Will insurance cover Wegovy for prediabetes?

In this article:

• Does Wegovy help treat prediabetes?
• Does insurance cover Wegovy for prediabetes?
• How to get insurance to cover Wegovy for prediabetes
• How much does Wegovy cost without insurance?
• What to do if your health insurance doesn’t cover Wegovy

In this article

• Does Wegovy help treat prediabetes?
• Does insurance cover Wegovy for prediabetes?
• How to get insurance to cover Wegovy for prediabetes
• How much does Wegovy cost without insurance?
• What to do if your health insurance doesn’t cover Wegovy

Wegovy (semaglutide) is a prescription injectable medication that helps with long-term weight management. It’s taken once a week and it belongs to a class of medications called glucagon-like peptide-1 receptor agonists (GLP-1s). The Food and Drug Administration (FDA) has approved Wegovy for two main indications. Along with diet and exercise changes, Wegovy is approved to lower the risk of major cardiovascular events such as heart attack and stroke in adults who have both cardiovascular disease and excess weight (classified as overweight or with obesity). Wegovy is also approved to lower body weight in people with obesity (including adolescents age 12 and older), or adults who are overweight and have at least one weight-related condition such as high blood pressure, high cholesterol, or Type 2 diabetes. While people with prediabetes may potentially benefit from a medication like Wegovy, insurance may or may not cover it. This article breaks down what insurance is most likely to cover and what your options are if you’re paying out of pocket.

Does Wegovy help treat prediabetes?

Prediabetes occurs when blood sugar levels are higher than normal but not high enough to be diagnosed as Type 2 diabetes. It’s typically diagnosed by a healthcare provider using blood tests that measure fasting blood glucose (FBG) or hemoglobin A1c (HbA1c) levels. 

Several factors can increase the risk of developing prediabetes, including:

• Having a body weight classified as overweight or obese
• Physical inactivity
• Poor diet
• Family history of diabetes
• Being over age 45
• Having polycystic ovary syndrome (PCOS) or a history of gestational diabetes

Typical treatments for prediabetes focus on lifestyle changes. This includes a balanced diet, increasing physical activity, quitting smoking, managing weight, and getting enough sleep. There are currently no FDA-approved medications specifically for prediabetes, but some healthcare providers may prescribe metformin, a diabetes drug, off-label if they believe it’s appropriate.

Although Wegovy isn’t approved to treat prediabetes, clinical trials have shown that semaglutide, the active ingredient in Wegovy, can help people with obesity and prediabetes reduce their weight and control blood sugar better than a placebo treatment. “People with prediabetes can benefit from semaglutide,” says Richa Mittal, MD, an obesity medicine specialist and founder of Radiant Health Dallas in Dallas, Texas. “Semaglutide itself improves pancreatic function and helps with reducing blood sugar. Additionally, because it helps people reduce caloric intake, semaglutide can help with excess body fat loss, which leads to improvement in insulin resistance and blood sugar levels,” she shares.

Does insurance cover Wegovy for prediabetes?

In most cases, insurance plans won’t cover Wegovy specifically for prediabetes. That’s because prediabetes isn’t one of the FDA-approved indications for the medication. If a healthcare provider prescribes Wegovy for prediabetes, it’s considered off-label use. While some insurance plans do offer coverage for off-label prescriptions, it’s typically limited and may require additional documentation or justification.

Major insurers like Blue Cross Blue Shield and United Healthcare may cover Wegovy, but only if it’s prescribed for an approved use, such as chronic weight management or reducing cardiovascular risk in eligible individuals. Each plan has its own criteria, and prior authorization is often required. For instance, some Blue Cross Blue Shield plans may ask for prior authorization, which means your healthcare provider will need to submit documentation to justify the prescription. 

Coverage under government plans is mixed. Some Medicare plans may cover Wegovy to lower the risk of heart attack or stroke in people with both heart disease and obesity, but not for general weight loss. Select state Medicaid programs may cover Wegovy for weight management in qualifying patients.

