What Insurance Covers Wegovy? Insurance Coverage of the Weight Loss Medicine 

Wegovy, or semaglutide, is one of the most highly written weight management prescription medications chronically in adults with obesity and overweight and co-morbidities in the past few years.  

Wegovy first was approved by the U.S. Food and Drug Administration (FDA) in 2021. Wegovy does this by mimicking a hormone called GLP-1 (glucagon-like peptide-1) that decreases appetite and food intake.  

It’s been shown to be adequately effective, but at a $1,300-per-month or more, cash-outlay price tag, it’s a make-or-break matter for millions whose coverage is in limbo.  

So, how much does insurance coverage for Wegovy cost? And how do you improve the odds of being covered?  

This report answers all of them.   

Key Points:  

• Wegovy insurance coverage is very diversified among insurance carriers, work-site plans, and Medicaid programs state by state.  

• Most Medicare plans won’t cover Wegovy because of federal limits on weight loss medications.  

• Some commercial insurance plans will cover Wegovy, particularly for use to treat a condition (e.g., obesity with comorbidities).  

• Prior authorization and medical documentation will probably be needed.  

• Savings programs, copay cards, and appeals processes can help lower out-of-pocket expenses. 

Wegovy (semaglutide 2.4 mg) is a once-weekly injectable GLP-1 receptor agonist. It’s used in adults who are:  

• Overweight (BMI ≥27), or  

• Obese (BMI ≥30), with at least one weight concern condition like:  

• Type 2 diabetes  

• High blood pressure (hypertension)  

• Elevated blood lipids (dyslipidemia)  

• Sleep apnea  

Wegovy is not intended for cosmetic weight loss and should be used widely as part of an overall weight management program that includes diet, exercise, and behavior modification.  

Why Insurance Coverage Matters  

Wegovy’s out-of-pocket expense is around $1,349.02 per month (up to 2025), which is more than $16,000 for a year’s supply.  

For most, it’s not something they can afford to pay out of pocket, so insurance coverage is essential. Here’s the deal with coverage on private insurance, employer-sponsored plans, Medicare, or Medicaid.  

Private & Employer-Sponsored Insurance Coverage  

Some Plans Do Cover Wegovy  

Most private insurance plans, especially those provided by large employers, now cover anti-obesity drugs like Wegovy—especially when prescribed for obesity and other related conditions.  

There are a few exceptions, however:  

• Preapproval is usually required for coverage.  

• Your physician will need to write a letter of medical necessity.  

• Plans will only pay if you’ve already attempted other weight-loss treatments first.  

Knowing If Your Plan Covers Wegovy  

1. Call your insurer yourself and ask:  

• “Do you cover Wegovy (semaglutide 2.4 mg) for weight management in obese or overweight patients?”  

• “Is prior authorization required?”  

• None  

• “Is Wegovy formulary tier X, Y, Z, or non-preferred?”  

• “Is there any restriction (comorbidities, BMI, etc.) on the utilization of this medication?”  

2. Review your policy documents under:  

• “Prescription drug benefits”  

• “Exclusions”  

• “Weight loss medications”  

3. Click the Wegovy Coverage Checker on the official Wegovy website for plan details regarding coverage.  

What Insurance Companies Can Reimburse for Wegovy  

Where availability is dependent on the employer and state plan, these are among some of the largest insurance carriers that should be offering coverage for Wegovy, depending on the details of your plan:  

Always call your plan carrier since coverage differs significantly by location and group agreement.  

Does Medicare Cover Wegovy?  

To our knowledge, Medicare does not cover Wegovy for weight loss.  

This is because of a federal law (Section 1860D-2(e)(2)(A)), which does not include weight loss drugs in Medicare Part D.  

Although Medicare has announced obesity as a chronic disease, Medicare goes ahead to announce weight loss drugs as lifestyle drugs instead of mandatory drugs.  

• If you have Medicare Advantage, check your plan and see if it includes supplemental drug coverage that will pay for GLP-1 diabetes drugs like Ozempic but not Wegovy.  

• Call your congressional representatives and call for reversible federal policy to stop weight loss medicine exclusions.  

