If your health insurance does not cover Wegovy®, you might still be able to gain coverage for it. See if one of these statements pertains to you and learn more about how you may still be able to get coverage for Wegovy®.
I have employer-covered and/or private insurance
Employers decide prescription benefits for their employees. If your company’s plan doesn’t include medicines to treat obesity, don’t be discouraged. You can submit a request for coverage with the help of your health care provider.
Just print out this sample letter that he or she can use as the basis for a note on their own letterhead. Then bring it to your benefits or human resources manager. That person may be able to contact your insurance provider on your behalf.
employer-covered
Unfortunately, Medicare does not cover medicines for obesity. However, some select Medigap and Medicare Advantage plans for retirees do. If you have one of these plans, please check with its administrator.
I have VA coverage
The VA will cover obesity management. See your local Veterans Administration provider to discuss obesity medication options.
I have Tricare coverage
Your plan provides coverage for this medication in certain situations. To determine if coverage is available, your health care provider may request a coverage review. Please contact your Military Treatment Facility or Tricare Network provider to discuss.
I am a government employee with health benefits
If you are a city, state, or federal worker, ask your benefits manager about coverage for obesity medications.
I have Medicaid coverage
Each state decides for itself what prescription drugs to cover through Medicaid, so you’ll need to contact your state’s Medicaid office to learn if it covers medicines for weight management and obesity.
I have individual and family coverage directly through an insurance company (ie, coverage through the Affordable Care Act)
Check with your insurance company to learn if you are eligible for an upgrade or an add-on to your plan. And with the possibility of changes to insurance laws, the more you know, the better.
Common coverage terms
Some terms you may hear but not be familiar with while trying to gain coverage for Wegovy® are defined for you below:
What is benefits verification?
Insurance benefits verification is the process of verifying a patient’s active medical coverage with his or her health insurance company and preventing billing issues.
What is a prior authorization?
Prior authorizations (PAs) are required by some prescription insurance plans to cover certain medications. Your health care provider will need to submit a form to your insurance company to seek approval for Wegovy®. You can reach out to your health care provider’s office and request that they initiate a PA.
Get free support with WeGoTogether®
Sign up for WeGoTogether® and get help setting and tracking your weight-loss goals. Stay motivated and surround yourself with support.