Is Wegovy covered by Blue Cross Blue Shield?

In this article:

• Does Blue Cross Blue Shield cover Wegovy?
• Does CareFirst cover Wegovy?
• Wegovy prior authorization criteria
• How much does Wegovy cost?
• How to check whether your BCBS plan covers Wegovy
• How to get Wegovy covered by insurance
• FAQs

In this article

• Does Blue Cross Blue Shield cover Wegovy?
• Does CareFirst cover Wegovy?
• Wegovy prior authorization criteria
• How much does Wegovy cost?
• How to check whether your BCBS plan covers Wegovy
• How to get Wegovy covered by insurance
• FAQs

Wegovy (semaglutide) was approved by the Food and Drug Administration (FDA) as a  weight loss medication in 2021. It belongs to a class of medications called glucagon-like peptide-1 (GLP-1) agonists. GLP-1s stimulate the production of insulin to reduce blood sugar, slow the digestion process, reduce appetite, and signal fullness. Insurance may cover Wegovy for patients who meet coverage requirements, but coverage varies by plan. Here’s what you should know about Wegovy coverage if you have a Blue Cross Blue Shield policy.

Does Blue Cross Blue Shield cover Wegovy?

Some Blue Cross Blue Shield (BCBS) plans cover Wegovy, but others don’t. To verify whether your BCBS plan will cover Wegovy, view your plan’s drug formulary. If you’re not sure how to access this online, call BCBS customer service. Wegovy’s manufacturer, Novo Nordisk, provides a tool on its website that allows you to easily check your insurance coverage as well. 

“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 and a physician who is board-certified in internal medicine, gastroenterology, and obesity medicine.

Does CareFirst cover Wegovy?

Yes, some CareFirst BlueCross BlueShield plans cover Wegovy. Wegovy isn’t covered in any BCBS CareFirst Exchange plans, but it’s listed as a tier 2 or tier 4 anti-obesity agent in formularies for large employer-sponsored plans and plans purchased before March 23, 2010. That said, coverage still depends on your plan, as some employers choose not to cover weight loss medications. 

Wegovy prior authorization criteria

Even if a BCBS plan does offer coverage for Wegovy, patients must meet specific criteria before BCBS will help pay for this medication. 

First, you need a valid Wegovy prescription for an FDA-approved indication. Currently, Wegovy is FDA approved for the following: 

• Children ages 12 years or older with a body mass index (BMI) at or above the 95th percentile for their sex and age
• Adults with a BMI at or above 30
• Adults with a BMI at or above 27 and at least one weight-related health condition, such as heart disease, diabetes, high blood pressure, or sleep apnea
• Adults with a BMI at or above 27 with established cardiovascular disease and a risk of major adverse cardiovascular events (like heart attack or stroke)
• Adults with noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis 

Note that there are slightly different prescribing rules for Wegovy pills versus Wegovy injections. If you’re an adult seeking Wegovy for weight loss, your prescriber may offer either option. However, it’s important to double-check that your BCBS insurance plan doesn’t require a specific form of Wegovy.

Next, your healthcare provider must fill out a prior authorization form and send it to BCBS. Without it, BCBS won’t help pay for your Wegovy prescription. Most insurance companies require prior authorization for GLP-1s like Wegovy.

Wegovy’s prior authorization criteria vary by plan. When Wegovy is prescribed for weight loss, BCBS is known to ask questions about the patient’s prior use of weight loss medications and their commitment to a healthy diet and exercise routine. They may also ask about your health history. 

How much does Wegovy cost?

Wegovy is one of the most expensive weight loss medications, with an average retail cost of $1,805 per 30, 1.5 mg tablets. Prices vary by form (pen versus tablets) and dosage. For example, you may pay more for Wegovy HD (the 7.5 mg pen) than for lower-dose pens. For people with insurance, the cost depends on the specific plan. You may need to pay out of pocket until you reach your plan’s deductible. Then, you pay a fixed rate per prescription (copay) or a percentage of the total cost of each prescription (coinsurance).   

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

• Use a SingleCare prescription discount card to save over $700 per month on Wegovy or Wegovy HD.
• Use a Novo Nordisk manufacturer coupon. This can also reduce the copay if you have insurance, but eligibility requirements and savings limits apply.

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 it?

How to get Wegovy covered by insurance

If an employer-sponsored healthcare plan does not cover Wegovy, you can ask your healthcare provider to explain why you need it covered. Novo Nordisk has a sample appeal 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. 

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. Your healthcare provider can help determine which medication is most suitable for you if Wegovy isn’t an affordable option.

Frequently asked questions

Do BCBS Medicare plans cover Wegovy for weight loss? 

Historically, no, but qualifying Medicare beneficiaries can get coverage for Wegovy from July 1, 2026, until December 31, 2027, via the new Medicare GLP-1 Bridge program.

What insurance companies have the best Wegovy coverage?

It’s hard to say because coverage varies considerably from plan to plan. Most major health insurance companies do offer plans that cover Wegovy, but you must meet eligibility requirements to purchase a specific plan.

What does BCBS cover for weight loss?

Blue Cross Blue Shield weight loss coverage varies from plan to plan, but some cover other GLP-1s like Zepbound (tirzepatide) or liraglutide (generic Saxenda), as well as weight loss pills like phentermine.

Does Blue Cross Blue Shield cover weight loss injections?

It varies by plan, but some BCBS plans do cover weight loss injections like Wegovy.