In the United States, amidst a market flooded with weight loss products and emerging weight management drugs, Wegovy presents a viable choice for chronic weight management in eligible adults and children 12 years and older.
According to Dexter Turnquest, MD, a bariatric surgeon at Houston Methodist Hospital, Wegovy is “an injectable medication that is taken once per week and will induce a feeling of prolonged satiety due to delayed gastric emptying, as well as decreased appetite.”
Wegovy is expensive, but there are ways to reduce the cost.
How much does Wegovy cost without insurance?
Wegovy is a weight loss medication that comes in a pre-filled single-dose injectable pen. The current list price for a 28-day supply (four pens) is $1,349.02, but that’s not necessarily the price you’ll pay. “The price is relatively consistent among pharmacies, but there may be some minor differences from pharmacy to pharmacy,” Dr. Turnquest says.
Healthcare providers prescribe a starting dose of 0.25 milligrams (mg) weekly for four weeks, increasing the dose every month until a weekly maintenance dose of 1.7 or 2.4 mg is reached.
Does insurance cover Wegovy?
In order to get Wegovy covered by insurance, you need to meet approval criteria set by the U.S. Food and Drug Administration (FDA). The FDA approves Wegovy for weight loss in adults who have obesity with an initial body mass index (BMI) of 30 or more and pediatric patients ages 12 and older with obesity and an initial BMI at the 95th percentile or higher. It’s also approved for adults who have a BMI of 27 or more with at least one weight-related medical condition, such as hypertension (high blood pressure), high cholesterol, or Type 2 diabetes.
Even if you meet the criteria for using insurance for Wegovy, it is important to check with your health insurance company before finalizing treatment plans. Many insurance providers require healthcare providers to request prior authorization before coverage is granted. “This request must include patient-specific information such as current weight, prior weight history and loss attempts, other medical conditions, and current activity levels,” Dr. Turnquest says.
If someone’s insurance plan doesn’t cover Wegovy, they can submit a request for coverage to their insurance company, who will review the request and reconsider coverage. Novo Nordisk provides a sample letter your healthcare provider can refer to to ensure they provide the correct information in their request for coverage.
If your insurance company still won’t cover Wegovy, consider speaking with your healthcare provider about Wegovy alternatives.
How much does Wegovy cost with insurance?
According to Novo Nordisk, the drug’s manufacturer, 80% of insured patients pay less than $25 a month for Wegovy. But, Wegovy insurance coverage largely depends on a person’s specific insurance policy. Some health insurance plans do not cover medications to treat obesity.
Do Medicare and Medicaid cover Wegovy?
Medicare does not cover weight loss drugs like Wegovy. “Medicare will cover its sister drug, Ozempic, for treatment of Type 2 diabetes if all criteria are met,” Dr. Turnquest says.
Medicaid coverage for Wegovy varies by state. Novo Nordisk recommends contacting your state’s Medicaid office to determine whether it will cover weight management medications.
How to get discounts on Wegovy
People with insurance can get a discount on the cost of Wegovy using a Novo Nordisk Wegovy savings card. Using the card with their insurance benefits, they can pay as little as $0, subject to a maximum savings of $225 per 28-day supply for up to 13 fills.
People without insurance (and those with insurance that does not cover Wegovy) can save $500 for a 28-day supply with the Novo Nordisk Wegovy savings card.
Another option, and one to consider once the Wegovy savings card benefits are exhausted, is a SingleCare prescription discount card. Depending on your preferred pharmacy, you may pay a couple of hundred dollars less for four 2.4 mg/0.75 mL pens (a 28-day supply).
Wegovy vs. Ozempic cost
Wegovy and Ozempic are made by the same manufacturer, Novo Nordisk. Both medications contain the same active ingredient, semaglutide, and work similarly. “Semaglutide helps the pancreas release the right amount of insulin to lower your blood sugar,” says Nilda Agnes Abellera, MD, medical director of Infuze MD.
However, the costs, approved uses, age restrictions, and dosages differ. After the dose is gradually increased, Wegovy delivers a higher maximum weekly dose and has a higher maintenance dose than Ozempic. Additionally, the FDA approved Wegovy for weight loss but not Ozempic. For that reason, Ozempic is sometimes prescribed off-label for weight loss.
As for cost difference, Ozempic costs slightly less than Wegovy. The list price of Ozempic, the price you’d pay without discounts or insurance, is $935.77 per pen, regardless of dose. While Wegovy comes in a box of four single-use pens, Ozempic is supplied as one pen that delivers multiple doses.
However, “both Wegovy and Ozempic are generally covered by insurance if prescribed for diabetes,” Dr. Abellera says. Again, the cost for each with insurance varies by plan.
Bottom line
The injectable prescription weight loss medication Wegovy offers a positive solution for those seeking chronic weight management. According to clinical trials, it was associated with sustained, clinically relevant reduction in body weight when combined with lifestyle interventions like diet and exercise.
Insurance coverage varies when it comes to weight loss drugs, so check your plan details to verify the cost. You can do this by calling the phone number on the back of your insurance or prescription drug card.
Without insurance, the list price of Wegovy is $1,349.02 per month, but there are discounts on the manufacturer’s website. With coverage, you could pay as low as $25, depending on your individual insurance plan. You can also use a SingleCare discount card to make Wegovy more affordable.
Sources
- Wegovy prescribing information, Novo Nordisk (2023)
- What is the list price for Wegovy® and will it impact me?, NovoCare
- Novo Nordisk: 80% of U.S. Wegovy patients with insurance paying less than $25/month, Reuters (2023)
- Once-weekly semaglutide in adults with overweight or obesity, The New England Journal of Medicine, (2021)