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A weight loss "pen": Is Wegovy covered by Blue Cross Blue Shield?
Drug Info

Is Wegovy covered by Blue Cross Blue Shield?

It’s likely that you’ll get Wegovy covered by Blue Cross Blue Shield if you meet eligibility criteria, but it ultimately depends on the details of your plan.
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By | Mar. 21, 2024 Medically reviewed by Leslie Greenberg, MD

Wegovy is the first weight loss medication approved by the Food and Drug Administration since 2014. It is a weekly injection that contains semaglutide as the active ingredient and is in a class of medications called GLP-1 (glucagon-like peptide) agonists that stimulate the production of insulin to reduce blood sugar and slow the digestion process. They’re also believed to interact with parts of the brain that reduce appetite and signal fullness. Most major insurance plans cover Wegovy for patients who meet coverage requirements.

Does Blue Cross Blue Shield cover Wegovy?

Many Blue Cross Blue Shield (BCBS) plans cover Wegovy, but coverage depends on the plan. To verify whether your BCBS plan will cover Wegovy, check with your insurance company or your employer if you have employer-sponsored coverage. Wegovy’s manufacturer, Novo Nordisk, also provides a tool on its website that allows you to check your insurance coverage. 

“Weight loss drugs are expensive and are covered by some insurance plans, but most people get insurance through their employers, so it’s a question of whether employers opted in or out of weight loss benefits,” says Michelle Pearlman, MD, CEO and co-founder of Prime Institute and ByteMD, who is board certified in internal medicine, gastroenterology, and obesity medicine.

Even if a BCBS plan does offer coverage for Wegovy, patients have to meet specific criteria. Patients 12 and older are approved for Wegovy if they either:

  • Have a BMI of 30 or above
  • Have a body mass index (BMI) of 27 or greater and at least one weight-related health condition, such as heart disease, diabetes, high blood pressure, or sleep apnea

In addition, patients must go through a comprehensive medical evaluation that includes lab tests and a full medical history.

How much does Wegovy cost?

Wegovy is one of the most expensive weight loss medications, with a list price of $1,349.02. For people with insurance, the cost depends on the specific plan.

There are, however, ways to save on Wegovy if you do not have insurance: 

How to check whether your BCBS plan covers Wegovy

Even if you first use the Novo Nordisk website to check BCBS coverage of the cost of Wegovy, it is a good idea to contact your insurance company for verification since they’re more familiar with the details of your specific plan. You can typically do this by calling the phone number on the back of your insurance card. If your prescription coverage is separate from your medical insurance, you’ll want to call the number on the back of your prescription card. 

Once you find out if your BCBS plan covers Wegovy, here are some questions to ask: 

  • Do I need prior authorization?
  • Have I met my deductible for the year?
  • Once I meet my deductible and out-of-pocket requirements for the year, how much will my copay be for Wegovy for the rest of that year?
  • Does my plan have an out-of-pocket limit or maximum? Once I reach that, how much will my copay be for Wegovy?
  • What can I do to get the best price? For example, will a 90-day supply be cheaper?
  • If I am turned down, what do I need to do to appeal?

If an employer-sponsored healthcare plan does not cover Wegovy, you can ask your healthcare provider to prove why you need it covered. Wegovy has a sample letter that healthcare providers can use as a template. You can then submit the letter to your insurance company to see if they’ll consider covering the cost. If your insurance company still does not cover Wegovy, you can consider enrolling in a clinical trial to get low-cost or free Wegovy if you qualify.

Keep in mind that there are other prescription weight loss medications, like Saxenda, that your health insurance plan may cover if it doesn’t cover Wegovy. Some medications, like Mounjaro, are approved for managing blood sugar levels in adults with Type 2 diabetes but are sometimes prescribed off-label for weight loss. Your healthcare provider can help determine which medication is most suitable for you if Wegovy isn’t an affordable option.