. Wegovy is a new drug under 20-year patient protection, so there are no cost-friendly generic versions on the market yet (and most likely not going to be for a very long time).
But, Ozempic, which is indicated for type 2 diabetes, is often prescribed off-label for treating overweight and obesity, as it also has semaglutide but at a lower dose than Wegovy. Insurance typically covers Ozempic because it’s a diabetes drug and not a weight loss drug, so health care providers may start you on that initially.
On top of that, even if Wegovy and Ozempic aren’t right for you, Found uses step therapy to help save you money and get the right treatment. Often, you’ll need to try generic versions of drugs before being prescribed the more costly brand-name medications. Found offers other generic prescription weight loss meds that have shown effectiveness in treating overweight and obesity to help you reach your goals.
To start your journey with Found, take our quiz.
GLP-1*
GLP-1 prescriptions, filled through your local pharmacy, are now available as part of Found's weight-loss toolkit. While GLP-1s are effective for weight loss, they are not clinically appropriate for everyone. Eligibility for a GLP-1 is based on a thorough evaluation of your medical history, eating behavior, lab work, and insurance coverage. If a GLP-1 is not appropriate for you, our providers will work with you to determine an effective medication for your health profile.
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Wegovy has a hefty out-of-pocket cost when paying full price, leaving many wondering if Wegovy is covered by insurance. Find out here if your insurer will cover this weight loss medication and your alternatives if not.