Megan Horsham, MD, a physician at Sanctuary Wellness Institute in Lakeland, Florida, shares that insurance plans may not cover drugs like Wegovy for multiple reasons. “One, they are expensive medications, and companies do not want to pay for them. Two, many plans do not consider weight loss drugs necessary, and three, some insurance companies may be concerned about inappropriate prescribing,” she says.

Wegovy was first approved for weight management in 2021 and later gained approval in 2024 for its benefits in preventing major cardiovascular events in certain adults. While its FDA-approved uses are expanding, Wegovy is not approved to treat prediabetes. As a result, insurance coverage isn’t guaranteed, especially if it’s being prescribed for prediabetes alone.

How to get insurance to cover Wegovy for prediabetes

If you’re hoping to get insurance coverage for Wegovy to treat prediabetes, you may need to go through a few extra steps. Start by visiting your healthcare provider to determine whether Wegovy is appropriate for your health needs. If they agree, you’ll receive a prescription. But keep in mind that this may be considered off-label use.

Next, check with your insurance company to understand their specific requirements for coverage. Some plans may cover off-label prescriptions if your healthcare provider can show that it’s medically necessary and explain its expected benefit. This often involves a process called prior authorization, where your provider submits documentation to support the need for Wegovy.

In some cases, your insurance plan may require step therapy, which means trying other, lower-cost treatments first and showing they weren’t effective before approving coverage for Wegovy.

If your initial request is denied, don’t stop there. Ask your insurer for the reason. Sometimes, additional documentation from your provider can help overturn the decision.

How much does Wegovy cost without insurance?

The cost of Wegovy without insurance varies. As of this writing, the average cash price for Wegovy is $1,817 for 4, 0.75 mL of 2.4 mg/0.75 mL single-dose pens. A standard dosage of Wegovy is one single-dose pen per week, which means the monthly cost of Wegovy is typically the cost of four single-dose pens. Based on this information, the cost of a year’s supply of Wegovy without insurance could be $21,804. 

The list price for Wegovy from its manufacturer, Novo Nordisk, is $1,349 per package of four single-dose pens for any of its doses. But the list price is the price charged to pharmacies. Drug prices fluctuate, and the actual price you may pay for Wegovy out of pocket depends on your pharmacy and location, which is why it is important to compare prices at local pharmacies. You can do this by calling pharmacies near you and asking how much Wegovy costs or by using the SingleCare website or app.

What to do if your health insurance doesn’t cover Wegovy

If your health insurance plan doesn’t cover Wegovy for prediabetes, there are other ways to get Wegovy more affordably. Consider the following options to avoid paying the full cash price for this medication. 

Use a SingleCare coupon

A SingleCare prescription discount card can get you a monthly supply of Wegovy for $1,225 for 4, 0.75 mL of 2.4 mg/0.75 mL prefilled single-dose pens. That’s 33% less than the average cash price of Wegovy.

The SingleCare prescription discount card is free to get and use, and you can use it at many major pharmacy chains. 

File an appeal

If you don’t have health plan coverage for Wegovy or your coverage was denied, you can still file an appeal to overturn the decision. Your healthcare providers can write an appeal letter and provide necessary information to prove that you need the drug and can medically benefit from it. They will have to prove that Wegovy will be a significant benefit for your prediabetes specifically. 

Consider alternative treatments

There may be other treatment options for prediabetes that are covered by insurance. Even though there aren’t any FDA-approved medications for prediabetes, some healthcare providers may recommend metformin, a medication that most insurance plans cover. 

People with prediabetes may also consider lifestyle-based treatments. “Non-medication recommendations for patients with prediabetes include nutrition changes, physical activity, optimization of sleep, and stress coping behaviors,” Dr. Mittal says. 

The National Diabetes Prevention Program (DPP) is a lifestyle change program for people who are at risk of developing Type 2 diabetes. It’s a year-long program that teaches people how to eat healthier, be more physically active, and manage their stress. The program is offered through federal, state, and community health programs; workplaces; and insurance companies. Medicare Part B covers the cost of the program fully as long as you qualify and it’s administered by a registered Medicare supplier. For those who don’t receive Medicare, the out-of-pocket cost of the program may vary.