Why is Wegovy not covered?

Wegovy® insurance coverage The short answer to whether or not Wegovy® is covered by insurance depends on your coverage. Unfortunately, the Affordable Care Act doesn't require health plans to cover obesity-related medications or surgeries.

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Wegovy® (semaglutide) is a once-weekly injectable GLP-1 drug that was approved by the FDA to treat overweight and obesity in 2021. Since its approval, there has been a surge in demand for the medication—in part thanks to clinical trial data that proved its efficacy: A recent randomized clinical trial found that patients who received the drug over a 68-week period lost 15.8% of their body weight on average. Novo Nordisk, a Danish pharmaceutical company that also makes Ozempic (semaglutide) and Saxenda (liraglutide), manufactures Wegovy®. Wegovy® is one of the medications Calibrate doctors prescribed to work in conjunction with the Calibrate One-Year Metabolic Reset. If you’re just hearing about Wegovy® for the first time and want to learn more about what it is and how it works, visit our Wegovy® detail page. However, if you’ve already done your research and want to ask your Calibrate doctor about starting Wegovy®, you might have a few questions about the financial responsibility.

Is Wegovy® covered by insurance? If so, how much of the total cost is typically covered, and what portion remains the patient’s responsibility?

The answers to these questions depend on a number of individual factors—the most important being the type of insurance coverage you hold. We’ll discuss the options and processes for obtaining Wegovy® insurance coverage within the Calibrate program and for those seeking treatment independently.

How much does Wegovy® cost without insurance?

Wegovy® launched with a list price of $1,350 per 28-day supply before insurance. The cash price is even higher, averaging $1,988.22 since August 2021 according to GoodRx. Drug list prices are set by the manufacturer, whereas cash prices fluctuate based on distribution costs that impact the pharmacies that fill the prescriptions. Cash prices can also vary depending on rebates and cost-saving programs offered by the manufacturer. These programs are free, but they often have restrictions and limitations regarding who they apply to. The Wegovy® list price is very similar to Novo Nordisk’s other approved drug for weight loss, Saxenda, which is listed at $1,349.02. Saxenda has an average cash price of $1,623.61, according to GoodRx.

Wegovy® insurance coverage

The short answer to whether or not Wegovy® is covered by insurance depends on your coverage. Unfortunately, the Affordable Care Act doesn’t require health plans to cover obesity-related medications or surgeries. While some plans do cover overweight and obesity treatment and drugs, the amount of coverage you’ll receive depends on your specific plan and prescription benefits. If the list prices above are giving you sticker shock, don’t worry: Through proprietary tools and data, Calibrate has helped over 95% of members get GLP-1 medication coverage at $25/month or less or (after any deductible is met). In the rare case that you are not satisfied with your plan's medication coverage, Calibrate can end your program and issue a refund. See our refund policy for full details. Whether you’re seeking treatment with Wegovy® through the Calibrate program or are doing so independently, here are some guidelines based on the type of health insurance coverage you carry:

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With employer-covered insurance, your employer sets the prescription benefits. These will vary depending on the plan level you have selected for yourself and your family. The easiest way to find out if your plan covers medication to treat obesity is to speak with a benefits advisor at your company. As a Calibrate member, however, you can skip this step. The Calibrate team is committed to working with your insurance company to help you get low-cost coverage so you don’t have to do any extra legwork or negotiating. As mentioned above, over 95% of members get GLP-1 medication coverage at $25/month or less. Note that Kaiser insurance plans are one exception in the commercial insurance category. Calibrate does not accept members with Kaiser insurance because we’ve found the company does not typically cover the medications your Calibrate medical team will prescribe.

Medicare, Medicaid, or Tricare:

As a general rule, Medicare does not cover medicines that treat overweight or obesity, including Wegovy®. However, certain Medigap and Medicare Advantage plans for retirees may provide this coverage. Contact Medicaid Check with your benefits administrator to learn more about your options. Medicaid prescription coverage varies from one state to another. Medicaid rarely covers GLP-1 medication, but there may be certain exceptions. Contact your state’s Medicaid office to learn more. Unfortunately, Calibrate is currently unable to accept members who are covered by government insurance (including Medicare, Medicaid, and Tricare), or with Kaiser plans. We’ve found these plans do not typically cover the medications that your Calibrate medical team will prescribe.

I am currently uninsured—what are my options?

At this time, Calibrate is unable to accept uninsured members. If you are seeking treatment with Wegovy® or other GLP-1 medications independently and do not have insurance coverage, you will likely need to pay the cash price for your prescription. There are currently no Patient Assistance Programs in place for Wegovy®.

Should I verify my insurance coverage for Wegovy® before joining Calibrate?

You don’t need to confirm your insurance coverage for GLP-1 medication before joining the Calibrate program. Our team will work with your commercial or employer insurance provider to get your labs and medication covered. In the rare case you are not satisfied with your plan's medication coverage, Calibrate can end your program and issue a refund. See our refund policy for full details. If you’d still prefer to contact your insurance provider before joining, here are a few questions you can ask:

Does my plan cover GLP-1 (glucagon-like peptide) medications?

If not, is step therapy an option?

Does my plan cover the following lab tests? Is there a copay?

If the medications are covered, the GLP-1 medication copay should be capped at $25 or less per month after any deductible is met. Keep in mind that your insurance provider may require information from your lab results before it’ll approve the medication. In addition, if you have a high-deductible health plan, you must fulfill the deductible before your medications are covered by your plan. Since the GLP-1 medications that Calibrate doctors currently prescribe are brand-name medications, high-deductible plans will not cover them before you reach your deductible (which may differ from their coverage of other—typically generic—medications).

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Visit our FAQs to learn more about the Calibrate program and medication insurance coverage.

Key takeaways

The list price of Wegovy® is $1,350 per 28-day supply before insurance

Whether or not your health insurance will cover Wegovy® or other GLP-1 prescription medication depends on the type of plan you carry and the prescription benefits it provides As a Calibrate member, our team will work with your insurance provider directly to help you obtain low-cost coverage for your labs and medication so you don’t have to do any negotiating Over 95% of Calibrate members get GLP-1 medication coverage at $25/month or less (after any deductible is met) Note that insurance does not cover the cost of the Calibrate Metabolic Reset or the Metabolic Health Assessment If you are not a Calibrate member, contact your insurance provider or benefits administrator to find out whether medication to treat obesity or overweight is covered within your plan

FAQ: Is there a Wegovy® shortage?

I read there is a shortage of Wegovy® and that the manufacturer is not initiating treatment for new patients in early 2022. Can Calibrate offer new members Wegovy®?

As you may have read, Wegovy’s manufacturer recently announced supply chain issues that may impact Wegovy’s stock availability in early 2022. As a result, the company has said it will prioritize existing prescriptions over new ones. You can follow along with news directly from Wegovy's manufacturer on this page, which is updated as new information becomes available. When you join Calibrate, your Calibrate doctor will work with you to prescribe the best GLP-1 medication for you based on your health history, insurance coverage, and current inventory. This may include starting on either Wegovy® or a different GLP-1—including in another form of semaglutide, the same active molecule in Wegovy®—and modifying based on your response to medication and availability. Your Calibrate Medical Team will work with you to make changes to dosing or transition to other GLP-1s if needed throughout your Calibrate program. Regardless of which GLP-1 you’re prescribed, our commitment to all of our members remains the same: we guarantee that you’ll lose at least 10% of your body weight or you’ll be eligible for a refund—see details here.

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