{"id":627509,"date":"2024-03-21T11:53:24","date_gmt":"2024-03-21T15:53:24","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=627509"},"modified":"2026-05-21T12:27:51","modified_gmt":"2026-05-21T16:27:51","slug":"how-to-get-wegovy-covered-by-insurance","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/how-to-get-wegovy-covered-by-insurance\/","title":{"rendered":"How to get Wegovy covered by insurance"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/blog\/news\/obesity-statistics\/\"><span style=\"font-weight: 400;\">Obesity<\/span><\/a><span style=\"font-weight: 400;\"> is a serious health issue associated with many leading causes of death, including heart disease, stroke, diabetes, and certain types of cancer. <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/wegovy\"><span style=\"font-weight: 400;\">Wegovy<\/span><\/a><span style=\"font-weight: 400;\"> is an injectable or oral weight loss medication that could help, but that doesn\u2019t mean insurance will always cover it. <\/span><\/p>\n<p><span data-sheets-root=\"1\" data-sheets-value=\"{&quot;1&quot;:2,&quot;2&quot;:&quot;&quot;}\" data-sheets-userformat=\"{&quot;2&quot;:6849,&quot;3&quot;:{&quot;1&quot;:0},&quot;9&quot;:1,&quot;10&quot;:2,&quot;12&quot;:0,&quot;14&quot;:{&quot;1&quot;:2,&quot;2&quot;:0},&quot;15&quot;:&quot;Arial&quot;}\" data-sheets-formula=\"=CONCATENATE(R[0]C[-2],R[0]C[-3],R[0]C[-1])\"><\/span><\/p>\n<h2 id=\"does-insurance-cover-wegovy\"><span style=\"font-weight: 400;\">Does insurance cover Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">It depends. Major health insurance providers tend to offer several different types of plans, whether employer-sponsored or individually obtained. Coverage can vary greatly between plans, even if they\u2019re offered by the same insurance company. It\u2019s important to verify coverage for Wegovy by looking at your specific plan documents. Consider checking for formulary updates periodically since it\u2019s possible to lose or gain Wegovy coverage at any time.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Wegovy is best known as a treatment for weight loss and chronic weight management. But it is also approved by the Food and Drug Administration (FDA) to lower the risk of cardiovascular events in adults with heart disease who have excess weight or obesity, and to treat adults with an advanced liver disease known as <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/news\/wegovy-liver-disease-fda-approval\/\"><span style=\"font-weight: 400;\">metabolic-associated steatohepatitis (MASH)<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Insurance plans may cover Wegovy for cardiovascular risk reduction and MASH treatment even if they don\u2019t cover Wegovy for weight loss. Your insurance provider may require that you try another (typically more affordable) cardiovascular or liver medication first. Check your specific plan\u2019s drug formulary to confirm.<\/span><\/p>\n<h3 id=\"does-insurance-cover-wegovy-for-weight-loss\"><span style=\"font-weight: 400;\">Does insurance cover Wegovy for weight loss?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Not all plans cover Wegovy for weight loss. If they do, they may have eligibility requirements, and they may also require <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><span style=\"font-weight: 400;\">prior authorization<\/span><\/a><span style=\"font-weight: 400;\">. Insurance plans that cover Wegovy for weight loss typically require that patients meet the following criteria:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Adults must have an initial body mass index (BMI) of 30 or higher, or a<\/span><span style=\"font-weight: 400;\">n initial BMI of 27 or higher (overweight) with at least one weight-related medical condition, such as:<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Heart disease<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">High cholesterol\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Type 2 diabetes<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">High blood pressure<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Sleep apnea<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pediatric patients ages 12 years and older must have an initial BMI at the 95th percentile or higher for age and sex.