How Much Does Wegovy Cost

FG Trade Latin/E+ via Getty Images

Wegovy (semaglutide), an under-the-skin injection, was FDA approved in 2021 for chronic weight management, making it the first medication to receive such an approval since 2014. Wegovy was also approved in March 2024 to help prevent heart attacks, strokes, and heart-related death in adults with a cardiovascular condition and either overweight or obesity. At that time, it became the first weight-loss medication to gain this indication.

Insurance coverage for Wegovy varies widely among insurance plans. Without coverage, Wegovy can cost around $16,000 or more annually. Wegovy also doesn't have a generic equivalent, meaning there isn't a more affordable version available. Even so, there are ways to save.

How much does Wegovy cost, and what affects the price?

The list price for Wegovy is about $1,350 for a 28-day supply, which adds up to over $16,200 annually. However, due to pharmacy markups, you could end up paying between $1,500 and $2,000 for your prescription every month if you are paying entirely out of pocket.

If you have health insurance that covers Wegovy or you qualify for a manufacturer savings program, you may be able to pay much less. For example, if you have commercial insurance and qualify for the Wegovy Savings Card, you may be able to pay as little as $0 per month for up to 13 fills. You can also consider using a GoodRx coupon to make your prescription more affordable and asking your prescriber about free samples.

In general, many factors can affect how much you pay out of pocket for Wegovy, including:

• The pharmacy you choose

• Your insurance coverage status

• Your location

• Your prescribed dosage

• Your eligibility for patient assistance programs or manufacturer savings cards

Given that Wegovy is typically prescribed for long-term use, the out-of-pocket costs can add up fast. There's no generic available, either, so Wegovy prices are expected to remain high.

Which insurance plans cover Wegovy?

Coverage for obesity care and weight-loss medications varies widely among insurance plans.

For example, Medicare plans are not allowed to cover prescription medications taken solely for weight loss, since they're not considered medically necessary by the agency. However, if you take Wegovy to reduce the risk of a heart condition, it may be covered. As mentioned, Wegovy was FDA approved in March 2024 to reduce the risk of a life-threatening cardiovascular event in certain adults.

Cigna, a private insurance company, covers Wegovy if it is considered medically necessary for weight loss, but you must meet all the criteria. Some Blue Cross Blue Shield plans also cover Wegovy for members who meet plan eligibility requirements.

Here's what to expect for weight-loss medication coverage with a few common insurance options.

If you have Medicaid, your coverage will depend on where you live. Insurance coverage policies for weight-management medications such as Wegovy are evolving. You can go to Wegovy's website, go to the "Check your insurance coverage" page, click on "I am a patient," and choose Medicaid to see if your state's program covers the medication.

These state Medicaid programs currently cover Wegovy:

• California

• Delaware

• Georgia

• Hawaii (not all plans)

• Indiana (for people 12 to 21 years old)

• Kansas

• Massachusetts

• Michigan

• Minnesota

• Mississippi

• New Hampshire

• North Carolina (for people 12 to 21 years old)

• Oregon (for people 12 to 21 years old)

• Pennsylvania

• Rhode Island (not all plans)

• Tennessee (for people 12 to 21 years old)

• Virginia

• Wisconsin

Keep in mind that your insurer may require a prior authorization or have you try other treatments before you can get coverage for Wegovy.

Is a generic version of Wegovy available?

No, because Wegovy remains under an active patent, a generic version isn't available. And there probably won't be one for quite a while because patent terms are set at 20 years.

There are other prescription medications that contain semaglutide, the active ingredient in Wegovy. But they aren't FDA approved for chronic weight management. Another Novo Nordisk medication, Ozempic, which is approved to help people with Type 2 diabetes manage their blood glucose (sugar) levels, also contains semaglutide but at a lower dose than Wegovy. Rybelsus is an oral version of semaglutide that's also approved for blood glucose control in people with Type 2 diabetes.

How to get Wegovy covered by insurance

Because Wegovy is FDA approved for chronic weight management, many insurance providers won't cover it. However, following the three steps below could increase your chances of getting Wegovy covered under your insurance plan:

1. Review your health insurance plan. Find out what, if any, insurance coverage your provider offers for treatments for weight loss or chronic weight management, including prescription medications. Check your plan's formulary to see if Wegovy is listed as a covered medication. If necessary, contact your insurance provider and ask for coverage details.

2. Schedule an appointment with your healthcare professional. Wegovy is in a medication class called glucagon-like peptide 1 (GLP-1) agonists and is meant to be used alongside a nutritious diet and routine exercise. Ask your prescriber if they can write a letter to your insurance plan outlining why Wegovy is medically necessary for your care. Then, submit it to your insurance provider for their review, or ask your prescriber to submit it.

3. Appeal for reconsideration. If your insurance provider denies your first request for coverage, you can file an appeal. Check your insurance plan for details on the appeal process, which will likely involve sending an appeal letter that outlines why Wegovy is necessary to your overall health.

Are there other ways to save on Wegovy?

For those who qualify, Wegovy's manufacturer offers a savings program that covers up to 13 fills of a 28-day supply (four injectable pens) of the medication. With the savings offer, you could pay as little as $0 for each eligible 28-day supply.

Wegovy savings offer

How do you get a prescription for Wegovy?

Wegovy is available in pharmacies across the U.S. for those with a prescription. If you are interested in getting a prescription for Wegovy, you can do the following:

• Reach out to a prescriber. Make an appointment with a prescriber to discuss your health and weight-management goals. Based on your medical history, needs, and health status, they can help you determine if Wegovy is a good option for you.

• Obtain a medical exam. A prescriber may want to give you a physical exam to determine your current health status before recommending a weight-loss medication. To qualify for a Wegovy prescription, you must have obesity or overweight and at least one weight-related medical condition.

• Decide on a treatment plan. If a prescriber determines that Wegovy is an option for you, they will talk you through a treatment plan, which will likely include making lifestyle changes. They will also provide you with details about potential side effects and how to use the medication.

• Schedule follow-up care. If you receive a prescription for Wegovy and start treatment, your prescriber may ask you to retufor follow-up care, so they can monitor your progress and address any concerns you may have.

You may also be able to get a prescription for Wegovy online, using a telehealth service. However, the service may charge fees or require you to enroll in a subscription or membership program to meet with a prescriber.

It's important to note that increased demand for Wegovy has resulted in a shortened supply. So you may have to wait until the supply increases to fill your prescription.

Attachments

• Original Link
• Permalink

Disclaimer

GoodRx Holdings Inc. published this content on 03 September 2024 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on September 03, 2024 at 17:35:22 UTC.