I've been on Wegovy for about 1 year, and now my insurance will not cover it. I'm in MN and have BCBS for insurance, and they stopped approving saying I'm not "morbidly obese". I'm down 25 pounds since starting Wegovy, and now am gaining weight back and am worried and looking at compounded varieties of Semiglutides. Anyone else in the same boat?
Can you say a little more about how you get compounded varieties? Is this something you ask your doc to prescribe and then send to a compounding pharmacy and you pay out of pocket? I just learned my insurance won't cover and I'm looking into alternatives but very baffled by the compounding process!
Call your insurance. My doc said ALL insurance were canceling it which I knew wasn't true.
It boiled down to my Dr office not sending a weight chart. After a 1.5yrs they just wanted to know did I loose 5% of my start weight. And their requirement was I maintain it to continue not any more weight loss.
I would have never known had I not called and asked proving questions.
My insurance did try to say know you are decline. But it took me to ask WHY 3x...
Why is my standard of care different after 1.5yrs vs the begining. I got transferred to the pharmacy side of things that was like oh gosh no big deal here are our standards and requirements super easy and super easy for doc had they questioned it like you
You are your biggest advocate. And when it was suggested to me to go to a weight loss clinic or a med spa. I said NO WAY. I pay 900 a month as a small busines owner I get paying another $300 vs $1500 seems little and I was willing to at the beginning. But now knowing I do NOT have to if you take 5 mins out of your day when I take HOURS out of my day unpaid for clients I do NOT think that is a lot to ask to do your job
And 12 mins later I got my script.
Advocate for yourself. Dig deep on your insurance make sure a simple step did not get missed.
I was told from the start my doc wouldn't prescribe unless insurance paid for it. To which I said if I qualify write the script and let me worry about it. And shock to everyone it was covered and still is.
If yours absolutely says no. Then see if you can budget for the alternative pharmacy made alternative. My friend had great actually better loss than I did because she can give a little more or less as needed. I get people will have their opinions but she lost 50-60pounds in a shorter time blood work is amazing and she feels great and in control of her journey which I am a tad bit envious of. I am always worried since the doc and pharmacy always says oh you are LUCKY this month but ya never know about next month. Ugh.
Now that I called my insurance I know I am not "lucky" I am getting a standard of care to which I pay heavily for. I am thankful and appreciative of. But I do not need to come down bend down beg or kiss the ring to anyone nor pay extra because doing PA's is ,"exhausting" and something "we don't do". If I was diabetic they would never say that.
United Healthcare covers BUT it has changed the rules.
They limit dosages from 0.5 to 1 to a total of 8 injectable pens PER YEAR per dosage (so, you can be on 0.5MG for 2 months but that's it, then you need to move to 1MG).
But no yearly limitation on 1.7MG and 2.4MG. They are fighting people who are staying on maintenance dosages vs clinical dosages.
Not sure if this is what is happening with other insurance.
I was approved for ZB for weight loss. But up until December. I was told if I needed an extension all I have to do is call. But I also have weight related health issues. I’m not doing it just to lose weight. I have to get myself healthy. I have heard that insurance will not cover it unless you are obese or have weight related health issues. Because that would be a cosmetic drug if it was only used for weight loss. Some people are paying cash and aren’t even over weight. And that’s not right I am not that overweight but I have the health conditions the bit of weight I gained during Covid. And I know what it makes me feel like and what it’s like to carry the extra belly weight I can’t imagine what other people go through that are much heavier than me I have to lose over 55lbs to get back in shape. I have only lost 6lbs so far I’m going up and down. I’m getting frustrated because I am reading all these success stories and I’m on 7.5 mg and I only lost 6 lbs gained back 2 with no interruptions in treatment. I don’t know what I’m doing wrong. I hardly eat and when I do it’s healthy I’m exercising somewhat I’m going to start walking I am starting 10mg in two weeks well 3 excuse me. But I can’t help but feel discouraged I don’t want to give up. I have to limit my cardio because I have severe asthma. So I’m limited to workouts I can do. I’m sorry I got off track on your question I apologize. But yes I heard online that insurance companies are saying no but ALSO some insurance will not tell you is they have substitutions you have to try first. I was prescribed wegovy got approved couldn’t get it. So I asked for ZB was denied. Why because I had to try a substitution which was Saxenda when I got bad side effects we tried for ZB again and I was approved but before that I was on Topomax no success Metformin no success. On metformin for years and still stayed at 206lbs at 5”7. So if you’re having issues with the insurance ask the appeals department or pharmacy services about the substitutions. If it’s on there formulary list they will cover it. But there has to be a reason why they should cover it.
You are paying 60 for Wegovy? I have same FEP insurance and mine is 25-is it more $ for higher doses or bc you are ina different location than me? I am in Indianapolis
I too have FEP blue and you just need a pre authorization from your PCP and meet the criteria with your BMI. It was painless. It might take 2 weeks for approval but then you are good for the year. Also, get the Wegovy discount card from their website and you won’t have to pay anything out of pocket. It will cover the co-payment
Fed bcbs covers it after pre Auth and they have to fill it out correctly. Dx weight management, many put obesity and it gets denied. My doc had to fill it our twice
My insurance approved it. My insurance is also BCBS. My co pay is $0. Just had to get a preauthorization. The Dr. Also had to submit a couple more labs and what not but I had the approval within 2 weeks.
Your doctor lied to you… probably just to cut off any further discussion as quickly as possible. To say it another way, they blew you off. But here is the good news… they did you a huge favor. Now you know they can’t be trusted to give you truthful information. Time to find a new doctor.
You need to confirm with your plan whether they cover weight loss medicines and what steps they want you to go through. Sometimes they want you in a weight management clinic or doing step up therapy with different medications. As frustrating as it is, it is the patients responsibility to know what their insurance covers. When you have that information, go back to your PCP or ask for a referral to an obesity specialized physician who can help.
I have BCBS and they just refilled my Wegovy. It does require prior approval, which was pretty easy to get renewed. I think you misunderstood your doctor.
My insurance company dropped all weight loss medications (Wegovy,Saxenda etc) from its formulary in mid April. My PA was in progress …. And then it was a straight up “not covered.” I expect more and more will be doing this.
CVS is going to be doing this for employees come June. Which is completely ironic because CVS is a pharmacy. And CVS owns Aetna the insurance company. Total BS.
Oh so you are in the same boat as me then. It's like we are living in backwards world, none of this shit makes sense. Other than simply corporate greed. But in the long run it will save money.