<\/span><\/li>\n<\/ul>\n<p><b>RELATED:<\/b> <a href=\"https:\/\/www.singlecare.com\/blog\/wegovy-prior-authorization-criteria-blue-cross-blue-shield\/\"><span style=\"font-weight: 400;\">Wegovy prior authorization criteria<\/span><\/a><\/p>\n<h2 id=\"how-to-get-insurance-to-cover-wegovy\"><span style=\"font-weight: 400;\">How to get insurance to cover Wegovy\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.singlecare.com\/blog\/how-to-qualify-for-wegovy-a-guide-to-getting-a-prescription\/\">Getting Wegovy covered by insurance<\/a> <\/span><span style=\"font-weight: 400;\">starts with a visit to your healthcare provider, who will determine whether you qualify for Wegovy. If you do, they\u2019ll write you a prescription. You can either have your healthcare provider send the prescription to the pharmacy or take it there yourself, where your pharmacist can check your coverage.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Alternatively, you can call your insurance company to find out if your plan covers the cost of Wegovy before having the prescription sent to your pharmacy. The phone number is listed on the back of most insurance cards and prescription drug cards. You may want to ask whether you need prior authorization. If so, your healthcare provider will have to contact your health insurance provider for approval before your prescription can be filled under your insurance plan. If you are turned down, ask what you need to do to appeal. Or, you can check the manufacturer&#8217;s website for self-pay options.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If your insurance won\u2019t cover Wegovy, ask why. It could be because you didn\u2019t meet the criteria, but it could also be because your employer has opted out of weight loss benefits. If so, your healthcare provider can submit a request to the employer asking them to reconsider benefits or send an appeal to the insurance company to show that you meet the FDA requirements for the medication.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cIf you are having trouble getting medication covered, find a provider with experience with these medications who will be an advocate,\u201d says <\/span><a href=\"https:\/\/www.primeinstitute.us\/michelle-pearlman-md\/\"><span style=\"font-weight: 400;\">Michelle Pearlman, MD<\/span><\/a><span style=\"font-weight: 400;\">, CEO and co-founder of Prime Institute and ByteMD, who is board-certified in internal medicine, gastroenterology, and obesity medicine.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\t\t<div id=\"coupon-cta\" class=\"coupon-cta master-template\">\n\t\t\t<p id=\"headline\">Save up to 80% on Wegovy with SingleCare<\/p>\n\t\t\t<p id=\"subheadline\">Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.<\/p>\n\t\t\t<div class=\"details-wrap\">\n\t\t\t\t<div class=\"details\">\n\t\t\t\t\tWegovy 2.4 mg\/0.75 mL (4 Pens)\t\t\t\t<\/div>\n\t\t\t\t<div class=\"address\">\n\t\t\t\t\t23666 - Hampton, VA\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"api-response\">\n\t\t\t\t\t\t<div class=\"coupon\">\n\t\t\t<div class=\"logo\">\n\t\t\t<img decoding=\"async\" src=\"https:\/\/images.singlecare.com\/content\/images\/pharmacy\/logo-color-kroger.svg\" alt=\"Kroger Pharmacy\" \/>\t\t\t<\/div>\n\t\t\t<div class=\"price\">\n\t\t\t\t<div class=\"price-number\">\n\t\t\t\t\t$1170.27<br\/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"price-signup\">\n\t\t\t\t\t<span class=\"info-icon\">i<\/span>\n\t\t\t\t\tPrice with <a href=\"#\">signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"couponbtn\">\n\t\t\t\t<a target=\"_blank\" href=\"#\">Get free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"coupon\">\n\t\t\t<div class=\"logo\">\n\t\t\t<img decoding=\"async\" src=\"https:\/\/images.singlecare.com\/content\/images\/pharmacy\/logo-color-harristeeter.svg\" alt=\"Harris Teeter Pharmacy\" \/>\t\t\t<\/div>\n\t\t\t<div class=\"price\">\n\t\t\t\t<div class=\"price-number\">\n\t\t\t\t\t$1170.27<br\/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"price-signup\">\n\t\t\t\t\t<span class=\"info-icon\">i<\/span>\n\t\t\t\t\tPrice with <a