09/03/2024 | Press release | Distributed by Public on 09/03/2024 11:35
Key takeaways:
Wegovy (semaglutide), a prescription-only medication for chronic weight management, has a list price of about $1,350 for a 28-day supply. This means that the medication could cost more than $16,000 per year without insurance or manufacturer discounts.
Coverage for weight-loss medications like Wegovy varies widely among insurance plans.
A manufacturer savings program may help reduce the cost of Wegovy. If you have commercial insurance that covers Wegovy, you could pay as little as $0 for a 28-day supply of the medication (for up to 13 fills).
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.
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.
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.
Wegovy side effects: Before you start taking Wegovy, you should be aware of these possible long-term side effects.
Not losing weight? Here are some reasons you might not be losing weight with Wegovy and what you can do about it.
Use a flexible spending account (FSA). If you have an FSA, you can save on prescription medications like Wegovy by using the tax-free dollars in your account.
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.
Type of insurance |
Expected coverage for weight-loss medications |
Employer-sponsored insurance |
Coverage varies. If your plan doesn't offer coverage, you may be able to work with your prescriber to write a letter requesting coverage. |
Medicare |
Medications prescribed for weight-loss purposes alone are not covered. But you may receive coverage for medically accepted indications, such as heart attack and stroke prevention. |
U.S. Department of Veterans Affairs (VA) health benefits |
Those participating in the MOVE! program may qualify for coverage. |
Tricare (military) insurance |
Tricare Prime and Tricare Select plans may offer coverage for medications that are determined to be medically necessary for treating obesity. |
Individual/family coverage via the Affordable Care Act (ACA) |
Coverage varies. ACA marketplace plans aren't required to offer obesity medication coverage, but some plans may. |
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.
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.
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:
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.
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.
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.
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.
Program website |
https://www.novocare.com/obesity/products/wegovy/savings-offer.html |
Phone number |
|
Manufacturer |
Novo Nordisk |
How much can I save? |
If you have commercial insurance, you could pay as little as $0 per month for up to 13 fills, with maximum savings of $225 per 28-day supply. If you are self-pay or your commercial insurance doesn't cover Wegovy, your maximum savings could be $500 per 28-day supply. |
How do I get the discount? |
Sign up for the offer on the program's website. |
Are there any restrictions? |
This discount is only available to people with a valid prescription who live in the U.S. People covered by government-sponsored programs such as Medicaid, Medicare, Medigap, Tricare, or VA benefits aren't eligible. |
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 return for 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.
Wegovy (semaglutide) is a medication for chronic weight management that's designed to be used alongside a healthy diet and exercise. The list price is around $1,350 for a 28-day, but the medication can cost even more out of pocket due to pharmacy markups. If you have commercial insurance and meet certain criteria, you may be able to pay as little as $0 for a 28-day supply (for up to 13 fills) with the Wegovy Savings Card. Regardless of your insurance status, you can use a GoodRx coupon for potential savings on Wegovy.
BlueCross BlueShield of North Carolina. (2021). Saxenda & Wegovy - NC standard.
Cigna Healthcare. (2023). Prior authorization policy: Weight loss - Glucagon-like peptide-1 agonists prior authorization policy.
Federal Register. (2017). Establishment of TRICARE Select and other TRICARE reforms. National Archives and Records Administration.
Gomez, G., et al. (2017). US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity. International Journal of Obesity.
NovoCare. (n.d.). Terms and conditions of use: Standard savings offer.
NovoCare. (n.d.). What is the list price for Wegovy and will it impact me?
Novo Nordisk. (2024). Updates about Wegovy.
U.S. Department of Veterans Affairs. (2024). MOVE! Weight management program.
U.S. Food and Drug Administration. (2020). Frequently asked questions on patents and exclusivity.
U.S. Food and Drug Administration. (2021). FDA approves new drug treatment for chronic weight management, first since 2014.
U.S. Food and Drug Administration. (2024). FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweight.
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