Medicaid Wegovy Coverage  

State-by-State Coverage  

Medicaid programs are state administered, so Medicaid Wegovy coverage can vary widely across America.  

Medicaid Covered States (through 2024-2025):  

• California  

• New York  

• Massachusetts  

• Illinois  

• Pennsylvania  

• Washington  

• New Jersey  

These have coverage if there is a clear set of medical conditions met, which are:  

• Documentable obesity diagnosis  

• History of trial and failure at other treatments  

• Underlying condition  

The States that Usually Don’t Pay for Wegovy:  

• Texas  

• Florida  

• Georgia  

• Alabama  

If you must go through getting the Wegovy treatment as a Medicaid recipient, you would:  

1. Call your doctor and inquire if you would be approved on a medical basis.  

2. Consult your state Medicaid formulary.  

3. Attempt to fill out an appeal or prior authorization request.  

Wegovy Prior Authorization  

Prior authorization normally is needed by most health insurances to be covered with Wegovy. Pre-coverage review of records.  

This is what you’ll want to have handy:  

What You’ll Need  

• BMI documentation: Typically should be ≥30, or ≥27 with comorbidities.  

• Medical necessity documentation for weight condition: Diabetes, HTN, OSA, etc.  

• History of previous attempts at weight loss: Diet, exercise, other medications, etc.  

• Medical necessity letter: Prescribing physician signature.  

Your doctor will likely get your doctor to sign this for you, but it will be worth it if you preread your treatments and medical history in hand beforehand.  

Saving Money on Wegovy When Insurance Won’t Pay  

Even without insurance, you can save on the price of Wegovy:  

1. Wegovy Savings Card (Copay Card)  

Novo Nordisk offers an savings card for qualified commercially insured patients.  

• $0 copayment monthly for 6 months (if eligible)  

• Up to $225/month savings afterwards  

Access at: wegovy.com/savings  

2. Patient Assistance Programs  

Check the Novo Nordisk Patient Assistance Program if uninsured or of low income: www.novocare.com  

3. Health Savings Account (HSA) or Flexible Spending Account (FSA)  

Not insured but potentially reimbursed by FSA or HSA on a letter of medical necessity.  

4. Prescription Discount Cards  

Programs and sites such as:  

• GoodRx  

• SingleCare  

• WellRx  

May provide discounts, though Wegovy is usually not discountable because it is brand-name.  

What to Do If Coverage Is Denied  

Don’t give up hope if your first insurance claim is denied. Do the following:  

1. Get a written denial letter.  

2. Appeal – Your physician or you can appeal, particularly if your obesity is becoming a health issue.  

3. Have your provider work for you – A well-written and proper letter of medical necessity should be enough.  

4. Have an independent medical reviewer go over your appeal if necessary.  

If Wegovy Is Not Covered  

If Wegovy is not covered, substitute instead:  

• Ozempic (semaglutide 1 mg) – Same medication, typically reimbursed for type 2 diabetes.  

• Saxenda (liraglutide) – Second GLP-1 medication, possibly more reimbursement.  

• Mounjaro (tirzepatide) – Newer dual GLP-1/GIP medication that’s becoming more popular.  

• Contrave or Qsymia – Older weight-loss medications that are more likely to be covered.  

Your doctor can determine which will work best for your history and coverage.  

Last Thoughts  

Wegovy disrupted the debate on weight loss in medicine, but its price and dubious insurance coverage are ginormous hurdles for most.  

Whereas some private insurance plans and Medicaid programs cover Wegovy in certain situations, Medicare is a big loophole. Approval or rejection is based on stick-to-itiveness, forms, and talking with your doctor and insurer.  

You or your loved one considering Wegovy don’t have to think it’s not an option—act to confirm coverage, ask for discounts, and fight denials. With a bit of persistence, the door to medically supported weight control might swing open. 

Also read

• Voluntary Life Insurance: An Employee and Family Guide.
• What Insurance Covers Zepbound? A Guide to Understanding Your Options.
• How Much Do X-Rays Cost Without Insurance? A Complete Guide to Expenses, Coverage, and Savings.