What are the requirements to qualify for Wegovy?
Asked by: Marcelino Rolfson | Last update: November 12, 2025Score: 4.1/5 (12 votes)
What are the criteria for Wegovy to be covered by insurance?
To determine if you meet the criteria for Wegovy, several factors are considered: Body Mass Index (BMI): If your BMI is >30, or >27 and you have a weight-related medical condition such as high blood pressure or high cholesterol, you may be eligible.
What to say to a doctor to get Wegovy?
I wouldn't send a message via portal to your doctor, but go in and chat with them further. Make the appointment specific to your weight. Explain you've already done the calorie counting and you feel you need assistance. They may (and most likely) will have you try other weight lost drugs first (contrave, etc).
Is it hard to get approved for Wegovy?
The requirements to qualify for Wegovy are: A body mass index (BMI) of 30 kg/m2 or higher. A body mass index (BMI) of 27 kg/m2 or higher with at least one weight-related medical condition. Examples of weight-related medical problems include diabetes (high blood sugar), high blood pressure, and high cholesterol.
Why is my insurance denying Wegovy?
If the insurer doesn't consider Wegovy medically necessary, it will likely deny coverage for the medication. Although the drug may have medical benefits and be medically beneficial, this doesn't necessarily mean the insurer considers it medically necessary.
Doctor Talks WEGOVY--Do YOU Qualify?
How do you get Wegovy for $25 a month?
You may be able to get Wegovy for $25 (or less!) with the Wegovy Savings Card—that is, however, as long as you have a valid prescription for the drug, have private or commercial insurance, and meet the other eligibility requirements.
Why won't my doctor prescribe Wegovy?
To qualify for a prescription of Wegovy, a patient must have a body mass index (BMI) of 30 or higher, indicating having obesity, or a BMI of 27-29 and a weight-related chronic health condition, such as high blood pressure or high cholesterol.
How much is Wegovy without insurance?
The cost of Wegovy depends on your insurance coverage and pharmacy. A package of Wegovy contains four pens, each pre-filled with a single dose of Wegovy. Without insurance, the cost of Wegovy is $1,349.02 per month or 28-day package, which breaks down to $337.25 per week or $16,188.24 per year.
What are the clinical criteria for Wegovy?
It is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial BMI of 30 kg/m2 or greater (obesity) or 27 kg/m2 or greater (overweight) in the presence of at least 1 weight-related comorbidity such as hypertension, type 2 diabetes ...
How can I get my insurance to approve weight loss medication?
- Read your policy. Review the details of your health insurance plan. ...
- Gather information from your healthcare professionals. ...
- Get prior authorization. ...
- Write a letter advocating for coverage. ...
- Write an appeal if you're denied coverage.
Is there an over the counter equivalent to Wegovy?
Wegovy is twice as effective as Orlistat for weight loss after one year. So, if you're looking for the most affordable weight-loss pill you can purchase over the counter, then Orlistat could be an option.
Is there a BMI requirement for Wegovy?
BMI equal or greater than 30. BMI equal or greater than 27 with one or more obesity-related conditions (like high blood pressure or diabetes)
How to get authorized for Wegovy?
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.
Who does not qualify for semaglutide?
Avoid semaglutide if you have: History of medullary thyroid cancer. History of gallbladder disease. History of pancreatitis.
What makes Wegovy medically necessary?
It is important that your healthcare provider demonstrate that you meet the BMI criteria for Wegovy. If your BMI puts you in the overweight category but not obesity, you may need to have another weight-related medical condition, such as high blood pressure, to qualify for Wegovy.
Which is cheaper, Ozempic or Wegovy?
Wegovy and Ozempic, both forms of semaglutide, are used for different medical conditions but come at similar costs. Typically, these medications are priced at: Weekly: $50 to $87.50 per week. Monthly: $200 to $350 per month.
How much weight can you lose in 3 months with Wegovy?
Wegovy patients tend to lose around 4% body weight after two months, 6% after three months, and 8% after four months. After 17 months you can expect to lose around 15% of your starting body weight.
Which insurance covers Wegovy?
Most major insurance plans cover Wegovy, including Blue Cross Blue Shield, Aetna, Cigna, and United Health Care, but coverage may vary with each plan. Benefits offered by employer plans also vary, and coverage is often based on what employers are willing to cover.
How do I convince my doctor to give me Wegovy?
- Explain why it's important to you. Ex: I think a medication that controls my appetite could help me with my eating habits.
- Tell them about your previous experience with weight management. ...
- Share how you feel about it. ...
- Clearly state what you want.
Why is it so hard to get approved for Wegovy?
The main reason for the Wegovy shortage is because the medication keeps growing in popularity. According to its manufacturer, Novo Nordisk, the number of new patients taking the drug has quadrupled in less than a year.
What new weight loss drug is better than Wegovy?
Lilly's Zepbound® (tirzepatide) superior to Wegovy® (semaglutide) in head-to-head trial showing an average weight loss of 20.2% vs. 13.7% INDIANAPOLIS , Dec. 4, 2024 /PRNewswire/ -- Eli Lilly and Company (NYSE: LLY) today announced topline results from the SURMOUNT-5 phase 3b open-label randomized clinical trial.
Can I lose 20 pounds in a month with semaglutide?
How fast you can lose 20 lbs on semaglutide (Wegovy) depends on your starting weight and other factors. If you weigh 232 lbs at the start of Wegovy treatment, you can expect to lose 20 lbs in around 16-20 weeks (4-5 months).
How much does CVS charge for Wegovy?
Pay $ 1,388 chevron_right at Walgreens with a GoodRx discount. That's 14% off the retail price of $1619. Pay $ 1,352 chevron_right at CVS Pharmacy with a GoodRx discount. That's 15% off the retail price of $1590.