href=\"#\">signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"couponbtn\">\n\t\t\t\t<a target=\"_blank\" href=\"#\">Get free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t<a target=\"_blank\" href=\"#\" class=\"coupon-see-all-btn\">See Wegovy prices at all pharmacies<\/a>\n\t\t<\/div>\n\n\t\t<\/span><\/p>\n<h2 id=\"what-insurance-covers-wegovy\"><span style=\"font-weight: 400;\">What insurance covers Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Several insurance companies, including <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/is-wegovy-covered-by-blue-cross-blue-shield\/\"><span style=\"font-weight: 400;\">Blue Cross Blue Shield<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/does-aetna-cover-wegovy\/\"><span style=\"font-weight: 400;\">Aetna<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/cigna-weight-loss-coverage\/\"><span style=\"font-weight: 400;\">Cigna<\/span><\/a><span style=\"font-weight: 400;\">, and <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/does-united-healthcare-cover-wegovy-for-weight-loss\/\"><span style=\"font-weight: 400;\">United Healthcare<\/span><\/a><span style=\"font-weight: 400;\">, typically cover Wegovy in some form or another. However, coverage varies by plan. Benefits offered by employer plans also vary, and coverage is often based on what employers are willing to cover. And some plans will cover Wegovy for cardiovascular risk reduction, but may not cover it for weight loss.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Novo Nordisk, the manufacturer of Wegovy, sponsors NovoCare, a website with resources that help people <\/span><a href=\"https:\/\/www.novocare.com\/obesity\/products\/wegovy\/cost-navigator.html\"><span style=\"font-weight: 400;\">check insurance coverage<\/span><\/a><span style=\"font-weight: 400;\">, manage the cost of medication, explore savings and assistance options, and more.\u00a0<\/span><\/p>\n<h2 id=\"does-medicare-cover-wegovy\"><span style=\"font-weight: 400;\">Does Medicare cover Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Historically, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-wegovy\/\"><span style=\"font-weight: 400;\">Medicare<\/span><\/a><span style=\"font-weight: 400;\"> hasn\u2019t covered weight loss medications and doesn\u2019t let people use the manufacturer\u2019s coupons in combination with their Part D plan. The ban on coverage for weight-loss treatments was instituted in 2003, partly due to concerns over the safety of fen-phen (the combination of fenfluramine and phentermine), the popular weight loss medication at the time. Fen-phen was associated with life-threatening hypertension and heart valve issues.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">But Medicare coverage is changing. In December 2025, the Centers for Medicare and Medicaid Services announced the upcoming launch of the <\/span><a href=\"https:\/\/www.cms.gov\/medicare\/coverage\/prescription-drug-coverage\/medicare-glp-1-bridge\"><span style=\"font-weight: 400;\">Medicare GLP-1 Bridge<\/span><\/a><span style=\"font-weight: 400;\"> program. Eligible Medicare beneficiaries can receive Wegovy starting July 1, 2026, and ending December 31, 2027. You must receive prior authorization for Wegovy and be enrolled in a standalone prescription drug plan or a Medicare Advantage prescription drug plan.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Because Wegovy has FDA approval for cardiovascular risk reduction and MASH treatment, many Medicare prescription plans that haven\u2019t covered Wegovy for weight loss may now cover it for these indications. However, coverage varies by plan, and prior authorization may be required, so it\u2019s best to check your plan documents.<\/span><\/p>\n<h2 id=\"does-medicaid-cover-wegovy\"><span style=\"font-weight: 400;\">Does Medicaid cover Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Every state decides what prescription medications to cover through Medicaid, so coverage for Wegovy depends on the reason for use and the state you live in. As of January 2026, <\/span><a href=\"https:\/\/www.kff.org\/medicaid\/medicaid-coverage-of-and-spending-on-glp-1s\/\"><span style=\"font-weight: 400;\">13 states<\/span><\/a><span style=\"font-weight: 400;\"> (Delaware, Kansas, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Rhode Island, Tennessee, Utah, Virginia, and Wisconsin<\/span><span style=\"font-weight: 400;\">) cover <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/glp-1-agonists\"><span style=\"font-weight: 400;\">GLP-1 receptor agonists<\/span><\/a><span style=\"font-weight: 400;\"> (such as Wegovy) for weight loss.