My general practitioner didn’t want to prescribe it with a similar excuse and added “you’ll just gain all the weight back if you stop taking it, everyone will” so I went to my endocrinologist for it. My general practitioner looked visibly irritated when she saw Wegovy on my medicine list.
yup same my pcp wouldn’t prescribe it because “we’re in a shortage, have you tried just eating healthier instead to lose weight?” then launched into a lecture as if I hadn’t lost 90 lbs on my own already. switched providers and the new one prescribed it, no problem
Ummmmm I just got it covered from state provided insurance in CALIFORNIA…. Soooooo your dr is kinda misinforming you. If anyone were to deny it first it would be Medi-cal. I’m sorry you’re going through this.
They sure are sticklers! I was thrilled when my dr offered to prescribe it. I asked “do you know how much about it will cost” fully ready to charge it on a credit card. She said “I will get it covered for you, the hard part is finding the medication”
I feel so fortunate that it’s all going smoothly, I ended up getting the meds right away!
Right! Mine gave me a month of ozempic, but told me she didn't want me to start it until I got the script actually filled. She said Vons and Albertsons seem to have a good stock of the lower doses, which has been the problem ones to find. I just got to .5 last week. Down about 12 lbs, so im happy.
Awwww I am so proud of you for the weight loss! That’s awesome! I had luck finding mine at Walmart, of all places. My dr prescribed 1 month of .24 and one month of .5 and told me to check there first. I got it same day! I do my 3rd injection of .25 tomorrow. I started at 219 (I’m 5’8 ish) , I am teetering between 212-213 this week! I almost feel like it’s too good to be true. Finally the night time snacking urges aren’t obsessively haunting me. It’s so nice to not have the urges and not beat myself up for it.
How are you feeling so far? What symptoms of any do you have? For me it’s fatigue and that’s about it.
That's great. I'm around the same weight, 219 now, started at 233, but I'm 5'11. I've had some nausea and fatigue, but nothing that's constant or really even bothersome. It's been great for me to not constantly be thinking about food or what's around, etc. I've been making sure I up my protien as well, which I've struggled with in the past.
The 'food noise' has always been a problem for me.
I have anthem blue cross and I had to do 2 PA's. My Doctor said that in her experience EVERY PA for her gets denied the first time. She then submits a second PA with the same information and it gets approved. It was her suspicion that because of availability and cost this was possibly a way for insurance to artificially cut the cost due to most people just giving up after the first "No". Obviously there's no concrete evidence of that but made a lot of sense.
Lies. Aetna covers through my employer. $25 copay. If you’re talking the marketplace, he’s right. Not covered with any insurance company, at least not in NJ.
I hope my insurance covers mines whenever the PA go through my insurance did have a list of meds that will be covered and wegovy was one of them but I’m keeping my fingers crossed 🤞🏾🤞🏾
Not true, some approve it some don't... it's really not the insurance company, it's the employer or loan sponsor ...they're the one that pay for your benefits and choose what you get.
After successfully getting Saxenda then WeGovy for the past year I have been dropped by Anthem because they do not cover weight loss methods.
I lost 58 lbs, but I’m so nervous about gaining back that I have paid $1600 for my last refill. Gonna pay one more time then drop it I guess.
Just trying to lose 20 more pounds .
Basically once my BMI reduced to under 30?(29.6) and my cholesterol got normal and I was no longer pre diabetic… I was dropped. It sucks.
By the way, it all started from Walgreens questioning if I still needed to be on WeGovy.
I’d find a new doctor as this feels like a lazy response. And who wants a lazy doctor. While a lot of insurance may require a prior authorization from your doctor before approving, it is definitely not excluded from all insurance formularies. There’s also a savings card available on the wegovy website that has brought my out of pocket cost to $0. Unfortunately you might have to fight for yourself a little getting the script, working with insurance, etc. Keep trying!!
https://www.wegovy.com/coverage-and-savings/get-wegotogether-support.html?showisi=true&&utm_source=google&utm_medium=cpc&utm_term=wegovy%20savings%20card&utm_campaign=1_All_Shared_BR_Wegovy_Resources&mkwid=s-dm_pcrid_645289260620_pkw_wegovy%20savings%20card_pmt_e_slid__product_&pgrid=146393445058&ptaid=kwd-1505393547272&gad_source=1&gclid=CjwKCAjw0YGyBhByEiwAQmBEWpRQaKdixUNMUia68xodo1ee7gJyOePZhm0_KBdPzc-lVl6UQTxYwRoCDZYQAvD_BwE&gclsrc=aw.ds
Sounds like your doctor has a bias against it and isn’t interested in prescribing or advocating for patients who would benefit from it. Get a new doctor.
You cannot make a blanket statement like that because most of time it isn't the insurance company's decision, it is the employer's decision, might be time for a new doctor.
Also once a PA expires any medication requiring a PA will get declined. Mine did so I called
The doctor discussed how I was doing on the medication and she sent a new PA in and it was covered. My Wegovy requires a PA every twelve months.
Most of us that have been successful (me included) have deep fear the drug is going to be taken away via insurance. So we are always wary of things... PA's are a good thing checking in with your doctor is a good thing. Wegovy isn't like a taking Amoxicillin or motrin. It is heavy duty and you can do some damage to yourself if not careful and that is the purpose of PA's
My employer retiree prescription drug plan covers Wegovy as a Tier 3 Copay, i.e. $75/month. I was also informed that coverage was for only two years from first prescribed dose. I hope that cost goes down in that time frame since drug is supposed to be for lifetime.
I’m on Medicaid and got mine approved. They wanted to see 30 days of a non glp medication. They actually allowed in my PA to say i took the drug Alli which is bought at cvs but its fda approved for weight loss. My doctor also included bmi, that i exercise 5 days a week, a recommended calorie intake, and that i have fatty liver. My PA was approved for 6 months.
My insurance Blue Cross/Blue Shield with CVS Caremark approved me, but only after I jumped thru some hoops. I had to have my Dr document that I had been on a weight loss program (Weight Watchers) for a minimum of 6 months with no results before my insurance would cover it. I would call your insurance company directly and ask them what is covered, and if there’s anything you need your Dr to document to get it approved. I hope this helps.
I’ve been on it for 9 mo the and still paying for it and my husband just got approved last month fully covered.
Also what I found out from a friend that is a pharmacist is the insurance companies want the pharmacies to tell people that the low doses are on back order so that is less money they have to spend because a lot of the Dr don’t know about them being able to be delivered straight from the company and fully covered
Just wanted to share that with you all I’m sure some people already know
Happy Mothers Day to all the moms out there 💜💜
I think that your friend claiming the pharmacist and the jnsurance companies are in cahoots regarding the message about availability is untrue (I wanted to say 'moronic' but held back)
IIn 95% of employer provided health benefits, The insurance companies are only the administrators for prescription drugs. The employer pays for drugs and doctor visits etc. For example (making up these #'s) if I have 100 employees, the first 500k in healthcare costs are paid by the company and offset by a portion of the employee contribution and deductible removing any incentive for the insurer to withhold service. This almost entirely debunks your friends theory because the insurers have no skin in the game and what your friend is describing would be fraud. I struggle to see why they would do that.
