Does Blue Cross Blue Shield cover Saxenda?

In this article:

• Does Blue Cross Blue Shield cover Saxenda?
• How much is Saxenda without insurance?
• How much does Saxenda cost with BCBS?
• How to check whether your BCBS plan covers Saxenda
• How to save on Saxenda

In this article

• Does Blue Cross Blue Shield cover Saxenda?
• How much is Saxenda without insurance?
• How much does Saxenda cost with BCBS?
• How to check whether your BCBS plan covers Saxenda
• How to save on Saxenda

Saxenda (liraglutide) is a brand-name prescription drug that’s approved by the Food and Drug Administration (FDA) to help people 12 and older lose weight and maintain their weight loss. Like most glucagon-like peptide-1 (GLP-1) receptor agonists, Saxenda is injected under the skin, once daily in this case, and works best when used alongside a low-calorie diet and routine physical activity. Some insurance companies cover weight loss medications like Saxenda, but others don’t. 

Does Blue Cross Blue Shield cover Saxenda?

Blue Cross Blue Shield (BCBS) drug coverage varies based on a couple of factors:

• BCBS affiliate: There are more than 30 independently owned and operated BCBS affiliates around the country, and some don’t cover Saxenda in any of their health plans.
• Plan: When a BCBS affiliate does offer Saxenda coverage, it’s usually only available in specific insurance plans. 

For example, most Anthem BCBS formularies list Saxenda with a “BE” caveat. This stands for “benefits exclusion” and means specific plans might not cover Saxenda. 

In addition, federal law prevents Medicare plans from covering weight loss drugs like Saxenda. An alternative, Wegovy (semaglutide), may be covered when used for heart disease indications. Insurance coverage for Saxenda under Medicaid varies by state.  

When Saxenda is covered, it’s usually as a non-preferred drug that requires prior authorization. This means the insurance company wants to know why you need to take Saxenda instead of a lower-cost alternative. Your healthcare provider will handle that on your behalf. There’s a chance the insurance company will deny your claim, so coverage isn’t guaranteed. 

“I have had a few patients with BCBS plans who were able to get Saxenda approved after submitting a prior authorization,” says Jennifer Brown, MD, a board-certified obesity medicine doctor at Maxwelton Health Center in Maxwelton, West Virginia. She says once your initial prior authorization is approved, the insurance company will request updates on a regular basis. 

If Saxenda isn’t included in your BCBS plan’s formulary, you can ask your healthcare provider to submit an exception request, or you could appeal the denial. Under certain circumstances, health insurance companies may cover the cost of a prescription drug that they normally don’t cover. You or your healthcare provider will need to explain why Saxenda is medically necessary and why you can’t take an alternative medication.

RELATED: BCBS Wegovy prior authorization criteria

How much is Saxenda without insurance?

Without insurance, a one-month supply of Saxenda retails for about $1,810 for 5, 3 mL of 18 mg/3 mL pens. This is about the same price as 4, 0.75 mL of 2.4 mg/0.75 mL pens of Wegovy, but around $300 more expensive than 4, 0.5 mL of 5 mg/0.5 mL pens of Zepbound (tirzepatide).

How much does Saxenda cost with BCBS?

The cost of Saxenda with BCBS varies by plan. Some BCBS plans have a $0 copay and 0% coinsurance for prescription drugs as long as you get them from a participating pharmacy. 

Others have a coinsurance of 40% or higher for Tier 3 drugs like Saxenda, which means you’d pay about $724 in out-of-pocket costs each month until you reach your plan’s out-of-pocket maximum. 

How to check whether your BCBS plan covers Saxenda 

There are several ways to check whether your BCBS plan covers Saxenda: 

• Check for coverage through the manufacturer’s website. Fill out a short form on the NovoCare website to find out if your plan covers Saxenda. You’ll need to share your first and last name, date of birth, gender, ZIP code, and healthcare provider’s last name and state.
• Call the customer care number on the back of your insurance card. A representative can look up your plan information and verify whether Saxenda is covered.
• Log in to your BCBS account. Look for Saxenda on the latest drug formulary (also called a drug list).

How to save on Saxenda

If your BCBS plan doesn’t cover Saxenda, consider using a SingleCare prescription discount card to avoid paying the full retail price. SingleCare coupon cards are free to download and are accepted at most major pharmacies nationwide. 

With a SingleCare card, the total cost of 5, 3 mL of 18 mg/3 mL Saxenda pens is as low as $1,215. That’s about 30% off, or about $600 in savings. 

But that’s still pretty pricey. To save even more, Dr. Brown recommends talking to your healthcare provider about liraglutide, the generic version of Saxenda and Victoza, which is FDA approved to treat Type 2 diabetes. “I have used it off-label for weight loss treatment, and it’s significantly less expensive than the other GLP-1 medications,” she says.

Liraglutide costs about $211 for 1, 3 mL of 18 mg/3 mL pen with a SingleCare liraglutide coupon—a savings of about $150 per 3 mL pen compared to the cost of brand-name Saxenda.

To get a SingleCare coupon, search for Saxenda (or liraglutide, if applicable) on the SingleCare website. Then enter your ZIP code and browse the list of pharmacies that accept SingleCare coupons. Prices vary by pharmacy, so choose the one that works best for you. Click the “Get Free Coupon” button to view your unique discount code. You can print it, email it, text it, or access it later via your SingleCare account.

Tell your healthcare provider to send your Saxenda prescription to the pharmacy you chose when selecting your coupon. When it’s ready for pickup, show the pharmacy staff your SingleCare discount code and enjoy your savings.

To save the most money, you may want to consider a different weight loss medication altogether. Your healthcare provider can help you weigh the pros and cons of Saxenda alternatives and help you explore covered options. 

Learn more about how to save on Saxenda.