Is Wegovy Covered by Insurance? (2025 Guide)
Getting Wegovy approved through your insurance plan can feel like navigating a maze. While some policies cover it for weight loss or diabetes-related obesity, many require prior authorization or deny coverage altogether. This guide will walk you through what to expect, who’s more likely to get approval, and what to do if you’re denied.
Quick Insights: Wegovy Insurance Coverage in 2025
- Wegovy is often covered for obesity or diabetes, but requires prior authorization.
- Medicare Part D does not typically cover Wegovy unless tied to another condition like diabetes.
- Employer-based and ACA plans may include Wegovy under preventive care if BMI >30.
- If denied, appeal options and discount programs like GoodRx or NovoCare exist.
- State Medicaid coverage for Wegovy varies—check local formularies.
What Is Wegovy and How Does It Work?
Wegovy is a GLP-1 receptor agonist (semaglutide) that mimics hormones to suppress appetite and reduce body weight. Approved by the FDA in 2021, it’s typically prescribed for individuals with a BMI of 30+ or 27+ with related conditions like Type 2 diabetes or high blood pressure.
When Is Wegovy Covered by Insurance?
Insurance plans may cover Wegovy if you meet certain clinical guidelines:
- BMI ≥30, or ≥27 with coexisting conditions
- Prior use of other weight loss strategies (documented)
- Physician documentation supporting medical necessity
Most plans require a prior authorization form, often reviewed by a pharmacy benefit manager (PBM) like CVS Caremark or OptumRx.
How Do I Check if Wegovy Is Covered by My Insurance?
Start by:
- Logging into your insurer’s portal (e.g., Aetna, Cigna)
- Searching the formulary for “semaglutide” or “Wegovy”
- Reviewing notes about step therapy or prior authorization
- Calling the customer service line for confirmation
You can also ask your provider to submit a coverage determination form.
Which Insurance Plans Cover Wegovy in 2025?
| Insurer | Covered? | Prior Auth? | Notes |
|---|---|---|---|
| Aetna | Yes | Often | Varies by employer group plan |
| Blue Cross Blue Shield | Sometimes | Yes | Some plans exclude obesity meds |
| UnitedHealthcare | Yes | Yes | Approval depends on diagnosis |
| Cigna | Yes | Likely | May require clinical notes |
| Medicare Part D | Rarely | N/A | Limited obesity drug coverage |
| Medicaid (varies by state) | Sometimes | Yes | Check local rules |
Why Might Wegovy Not Be Covered?
Common reasons include:
- Obesity not listed as a covered diagnosis
- Your plan excludes weight-loss medications
- Prior authorization was incomplete
- Medication not on formulary
- Generic alternatives required first
What to Do If Wegovy Is Not Covered by Insurance
You have options:
- File an appeal with medical records and BMI history
- Ask your doctor to re-submit with new ICD-10 codes
- Request a formulary exception
- Use NovoCare’s $25 copay card or GoodRx
- Consider alternatives like compounded semaglutide (if allowed)
Case Example: How a Teacher Got Coverage via UMR
A 42-year-old public school teacher in Texas was denied Wegovy under her UMR plan due to lack of prior documented weight loss attempts. After submitting three months of diet logs and a letter from her endocrinologist, she gained approval—highlighting the importance of documentation.
Expert Tips for Getting Wegovy Approved
- Get your doctor to submit progress notes and previous weight management attempts.
- Use the exact medical codes your insurer’s PBM requires.
- Call your insurer and ask for the pharmacy department—not general customer service.
How long does it take for insurance to approve Wegovy?
It typically takes 2 to 6 weeks, depending on how quickly your provider and insurer process the paperwork.
Is Wegovy covered by Medicare Advantage plans?
Some Medicare Advantage plans cover Wegovy if tied to obesity-related comorbidities. Original Medicare rarely does.
Can Wegovy be covered if prescribed for PCOS or prediabetes?
Possibly, but these off-label uses may require appeals with strong medical justification.
Does insurance cover Wegovy for teenagers?
Coverage is limited for those under 18, and usually requires specialist approval and extra documentation.
Are there cheaper alternatives if Wegovy isn’t covered?
Yes—Ozempic, Saxenda, or compounded semaglutide may be viable, but consult your physician first.
Final Thoughts
Understanding Wegovy coverage means knowing your insurer’s rules, gathering the right documentation, and being persistent. If you’re unsure whether your plan will approve it, speak with a licensed Hotaling insurance advisor to get help navigating prior authorizations and appeals.
Ready to Check Your Coverage?
Our benefits advisors help clients nationwide determine if Wegovy is covered under employer, ACA, or Medicare Advantage plans. Contact Hotaling Insurance Today →