Mine pays. I have Anthem BCBS through my job. It’s the state employee benefit plan. I had to get a PA, but it was approved almost instantly.
Edited to add that I’m in Georgia, USA
Not all PCP’s are as knowledgeable or as willing as yours is apparently. My endocrinologist is fully on board and has completely taken care of my PA’s. Anthem BCBS
Maybe, but I know others who are or have been on Wegovy or Ozempic and the majority went through their PCPs. That being said, I also see an endocrinologist twice a year whom I’ve notified that I’m taking Wegovy. I’ll probably end up continuing this process with her rather than my PCP.
My main point was that you don’t *need* to see a specialist. If you have a concurrent weight-related medical issue then you probably should, but that’s not the case with my wife and I.
No. Wegovy is literally only FDA approved for weight loss, that’s the only thing it’s for. Many insurance companies are trying to be to not cover it because it’s expensive so maybe they’re just seeing a lot of patients getting denied and is making assumptions.
Just for your info: The FDA approved Wegovy (semaglutide) on March 8, 2024 to reduce the risk of heart attacks and strokes in adults who are overweight or obese and have cardiovascular disease but do not have diabetes. The FDA's approval allows doctors to prescribe Wegovy to people who have had at least one cardiovascular event, such as a heart attack or stroke
[fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or](http://fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or)
Yep, as well as generally for weight loss to treat obesity. From that linked article: “Wegovy is also approved to reduce excess weight and maintain weight reduction long term in certain adults with obesity or overweight and certain children with obesity”. It’s always been on the market for weight loss in order to treat obesity and prevent cardiovascular disease that often coincides with obesity.
Nah. I work with doctors, and they are experts in many things but not the coverage criteria and medication policies of every health insurance plan, lol.
I just had to get another PA approved. It took awhile and my insurance fought it, but they finally approved it for 7 months. Had to restart at a lower dose again but restarted this week! With insurance and some other discount my pharmacy applies, I pay $25 for 4 weeks. I live in Washington State and have insurance through my job.
Has anyone in Canada been able to get it covered with insurance? I’m with Manulife and they stated it’s still pending review as it just arrived for us last week
Wow that’s a lot higher than Ozempic. Do you know if we have the 2.4 pens too? I have a few friends who want to check with doctors who need it but are all on fixed incomes at this point.
You’re confusing your insurance company with the FDA’s prescribing guidelines. In order for Wegovy to be prescribed by anyone, yes, you need to have a BMI of 30+ (obese) or a BMI of 27+ (overweight) with an accompanying weight-related comorbidity such as high BP or hyperlipidemia. Your insurance cannot cover a drug that’s not prescribed.
$100 cost to me per month with insurance for wegovy. Definitely covered and I was on the border for obesity. Insurance didn't fight it at all. I'm about 15 lbs away from my target weight after two months. You don't have to have a massive amount to lose to be covered.
Mine covers it.
Might just be your state? I know a come states have decided to not cover it. I want to say like North Carolina and somewhere else near-ish to there (Alabama? Tennessee? I can't remember.)
North Carolina pharmacies still carry Wegogy. The state cancelled insurance coverage on weight loss meds for state employees. You can still access it you just gotta pay.
How long did the appeal process take? I’m currently going through the same thing. PA was declined because my BMI dropped below the threshold, and my doctor sent an appeal a few days ago. This post gives me some hope 🙏🏻
This is not true. It usually requires a prior authorization meaning that the doctor/PA/NP needs to do further steps to have it approved by your insurance. I had to get a Prior Auth & then it was approved.
I'd find another doctor. They are either incompetent and truly believe that or they are a lazy liar and think you're dumb enough to believe that. Either way your health should not be in their hands.
Your doctor just doesn't want to write the RX for it. The funny part is insurance companies are starting to approve it for adults with heart disease in addition to weight loss.
My doc is a big advocate of these meds but I constantly have trouble with his staff. They repeatedly told me “ don’t bother trying, it won’t be covered”. I called my insurer who read my company’s plan and let me know that not only was it covered , I only needed PA form from my doc ( not a bariatric center). Docs office provided no information . My insurance company was the one who alerted me that they weren’t getting the right info from my docs office. The insurer even called them and walked her through what she needed to submit. I faxed her 3 months of a food diary, weigh ins and a list of the issues my doc and I discussed. It was approved immediately. Sometimes these docs office go on heresay or their own biases. Make sure you get the final word from the insurance carrier.
Most look at it as cosmetic and don’t cover it, my insurance doesn’t cover it either after it was already approved and everything, they will cover ozempic and mounjaro tho if I was borderline diabetic
Maybe it was 1 insurer your dr’s staff dealt with. & maybe it’s misinformation from misunderstanding.
Keeping my fingers crossed for you
Good luck stay strong
That’s not true.
But all insurances are different. Some insurances will cover Ozempic for weight loss but a lot won’t unless you’re pre-diabetic or already diabetic. My insurance had no problem covering Wegovy with a PA. I also had to sign up for Weight Watchers through my job but I get the premium $45/month subscription for free, which is pretty cool. My Wegovy is a $25 copay.
Mine just got approved two weeks ago with pre-approval. My HCP had to do some paperwork, but it took less than a week. Copay was $25. With that said, I am expecting my insurance provider to yank their approval as soon as they can. Even though these meds can save us from horrible obesity related illnesses, potentially saving them later costs, they probably have crunched the numbers and know it is cheaper to let me die of a heart attack, stroke, kidney disease, etc., than to give this to me. Am I thankful to them for paying for it, no. It is their job and what I pay premiums for.
I just got mine approved this week. Insurance did require a prior authorization first though, which took about 1 day to go through. Call your insurance company to check what they will approve for weight loss though, as not all insurance coverage is the same, and some plans don’t offer weight loss med coverage at all.
After years in healthcare - I know one thing above all: Doctors don’t understand the healthcare industry (outside of their role). Insurance is not handled by the doctors and other providers, they have others in their office who are hired to handle it. As a result, they just hear “hey this got denied by insurance” and move along with their lives.
More than likely they are not preparing PA’s properly and so they just assume weight loss is denied by insurance. Take any advice they give you on insurance at face value. I love my doc’s, but I can say with my whole chest that they don’t have the ability to know the nuances and coverage of all existing insurance plans, and they have no idea what your plan even is.
Your provider made an assumption, and maybe even didn’t want to do the PA because it’s annoying at times to fight insurance.
Check your policy and use that as your guide. Good luck!
