Does the VA cover Wegovy?

In this article:

• Does the VA cover Wegovy?
• The VA’s national formulary
• Requirements for coverage
• Costs of Wegovy under the VA
• Ways to save

In this article

• Does the VA cover Wegovy?
• The VA’s national formulary
• Requirements for coverage
• Costs of Wegovy under the VA
• Ways to save

According to a 2024 Gallup poll, 55% of Americans reported wanting to lose weight. And for some of those people, weight loss medications like Wegovy (semaglutide) might be the answer. A GLP-1 drug that’s FDA-approved for weight management, clinical trials have proven its effectiveness in reducing body weight, waist circumference, and waist-to-height ratio. However, Wegovy can be expensive when paying out of pocket, and if you have U.S. Department of Veterans Affairs (VA) benefits, you may wonder if they can be use. Possibly, but it depends on several factors. We’ve outlined them all here. 

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Does the VA cover Wegovy?

The VA does not typically cover Wegovy; however, it may do so under specific circumstances and after prior authorization is approved. Patients who receive coverage must meet several criteria, including body mass index (BMI) requirements, lifestyle modifications, and, in some cases, the presence of coexisting medical conditions. 

The VA’s national formulary

Every health insurance plan has a list of drugs that shows how they’re classified and covered, along with any special requirements. This is a formulary, and while private insurance companies have different formularies for each plan, the VA has a single overarching list called the national formulary. This formulary lists Ozempic, but not Wegovy.

“The VA formulary is created through the careful evaluation and selection of available drugs by committees of medical and pharmacy experts, including pharmacists, physicians, and nurses,” says Shannon Fitzgerald, Pharm.D, pharmacist, toxicologist, and contributor at Drugwatch.com. “These Pharmacy and Therapeutics Committees focus on clinical evidence, cost-effectiveness, and safety through a formal review process that can include voting on changes to the existing formulary.”

The U.S. Department of Veteran Affairs updates this list every month and posts every update—along with a new version of the list—on this page. The most recent formulary shows that Ozempic is covered, but it requires prior authorization. Name-brand Wegovy, however, is not. That said, individuals who meet specific criteria (see below) may have it approved. 

How to request coverage for a non-formulary drug

Wegovy isn’t listed on the national formulary, but that doesn’t mean coverage is out of the question. However, you and the prescribing healthcare provider will need to follow a few steps, and the first is submitting a non-formulary request explaining why Wegovy is medically necessary. 

“This request is sent to the VA Pharmacy, and reviews must be completed within 96 hours, resulting in approval or denial,” Fitzgerald says. “If the medication is not approved, information necessary to support a future request will be provided by a VA Pharmacist, and an appeal may be made to the VA care team.”

VA requirements for Wegovy coverage

Even in cases where the VA agrees to cover Wegovy for weight loss, that coverage comes with several contingencies. Here are the criteria.

Body mass index

Typically, the VA does not cover Wegovy for individuals with a body mass index (BMI) of 25-29.99 who simply want to lose a few pounds. In fact, they will only cover it for people with obesity, defined as a body mass index (BMI) of 30 kg/m2 or higher. People who have a BMI of 27 kg/m2 or higher can get coverage too, but only if they have a weight-related comorbidity like cardiovascular disease, metabolic disorder, or Type 2 diabetes.

Lifestyle changes

Weight loss medications work best when paired with a diet and exercise program, and the VA requires patients to have an existing program that includes both before they’ll cover Wegovy.

The VA will only cover Wegovy “for those patients who have verifiable participation in a comprehensive lifestyle intervention (CLI) that targets all three aspects of weight management: diet, physical activity, and behavioral changes,” Fitzgerald says. The Veterans Health Administration (VHA) offers its own weight loss program, MOVE!, available to all veterans.

Additional medical conditions

The BMI and lifestyle requirements are both non-negotiable for Wegovy coverage, but on top of that, patients must meet one of the following requirements:

• Other weight loss drugs on the VA formulary—like naltrexone/bupropion—must not be tolerated, not successful (less than 5% weight reduction), or medically inadvisable (with rationale).
• A BMI of 40 kg/m2 or more.
• A BMI of 35–40 with a significant weight-related condition, or is unable to achieve the weight loss required for surgery.
• A BMI of 27–40 with a previous heart attack, stroke, or symptomatic peripheral arterial disease.
• Type 2 diabetes is being treated with Ozempic, yet requires additional weight loss to achieve a 5% reduction in body weight.

Costs of Wegovy under the VA

The post-coverage (or out-of-pocket) cost of Wegovy depends on the priority group to which the VA has assigned you. Veterans in priority group 1 won’t have a copay for any medications, while those in groups 2–8 will. The VA determines your priority group based on:

• Military service history
• Disability rating
• Income level
• Medicaid eligibility
• Other benefits

For people in groups 2–8, the copay varies based on the type of drug you’re getting. The national formulary categorizes medications into four tiers, each with its own rate.

• Tier 0 (prescription and over-the-counter medicines with no copay): $0
• Tier 1 (preferred generic prescription medications): $5 for 1–30 day supply, $10 for 31–60 day supply, $15 for 61–90 day supply.
• Tier 2 (non-preferred generic prescription medications/some OTC medications): $8 for 1–30 day supply, $16 for 31–60 day supply, $24 for 61–90 day supply.
• Tier 3 (brand-name prescription medications): $11 for 1–30 day supply, $22 for 31–60 day supply, $33 for 61–90 day supply.

The cap on annual copays is $700, and once you hit it, you won’t have to pay any more for your meds.

Ways to save on Wegovy

To put it simply, for people paying completely out of pocket, Wegovy can be expensive. In fact, the average cost before any insurance coverage or savings is $1,850 for 4, 0.75ml prefilled 2.4mg/0.75ml pen pens. But even if you don’t receive coverage from the VA, there are still several ways to save—some of which can drop the price significantly.

For example, after signing up for SingleCare, you can get free coupons on Wegovy and more than 10,000 other medications. When you present your free SingleCare card at a participating pharmacy, it can reduce the out-of-pocket cost by hundreds. Instead of paying the average $1,850, you could pay $1,225 at CVS.

Or, you might be eligible for Medicaid benefits. Since the program is funded jointly by the federal and state governments, each state has its own eligibility requirements, so you’ll have to check on your state’s government website to see if you qualify.

Ozempic’s manufacturer (Novo Nordisk) also offers patient assistance programs and savings cards that can reduce the drug’s out-of-pocket cost. But unfortunately, people who have VA benefits aren’t eligible.