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Many Medicaid plans will provide Wegovy coverage for cardiovascular risk reduction, but it\u2019s best to check with your specific plan to confirm coverage details.\u00a0\u00a0<\/span><\/p>\n<h2 id=\"does-the-va-cover-wegovy\"><span style=\"font-weight: 400;\">Does the VA cover Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The Veterans Administration (VA) covers obesity management for eligible veterans, but whether it will cover the cost of Wegovy varies. Wegovy is <\/span><a href=\"https:\/\/www.va.gov\/formularyadvisor\/drugs\/4040576-SEMAGLUTIDE-INJ-SOLN\"><span style=\"font-weight: 400;\">not on the VA national formulary<\/span><\/a><span style=\"font-weight: 400;\"> and requires a non-formulary drug request and prior approval. See your local VA office to discuss your options.<\/span><\/p>\n<h2 id=\"wegovy-cost-with-insurance\"><span style=\"font-weight: 400;\">Wegovy cost with insurance<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The cost of Wegovy with insurance depends on many factors, including the specifics of the plan, prescription drug copays, and limits on coverage. In November 2023, Novo Nordisk told Reuters that <\/span><a href=\"https:\/\/www.reuters.com\/business\/healthcare-pharmaceuticals\/novo-nordisk-80-us-wegovy-patients-with-insurance-paying-less-than-25month-2023-11-02\/\"><span style=\"font-weight: 400;\">80% of insured patients pay less than $25 a month for Wegovy<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<h3 id=\"what-tier-is-wegovy\"><span style=\"font-weight: 400;\">What tier is Wegovy?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Many insurance plans place Wegovy in tier 2 or tier 3. This is typical for commonly prescribed brand-name medications. A higher tier means a higher copay or coinsurance, but exact costs vary by plan.<\/span><\/p>\n<h2 id=\"wegovy-cost-without-insurance\"><span style=\"font-weight: 400;\">Wegovy cost without insurance<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The typical cash price of 30, 1.5 mg Wegovy tablets is $1,805, but costs vary by dosage, form, and pharmacy. The injectable form of Wegovy is also expensive. However, there are <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/save-on-wegovy\/\"><span style=\"font-weight: 400;\">ways to save on Wegovy<\/span><\/a><span style=\"font-weight: 400;\">. With a <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/wegovy\"><span style=\"font-weight: 400;\">SingleCare prescription discount card<\/span><\/a><span style=\"font-weight: 400;\">, you could pay $1,011 for 30, 1.5 mg tablets of Wegovy, $1,170 for four 2.4 mg pens, or $1.321 for four 7.2 mg pens of Wegovy HD.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You can also check the Wegovy website for more information about the NovoCare savings program.<\/span><\/p>\n<h2 id=\"bottom-line\"><span style=\"font-weight: 400;\">Bottom line<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Many insurance plans cover Wegovy for patients who fit the criteria and have met their deductible, but this can vary by plan. Although weight loss medication can help, it\u2019s not a quick fix for obesity. Wegovy is typically recommended along with lifestyle changes like a reduced-calorie diet and increased physical activity.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cWhen we speak about obesity, we\u2019re looking at a multi-disciplinary approach that includes behavioral interventions, lifestyle modifications, and pharmacology, \u201c says <\/span><a href=\"https:\/\/www.linkedin.com\/in\/raj-dasgupta-md-facp-fccp-faasm-a9839093\/\"><span style=\"font-weight: 400;\">Raj Dasgupta, MD<\/span><\/a><span style=\"font-weight: 400;\">, a board-certified physician and associate professor of clinical medicine at the University of Southern California in Los Angeles. \u201cIt is especially important to realize that even when you are on medications, you need to continue with lifestyle modifications that include diet and exercise because when people stop these medications, they gain the weight back.