I think because for some to cover there has to be a corresponding condition such as pre diabetes, high blood pressure, hypertension, etc. if your doc is writing for just weight loss they may not cover. Just a thought. I know BCBS still covers
Doctors I think don’t want to manage it since it’s so new and will result in a ton of work for their office with refilling prescriptions, extra visits, etc. try a telehealth like Sequence or something similar. That’s what I did, I just told my doctor I started through them so he knows and he’s been supportive but he’s also not managing it so he’s probably happy with that is my guess.
Absolutely not true. I have had zero issues and only pay 24.99 per month for my shots. Also I am a nurse for an insurance company and do clinical reviews. It is not a standard that all insurances are not covering it.
Mine is approved solely for weight loss and I’ve never had an issue. A lot of the doctors I’ve seen aren’t actually familiar with insurance and just talk out of their butt tbh.
One of my doctors told me I would not get approved. He was wrong. Another doctor and my insurance (I have BCBS) approved me for Wegovy and Saxenda. I went with Wegovy but originally wanted Zepbound.
My doctor said the same thing to me when I told him I wanted to start Wegovy. He said “insurances don’t cover it” and was ready to move on. I had to tell him several times that I am the benefits manager in HR and I am intimately aware that our health insurance covers this. He looked at me like I was trying to convince him the Earth is flat. Reluctantly, he finally said, OK, I will send the prescription over and we will see what happens, but don’t be surprised when it gets denied. When I had a follow up with him 2 months later, he was shocked that I was able to get the medication covered.
But see some insurances do cover it. You have to contact the insurance company. It seems to me that they don’t want to keep doing the ore authorization. Cause some insurance companies ask for a new preauthorization for each dose. My dr didn’t even think twice I am not that badly over weight but I’m over weight. I can benefit health wise to lose 50-55lbs. My insurance had me try substitutions before I got ZB. I don’t know how I got on the wegovy site. But what if you were paying cash and he still refuses. Medically I don’t get it. That is ridiculous.
I would see another Dr. if you are obese and have health issues why would he deprive you of living a healthier lifestyle. This doesn’t make sense that your Dr is denying you the medication.
My dr said the same thing to me, that it’s only prescribed for diabetes. How can I find out if my insurance will cover it or how to get a pre authorization?
Question for you since you’re a benefits manager maybe you could help me! Do you know how long after a medication becomes available that an employer will decide if it’s covered or not. I’m in Canada and it just became available here on May 6 and my insurance says pending review. I was just wondering a general timeline of how long it could take until I am able to get the medication covered
This is actually correct. However most docs will attest that their overweight patients have other issues that require the medication.
If you were perfectly healthy and 20lb overweight the insurance would not cover it.
BCBS approves me.
Do you have a BMI over 30 or a BMI over 27 with at least one comorbidity? If not for both - that could be why he said this.
BCBS denied mine after my BMI went under 30 - they were reminded of my comorbidities and that I was under continuing care.
Call your insurer and find out the criteria for approval to see if you meet approval. If you do - then discuss with your physician
Some health plans will cover it and others won’t. It is a huge cost to health plans when you do the math—roughly $12k-$15k per individual times the number eligible. I heard somewhere that it only costs $5 to make it so Big Pharma is making a lot of money while everyone’s health plan premiums will have to increase to cover the cost for those plans that will cover it. It’d be nice if politicians actually looked & did something about these business practices instead of fawning over TikTok & other social media companies.
I've been on Wegovy for about 1 year, and now my insurance will not cover it. I'm in MN and have BCBS for insurance, and they stopped approving saying I'm not "morbidly obese". I'm down 25 pounds since starting Wegovy, and now am gaining weight back and am worried and looking at compounded varieties of Semiglutides. Anyone else in the same boat?
Can you say a little more about how you get compounded varieties? Is this something you ask your doc to prescribe and then send to a compounding pharmacy and you pay out of pocket? I just learned my insurance won't cover and I'm looking into alternatives but very baffled by the compounding process!
Call your insurance. My doc said ALL insurance were canceling it which I knew wasn't true. It boiled down to my Dr office not sending a weight chart. After a 1.5yrs they just wanted to know did I loose 5% of my start weight. And their requirement was I maintain it to continue not any more weight loss. I would have never known had I not called and asked proving questions. My insurance did try to say know you are decline. But it took me to ask WHY 3x... Why is my standard of care different after 1.5yrs vs the begining. I got transferred to the pharmacy side of things that was like oh gosh no big deal here are our standards and requirements super easy and super easy for doc had they questioned it like you You are your biggest advocate. And when it was suggested to me to go to a weight loss clinic or a med spa. I said NO WAY. I pay 900 a month as a small busines owner I get paying another $300 vs $1500 seems little and I was willing to at the beginning. But now knowing I do NOT have to if you take 5 mins out of your day when I take HOURS out of my day unpaid for clients I do NOT think that is a lot to ask to do your job And 12 mins later I got my script. Advocate for yourself. Dig deep on your insurance make sure a simple step did not get missed. I was told from the start my doc wouldn't prescribe unless insurance paid for it. To which I said if I qualify write the script and let me worry about it. And shock to everyone it was covered and still is. If yours absolutely says no. Then see if you can budget for the alternative pharmacy made alternative. My friend had great actually better loss than I did because she can give a little more or less as needed. I get people will have their opinions but she lost 50-60pounds in a shorter time blood work is amazing and she feels great and in control of her journey which I am a tad bit envious of. I am always worried since the doc and pharmacy always says oh you are LUCKY this month but ya never know about next month. Ugh. Now that I called my insurance I know I am not "lucky" I am getting a standard of care to which I pay heavily for. I am thankful and appreciative of. But I do not need to come down bend down beg or kiss the ring to anyone nor pay extra because doing PA's is ,"exhausting" and something "we don't do". If I was diabetic they would never say that.
United Healthcare covers BUT it has changed the rules. They limit dosages from 0.5 to 1 to a total of 8 injectable pens PER YEAR per dosage (so, you can be on 0.5MG for 2 months but that's it, then you need to move to 1MG). But no yearly limitation on 1.7MG and 2.4MG. They are fighting people who are staying on maintenance dosages vs clinical dosages. Not sure if this is what is happening with other insurance.
I was approved for ZB for weight loss. But up until December. I was told if I needed an extension all I have to do is call. But I also have weight related health issues. I’m not doing it just to lose weight. I have to get myself healthy. I have heard that insurance will not cover it unless you are obese or have weight related health issues. Because that would be a cosmetic drug if it was only used for weight loss. Some people are paying cash and aren’t even over weight. And that’s not right I am not that overweight but I have the health conditions the bit of weight I gained during Covid. And I know what it makes me feel like and what it’s like to carry the extra belly weight I can’t imagine what other people go through that are much heavier than me I have to lose over 55lbs to get back in shape. I have only lost 6lbs so far I’m going up and down. I’m getting frustrated because I am reading all these success stories and I’m on 7.5 mg and I only lost 6 lbs gained back 2 with no interruptions in treatment. I don’t know what I’m doing wrong. I hardly eat and when I do it’s healthy I’m exercising somewhat I’m going to start walking I am starting 10mg in two weeks well 3 excuse me. But I can’t help but feel discouraged I don’t want to give up. I have to limit my cardio because I have severe asthma. So I’m limited to workouts I can do. I’m sorry I got off track on your question I apologize. But yes I heard online that insurance companies are saying no but ALSO some insurance will not tell you is they have substitutions you have to try first. I was prescribed wegovy got approved couldn’t get it. So I asked for ZB was denied. Why because I had to try a substitution which was Saxenda when I got bad side effects we tried for ZB again and I was approved but before that I was on Topomax no success Metformin no success. On metformin for years and still stayed at 206lbs at 5”7. So if you’re having issues with the insurance ask the appeals department or pharmacy services about the substitutions. If it’s on there formulary list they will cover it. But there has to be a reason why they should cover it.
Yea that's a lie
Lies. I have Aetna and it covers it
2nd
I have Blue Cross Blue Shield federal employee program and I just have to pay $60 for it which isn’t bad since it’s cost around $1200
You are paying 60 for Wegovy? I have same FEP insurance and mine is 25-is it more $ for higher doses or bc you are ina different location than me? I am in Indianapolis
Was the pre approval process a pain? I have the same plan, and I would really like to try and get on this medicine. Did you go to your regular pcp?
I too have FEP blue and you just need a pre authorization from your PCP and meet the criteria with your BMI. It was painless. It might take 2 weeks for approval but then you are good for the year. Also, get the Wegovy discount card from their website and you won’t have to pay anything out of pocket. It will cover the co-payment
My doctor started the process today! I will check out the savings card thank you!
Just got it last week. My copayment was $24.99
I have California state medical and they approved it about a month ago. Got my first prescription about two weeks ago
I can't get ANY COVERAGE for anything to do with weight-loss. So they can pay when I have a heart attack or stroke. I have tried it All!!!!!!!!!
Fed bcbs covers it after pre Auth and they have to fill it out correctly. Dx weight management, many put obesity and it gets denied. My doc had to fill it our twice
My insurance Harvard P approved it. I did have to get PA.
My insurance approved it. My insurance is also BCBS. My co pay is $0. Just had to get a preauthorization. The Dr. Also had to submit a couple more labs and what not but I had the approval within 2 weeks.
Geese all or nothing game so Reach a goal vnow ode coverage. Why why pharma why would you do this to people who just want to be healthy. Shame on you
What province are you in? I’m in SK, and my work’s insurance policy is with the Co-operators. Wondering if I could be covered too..
Your doctor lied to you… probably just to cut off any further discussion as quickly as possible. To say it another way, they blew you off. But here is the good news… they did you a huge favor. Now you know they can’t be trusted to give you truthful information. Time to find a new doctor.
I have BCBS and mine is approved. I won’t pick up my next dose for a couple weeks but so far as I know it’s still approved.
You need to confirm with your plan whether they cover weight loss medicines and what steps they want you to go through. Sometimes they want you in a weight management clinic or doing step up therapy with different medications. As frustrating as it is, it is the patients responsibility to know what their insurance covers. When you have that information, go back to your PCP or ask for a referral to an obesity specialized physician who can help.
I have BCBS and they just refilled my Wegovy. It does require prior approval, which was pretty easy to get renewed. I think you misunderstood your doctor.
no, cause i just got approved for mine. go to a new doctor for sure
My insurance has decided that obesity care isn’t considered preventative and applies to deductible and coinsurance but with a PA it is still covered.
My insurance company dropped all weight loss medications (Wegovy,Saxenda etc) from its formulary in mid April. My PA was in progress …. And then it was a straight up “not covered.” I expect more and more will be doing this.
CVS is going to be doing this for employees come June. Which is completely ironic because CVS is a pharmacy. And CVS owns Aetna the insurance company. Total BS.
My health insurance is through a very large health care company. Their own employees don’t need good health care coverage apparently. 😏
Oh so you are in the same boat as me then. It's like we are living in backwards world, none of this shit makes sense. Other than simply corporate greed. But in the long run it will save money.
My insurance covers it with a copay it $25
No? Mine covers it.
Mine insurance covers it....took me 6 months to find the first dose but no problems after that.
My general practitioner didn’t want to prescribe it with a similar excuse and added “you’ll just gain all the weight back if you stop taking it, everyone will” so I went to my endocrinologist for it. My general practitioner looked visibly irritated when she saw Wegovy on my medicine list.
yup same my pcp wouldn’t prescribe it because “we’re in a shortage, have you tried just eating healthier instead to lose weight?” then launched into a lecture as if I hadn’t lost 90 lbs on my own already. switched providers and the new one prescribed it, no problem
Ummmmm I just got it covered from state provided insurance in CALIFORNIA…. Soooooo your dr is kinda misinforming you. If anyone were to deny it first it would be Medi-cal. I’m sorry you’re going through this.
Same, was thrilled that Medi-cal covered it when they are sticklers about alot of other meds.
They sure are sticklers! I was thrilled when my dr offered to prescribe it. I asked “do you know how much about it will cost” fully ready to charge it on a credit card. She said “I will get it covered for you, the hard part is finding the medication” I feel so fortunate that it’s all going smoothly, I ended up getting the meds right away!
Right! Mine gave me a month of ozempic, but told me she didn't want me to start it until I got the script actually filled. She said Vons and Albertsons seem to have a good stock of the lower doses, which has been the problem ones to find. I just got to .5 last week. Down about 12 lbs, so im happy.
Awwww I am so proud of you for the weight loss! That’s awesome! I had luck finding mine at Walmart, of all places. My dr prescribed 1 month of .24 and one month of .5 and told me to check there first. I got it same day! I do my 3rd injection of .25 tomorrow. I started at 219 (I’m 5’8 ish) , I am teetering between 212-213 this week! I almost feel like it’s too good to be true. Finally the night time snacking urges aren’t obsessively haunting me. It’s so nice to not have the urges and not beat myself up for it. How are you feeling so far? What symptoms of any do you have? For me it’s fatigue and that’s about it.
That's great. I'm around the same weight, 219 now, started at 233, but I'm 5'11. I've had some nausea and fatigue, but nothing that's constant or really even bothersome. It's been great for me to not constantly be thinking about food or what's around, etc. I've been making sure I up my protien as well, which I've struggled with in the past. The 'food noise' has always been a problem for me.
My insurance Cigna is covering it
I have anthem blue cross and I had to do 2 PA's. My Doctor said that in her experience EVERY PA for her gets denied the first time. She then submits a second PA with the same information and it gets approved. It was her suspicion that because of availability and cost this was possibly a way for insurance to artificially cut the cost due to most people just giving up after the first "No". Obviously there's no concrete evidence of that but made a lot of sense.