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Always consult your healthcare provider for more information and medical advice about Wegovy, including information about side effects and other important warnings.\u00a0<\/span><\/p>\n<h2 id=\"frequently-asked-questions\"><span style=\"font-weight: 400;\">Frequently asked questions<\/span><\/h2>\n<h3 id=\"does-humana-cover-wegovy-for-weight-loss\"><b>Does Humana cover Wegovy for weight loss?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Humana <\/span><a href=\"https:\/\/mcp.humana.com\/tad\/tad_new\/Search.aspx?searchtype=beginswith&amp;docbegin=W&amp;policyType=pharmacy\"><span style=\"font-weight: 400;\">doesn\u2019t currently<\/span><\/a><span style=\"font-weight: 400;\"> cover Wegovy for weight loss in adults without established cardiovascular disease or MASH. However, coverage can vary by plan, so it\u2019s worth checking your specific documents.\u00a0<\/span><\/p>\n<h3 id=\"why-won-t-my-insurance-cover-wegovy\"><b>Why won\u2019t my insurance cover Wegovy?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Your insurance may not cover Wegovy if you don\u2019t have an FDA-approved indication or meet the plan\u2019s prior authorization requirements. Some insurance providers choose to only cover certain indications, like cardiovascular risk reduction. Others don\u2019t cover Wegovy for cost reasons.\u00a0<\/span><\/p>\n<h3 id=\"how-do-i-get-wegovy-for-25-a-month\"><b>How do I get Wegovy for $25 a month?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Novo Nordisk offers a NovoCare savings program that may allow some people to get Wegovy for $25, but the offer is only for people whose commercial health insurance covers Wegovy, and there&#8217;s a maximum savings of $100 per month. Other terms and conditions may apply.\u00a0<\/span><\/p>\n<h3 id=\"does-insurance-pay-for-wegovy-pills\"><b>Does insurance pay for Wegovy pills?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">It depends on your insurance plan and why Wegovy is being prescribed. (Wegovy pills currently <\/span><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b\"><span style=\"font-weight: 400;\">aren\u2019t FDA approved<\/span><\/a><span style=\"font-weight: 400;\"> for anyone under 18 or for treating an advanced liver disease known as MASH.) Many insurance companies cover multiple forms of a medication. If Wegovy pills become more readily available and more affordable than Wegovy injections, insurance companies may be more likely to cover them.\u00a0<\/span><\/p>\n<h3 id=\"what-is-wegovy-hd\"><b>What is Wegovy HD?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Wegovy HD is a <\/span><a href=\"https:\/\/www.novonordisk-us.com\/media\/news-archive\/news-details.html?id=916517\"><span style=\"font-weight: 400;\">7.5 mg dose of Wegovy<\/span><\/a><span style=\"font-weight: 400;\">, which is the highest dose available. It is intended for adults who have been on the 2.4 mg dose of Wegovy for at least four weeks but need additional weight loss.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Obesity is a serious health issue associated with many leading causes of death, including heart disease, stroke, diabetes, and certain types of cancer. Wegovy is an injectable or oral weight loss medication that could help, but that doesn\u2019t mean insurance will always cover it. Does insurance cover Wegovy? It depends. Major health insurance providers tend [&hellip;]<\/p>\n","protected":false},"author":149,"featured_media":627510,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[21067,608,9825],"coauthors":[21074,21008],"class_list":["post-627509","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-glp-1-drugs","tag-health-insurance","tag-weight-loss","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>How to get Wegovy covered by insurance<\/title>\n<meta name=\"description\" content=\"Wegovy isn&#039;t always covered by insurance. 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