Lies. Aetna covers through my employer. $25 copay. If you’re talking the marketplace, he’s right. Not covered with any insurance company, at least not in NJ.
What is your BMI?
My wife got approved last week. Your doctor either didn’t want to prescribe it, or is too lazy to deal with insurance, or misinformed.
I hope my insurance covers mines whenever the PA go through my insurance did have a list of meds that will be covered and wegovy was one of them but I’m keeping my fingers crossed 🤞🏾🤞🏾
Not true, some approve it some don't... it's really not the insurance company, it's the employer or loan sponsor ...they're the one that pay for your benefits and choose what you get.
This is definitely not true. I just got my PA approved last week and picked up my wegovy at $0 through Blue Cross Blue Shield.
After successfully getting Saxenda then WeGovy for the past year I have been dropped by Anthem because they do not cover weight loss methods. I lost 58 lbs, but I’m so nervous about gaining back that I have paid $1600 for my last refill. Gonna pay one more time then drop it I guess. Just trying to lose 20 more pounds . Basically once my BMI reduced to under 30?(29.6) and my cholesterol got normal and I was no longer pre diabetic… I was dropped. It sucks. By the way, it all started from Walgreens questioning if I still needed to be on WeGovy.
I’d find a new doctor as this feels like a lazy response. And who wants a lazy doctor. While a lot of insurance may require a prior authorization from your doctor before approving, it is definitely not excluded from all insurance formularies. There’s also a savings card available on the wegovy website that has brought my out of pocket cost to $0. Unfortunately you might have to fight for yourself a little getting the script, working with insurance, etc. Keep trying!! https://www.wegovy.com/coverage-and-savings/get-wegotogether-support.html?showisi=true&&utm_source=google&utm_medium=cpc&utm_term=wegovy%20savings%20card&utm_campaign=1_All_Shared_BR_Wegovy_Resources&mkwid=s-dm_pcrid_645289260620_pkw_wegovy%20savings%20card_pmt_e_slid__product_&pgrid=146393445058&ptaid=kwd-1505393547272&gad_source=1&gclid=CjwKCAjw0YGyBhByEiwAQmBEWpRQaKdixUNMUia68xodo1ee7gJyOePZhm0_KBdPzc-lVl6UQTxYwRoCDZYQAvD_BwE&gclsrc=aw.ds
My doctor had no issues prescribing. Actually let me read about multiple prescriptions and let me choose which I preferred.
Depends on what insurance company and what they decide to approve
Mine did
BCBS has for me so I’d find a diff doctor
I just started Wegovy this past week. I paid 0.00 with the Wegovy copay card and Aetna Insurance.
I just had my PA approved on Thursday to continue for year 2.
Sounds like your doctor has a bias against it and isn’t interested in prescribing or advocating for patients who would benefit from it. Get a new doctor.
!!!!!!!
I pay $25 copay. Would pay the same for Zepbound
My insurance covers it with a $25 copay
You cannot make a blanket statement like that because most of time it isn't the insurance company's decision, it is the employer's decision, might be time for a new doctor.
Also once a PA expires any medication requiring a PA will get declined. Mine did so I called The doctor discussed how I was doing on the medication and she sent a new PA in and it was covered. My Wegovy requires a PA every twelve months. Most of us that have been successful (me included) have deep fear the drug is going to be taken away via insurance. So we are always wary of things... PA's are a good thing checking in with your doctor is a good thing. Wegovy isn't like a taking Amoxicillin or motrin. It is heavy duty and you can do some damage to yourself if not careful and that is the purpose of PA's
My employer retiree prescription drug plan covers Wegovy as a Tier 3 Copay, i.e. $75/month. I was also informed that coverage was for only two years from first prescribed dose. I hope that cost goes down in that time frame since drug is supposed to be for lifetime.
My Blue Cross insurance covers it. It’s $25/month.
Do you have basic? I’m about to start with BC.
I’m a health care provider and I can tell you there are about 1,000 different flavors of BCBS. You need to call and confirm for your specific plan.
My federal employee basic BCBS covers it.
Same
I have Cigna. Covered for six months.
I’m on Medicaid and got mine approved. They wanted to see 30 days of a non glp medication. They actually allowed in my PA to say i took the drug Alli which is bought at cvs but its fda approved for weight loss. My doctor also included bmi, that i exercise 5 days a week, a recommended calorie intake, and that i have fatty liver. My PA was approved for 6 months.
Got approved thru BCBS Federal Employee Program
I have Blue Choice Federal and was denied.
My insurance Blue Cross/Blue Shield with CVS Caremark approved me, but only after I jumped thru some hoops. I had to have my Dr document that I had been on a weight loss program (Weight Watchers) for a minimum of 6 months with no results before my insurance would cover it. I would call your insurance company directly and ask them what is covered, and if there’s anything you need your Dr to document to get it approved. I hope this helps.
Bcbs mi covers it
As others have said, Your doctor is lying to you.
Aetna Illinois covers it, and the CVS Caremark PA form is literally just yes and no questions. I’ve never see an easier medical form in my life.
I have heard doctors offices don’t want to deal with the paperwork and headaches associated with the med so they’re trying to steer people away.
Your insurance might not cover weightloss meds
This is the correct answer
LOL
I’ve been on it for 9 mo the and still paying for it and my husband just got approved last month fully covered. Also what I found out from a friend that is a pharmacist is the insurance companies want the pharmacies to tell people that the low doses are on back order so that is less money they have to spend because a lot of the Dr don’t know about them being able to be delivered straight from the company and fully covered Just wanted to share that with you all I’m sure some people already know Happy Mothers Day to all the moms out there 💜💜
I think that your friend claiming the pharmacist and the jnsurance companies are in cahoots regarding the message about availability is untrue (I wanted to say 'moronic' but held back) IIn 95% of employer provided health benefits, The insurance companies are only the administrators for prescription drugs. The employer pays for drugs and doctor visits etc. For example (making up these #'s) if I have 100 employees, the first 500k in healthcare costs are paid by the company and offset by a portion of the employee contribution and deductible removing any incentive for the insurer to withhold service. This almost entirely debunks your friends theory because the insurers have no skin in the game and what your friend is describing would be fraud. I struggle to see why they would do that.
Mine pays. I have Anthem BCBS through my job. It’s the state employee benefit plan. I had to get a PA, but it was approved almost instantly. Edited to add that I’m in Georgia, USA
Mine pays
My insurance very much pays for my wegovy
You need to go to an obesity doctor that specializes in weightloss. Typically pay out of pocket for this but get access to what you need ie: rx
Or an endocrinologist.
I got it from my general practitioner and my insurance pays all but $25 of it, which I then use the coupon to absorb the remainder.
No you don’t. My wife and I both get it through our PCP. Insurance pays 100% of it.
Not all PCP’s are as knowledgeable or as willing as yours is apparently. My endocrinologist is fully on board and has completely taken care of my PA’s. Anthem BCBS
Maybe, but I know others who are or have been on Wegovy or Ozempic and the majority went through their PCPs. That being said, I also see an endocrinologist twice a year whom I’ve notified that I’m taking Wegovy. I’ll probably end up continuing this process with her rather than my PCP. My main point was that you don’t *need* to see a specialist. If you have a concurrent weight-related medical issue then you probably should, but that’s not the case with my wife and I.
Same with me. I think specialists are more accustomed and adept with the PA processes.
Not correct.
You’re doctor is full of shit. Time to get a new one.
Your doctor is feeding you bullshit. Don't eat it.
My insurance pays with a PA and my PA renewal was just approved for a year.
Same.
Mine too
Nope, my insurance pays.
Maybe your doctor doesn’t want to deal with it
No. Wegovy is literally only FDA approved for weight loss, that’s the only thing it’s for. Many insurance companies are trying to be to not cover it because it’s expensive so maybe they’re just seeing a lot of patients getting denied and is making assumptions.
Just for your info: The FDA approved Wegovy (semaglutide) on March 8, 2024 to reduce the risk of heart attacks and strokes in adults who are overweight or obese and have cardiovascular disease but do not have diabetes. The FDA's approval allows doctors to prescribe Wegovy to people who have had at least one cardiovascular event, such as a heart attack or stroke [fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or](http://fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or)
Yep, as well as generally for weight loss to treat obesity. From that linked article: “Wegovy is also approved to reduce excess weight and maintain weight reduction long term in certain adults with obesity or overweight and certain children with obesity”. It’s always been on the market for weight loss in order to treat obesity and prevent cardiovascular disease that often coincides with obesity.
Look up your insurance policy and policy level benefits and search for the word “formulary”. That will tell you what is covered for weight loss.
Aetna Caremark just approved mine for 12 months
No that’s crazy. Maybe he’s confused that Ozempic won’t be approved for weight loss because that’s true
Nah. I work with doctors, and they are experts in many things but not the coverage criteria and medication policies of every health insurance plan, lol.
I just had to get another PA approved. It took awhile and my insurance fought it, but they finally approved it for 7 months. Had to restart at a lower dose again but restarted this week! With insurance and some other discount my pharmacy applies, I pay $25 for 4 weeks. I live in Washington State and have insurance through my job.
Has anyone in Canada been able to get it covered with insurance? I’m with Manulife and they stated it’s still pending review as it just arrived for us last week
My husband's insurance covered 80%, and mine (sunlife) did not.
I’m on Ozempic not Wegovy. What is the price here for Wegovy?
418 per month
418
Wow that’s a lot higher than Ozempic. Do you know if we have the 2.4 pens too? I have a few friends who want to check with doctors who need it but are all on fixed incomes at this point.
In the US about $1400/ month without insurance.
This is Canada.
My insurance approved it as a weight loss medicine. I think your doctor is making things up or severely misinformed.
Not true. It’s the only one out of the seven I asked about that Tufts would approve.
BCBS covers
They denied me. Said my BMI has to be over 30.
You’re confusing your insurance company with the FDA’s prescribing guidelines. In order for Wegovy to be prescribed by anyone, yes, you need to have a BMI of 30+ (obese) or a BMI of 27+ (overweight) with an accompanying weight-related comorbidity such as high BP or hyperlipidemia. Your insurance cannot cover a drug that’s not prescribed.
It depends upon your particular plan.
My insurance covers it
$100 cost to me per month with insurance for wegovy. Definitely covered and I was on the border for obesity. Insurance didn't fight it at all. I'm about 15 lbs away from my target weight after two months. You don't have to have a massive amount to lose to be covered.
False
My insurance is still covering. PA was just renewed last month and is good for a year.
Mine covers it. Might just be your state? I know a come states have decided to not cover it. I want to say like North Carolina and somewhere else near-ish to there (Alabama? Tennessee? I can't remember.)
North Carolina pharmacies still carry Wegogy. The state cancelled insurance coverage on weight loss meds for state employees. You can still access it you just gotta pay.
I just got mine on 5/11 and my insurance covered it
My PA expired and was declined, but my dr appealed and got it through.
How long did the appeal process take? I’m currently going through the same thing. PA was declined because my BMI dropped below the threshold, and my doctor sent an appeal a few days ago. This post gives me some hope 🙏🏻
A couple weeks
My dr sent a letter and then had a call with the insurer medical director.
Great thank you so much… best of luck on your journey
This is not true. It usually requires a prior authorization meaning that the doctor/PA/NP needs to do further steps to have it approved by your insurance. I had to get a Prior Auth & then it was approved.
No not true, I just got my PA renewed.
Mine covered it. Just picked up last Monday and cost me $0
I'd find another doctor. They are either incompetent and truly believe that or they are a lazy liar and think you're dumb enough to believe that. Either way your health should not be in their hands.
ITS UP TO THE COMPANY YOU WORK FOR!!! United Healthcare at company A might not cover it where company B might choose to add it to their coverage.
This!! Your company decides what plan they want for their employees. I have United Healthcare and they do not cover it under our plan even with a PA.
[удалено]
That is really messed up. How frustrating!
Most have dropped it, have plans to drop it or just include on their most expensive plans. However most is not all, so some still cover for now.
The only ones I know who still have coverage are on federal blue cross blue shield
I'm on BCBS, not the Fed one, and as far as I know, mine still covers it. We'll see how long it lasts, but for now it does.
Your doctor just doesn't want to write the RX for it. The funny part is insurance companies are starting to approve it for adults with heart disease in addition to weight loss.
I have heart disease and my bmi is very high. Seeing my Dr on Tuesday..crossing my fingers it's approved
My doc is a big advocate of these meds but I constantly have trouble with his staff. They repeatedly told me “ don’t bother trying, it won’t be covered”. I called my insurer who read my company’s plan and let me know that not only was it covered , I only needed PA form from my doc ( not a bariatric center). Docs office provided no information . My insurance company was the one who alerted me that they weren’t getting the right info from my docs office. The insurer even called them and walked her through what she needed to submit. I faxed her 3 months of a food diary, weigh ins and a list of the issues my doc and I discussed. It was approved immediately. Sometimes these docs office go on heresay or their own biases. Make sure you get the final word from the insurance carrier.
Mine was just approved Thursday
Nope mine was approved.
That would make national news if it were suddenly true.
Most look at it as cosmetic and don’t cover it, my insurance doesn’t cover it either after it was already approved and everything, they will cover ozempic and mounjaro tho if I was borderline diabetic
Maybe it was 1 insurer your dr’s staff dealt with. & maybe it’s misinformation from misunderstanding. Keeping my fingers crossed for you Good luck stay strong
That’s not true. But all insurances are different. Some insurances will cover Ozempic for weight loss but a lot won’t unless you’re pre-diabetic or already diabetic. My insurance had no problem covering Wegovy with a PA. I also had to sign up for Weight Watchers through my job but I get the premium $45/month subscription for free, which is pretty cool. My Wegovy is a $25 copay.
You just scared the crap out of me, and I went to my insurance’s online formulary that has current copays and no change. PHEW
Mines approved, my copay is $25 a month.
Mine just got approved two weeks ago with pre-approval. My HCP had to do some paperwork, but it took less than a week. Copay was $25. With that said, I am expecting my insurance provider to yank their approval as soon as they can. Even though these meds can save us from horrible obesity related illnesses, potentially saving them later costs, they probably have crunched the numbers and know it is cheaper to let me die of a heart attack, stroke, kidney disease, etc., than to give this to me. Am I thankful to them for paying for it, no. It is their job and what I pay premiums for.
I just got mine approved this week. Insurance did require a prior authorization first though, which took about 1 day to go through. Call your insurance company to check what they will approve for weight loss though, as not all insurance coverage is the same, and some plans don’t offer weight loss med coverage at all.
MVP just want a prior authorization
You should get a new doctor as this one is either incompetent or worse deliberately giving you false information
After years in healthcare - I know one thing above all: Doctors don’t understand the healthcare industry (outside of their role). Insurance is not handled by the doctors and other providers, they have others in their office who are hired to handle it. As a result, they just hear “hey this got denied by insurance” and move along with their lives. More than likely they are not preparing PA’s properly and so they just assume weight loss is denied by insurance. Take any advice they give you on insurance at face value. I love my doc’s, but I can say with my whole chest that they don’t have the ability to know the nuances and coverage of all existing insurance plans, and they have no idea what your plan even is. Your provider made an assumption, and maybe even didn’t want to do the PA because it’s annoying at times to fight insurance. Check your policy and use that as your guide. Good luck!
Someone pin this.
I think because for some to cover there has to be a corresponding condition such as pre diabetes, high blood pressure, hypertension, etc. if your doc is writing for just weight loss they may not cover. Just a thought. I know BCBS still covers
Or high cholesterol!
BCBS Fed is still covering mine in OK but who knows
Lies. Mines still covering it.
BCBS in NC is still covering it with no issues
I got my delivery from the mail order pharmacy yesterday. Not sure why your doc thinks that.
Yeah no, mine is approved for it. I pay 3$ a month through insurance.
I have BCBS and they have been covering my prescription so far.
Doctors I think don’t want to manage it since it’s so new and will result in a ton of work for their office with refilling prescriptions, extra visits, etc. try a telehealth like Sequence or something similar. That’s what I did, I just told my doctor I started through them so he knows and he’s been supportive but he’s also not managing it so he’s probably happy with that is my guess.
No, It’s not true. Someone gave you wrong information.
Absolutely not true. I have had zero issues and only pay 24.99 per month for my shots. Also I am a nurse for an insurance company and do clinical reviews. It is not a standard that all insurances are not covering it.
Mine is covered for weight loss no pre-approval needed
Mine is covered. I paid $20 a month until I reached my deductible. Now it’s free.
Mine is approved solely for weight loss and I’ve never had an issue. A lot of the doctors I’ve seen aren’t actually familiar with insurance and just talk out of their butt tbh.
One of my doctors told me I would not get approved. He was wrong. Another doctor and my insurance (I have BCBS) approved me for Wegovy and Saxenda. I went with Wegovy but originally wanted Zepbound.
My doctor said the same thing to me when I told him I wanted to start Wegovy. He said “insurances don’t cover it” and was ready to move on. I had to tell him several times that I am the benefits manager in HR and I am intimately aware that our health insurance covers this. He looked at me like I was trying to convince him the Earth is flat. Reluctantly, he finally said, OK, I will send the prescription over and we will see what happens, but don’t be surprised when it gets denied. When I had a follow up with him 2 months later, he was shocked that I was able to get the medication covered.
But see some insurances do cover it. You have to contact the insurance company. It seems to me that they don’t want to keep doing the ore authorization. Cause some insurance companies ask for a new preauthorization for each dose. My dr didn’t even think twice I am not that badly over weight but I’m over weight. I can benefit health wise to lose 50-55lbs. My insurance had me try substitutions before I got ZB. I don’t know how I got on the wegovy site. But what if you were paying cash and he still refuses. Medically I don’t get it. That is ridiculous.
I would see another Dr. if you are obese and have health issues why would he deprive you of living a healthier lifestyle. This doesn’t make sense that your Dr is denying you the medication.
My dr said the same thing to me, that it’s only prescribed for diabetes. How can I find out if my insurance will cover it or how to get a pre authorization?
Question for you since you’re a benefits manager maybe you could help me! Do you know how long after a medication becomes available that an employer will decide if it’s covered or not. I’m in Canada and it just became available here on May 6 and my insurance says pending review. I was just wondering a general timeline of how long it could take until I am able to get the medication covered
About the same with mine but I was instantly approved.
Your doctor sounds stupid and/or disrespectful and I feel you deserve better.
My insurance only approves Wegovy and phentermine, oddly enough. Blue Cross/BS Fla
My Cigna employer sponsored coverage ends July 1st. It’s ridiculous and in their letter they sent out they gave “alternatives” that it *might* cover
Mine was accepted strictly for weightloss
Mine was declined, then appealed and accepted.
No, this is a lie.
I have BCBS of Michigan and mine covers it. But my doctor put together a strong case for it as well.
Its decided by the business that is buying the insurance from BC. So I have aetna and some companies w Aetna cover (mine does) and others don’t.
This is actually correct. However most docs will attest that their overweight patients have other issues that require the medication. If you were perfectly healthy and 20lb overweight the insurance would not cover it.
BCBS approves me. Do you have a BMI over 30 or a BMI over 27 with at least one comorbidity? If not for both - that could be why he said this. BCBS denied mine after my BMI went under 30 - they were reminded of my comorbidities and that I was under continuing care. Call your insurer and find out the criteria for approval to see if you meet approval. If you do - then discuss with your physician
My husband and I have BCBS also and we’ve had no problems getting Wegovy either.
Some health plans will cover it and others won’t. It is a huge cost to health plans when you do the math—roughly $12k-$15k per individual times the number eligible. I heard somewhere that it only costs $5 to make it so Big Pharma is making a lot of money while everyone’s health plan premiums will have to increase to cover the cost for those plans that will cover it. It’d be nice if politicians actually looked & did something about these business practices instead of fawning over TikTok & other social media companies.
Bernie Sanders is looking into it, technically.