Does Anthem cover Wegovy?

Does Anthem cover Wegovy (semaglutide)? It depends. Many Anthem plans include Wegovy in their drug lists. However, plans differ widely in their coverage limitations and exclusions, which means it is possible that your specific plan may exclude Wegovy from coverage.

Read on to find out how to check if your Anthem plan covers Wegovy, what is required to get Wegovy covered by insurance, and how to save if your Anthem plan does not cover Wegovy.

It depends. Employers can choose which prescription medications they want to cover, so Anthem employer-sponsored plans can vary in their Wegovy coverage. Some cover it, while others do not. Medicare plans generally cover Wegovy, both for weight loss and other conditions. Medicaid plans may cover Wegovy for heart or fatty liver disease, but not weight loss.

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Does Anthem cover Wegovy for weight loss?

Again, it depends. Many Anthem drug lists list both the Wegovy pen and Wegovy pill as a Tier 2 medication. However, employers can choose whether or not they want to cover weight loss medications, including GLP-1 medications such as Wegovy or Foundayo (orforglipron).

Just because Wegovy is included on your plan's drug list is not a guarantee that it is covered by your specific plan. To find out, you will need to call the Pharmacy Member Services number on your ID card. You can also review the Certificate/Evidence of Coverage or Summary Plan Description for your plan.

Anthem Medicare Part D plans cover both the Wegovy pen and pill for weight loss under a temporary GLP-1 Bridge program, which is scheduled to end December 31, 2027.

Similar to employer-sponsored plans, Anthem Medicaid plans may or may not cover Wegovy for weight loss. It depends on the state. For example, Medi-Cal specifically excludes Wegovy from coverage when prescribed for weight loss to people who are 21 or older.

Does Anthem cover Wegovy for cardiovascular disease and fatty liver disease?

It depends on your Anthem plan. Employers can decide which medications they want to cover in their plans, so employer-sponsored plans may vary in their coverage of Wegovy for heart disease or fatty liver disease.

If you have an Anthem Medicare or Medicaid plan, Wegovy may be covered for cardiovascular disease and fatty liver disease. Medicare Part D plans generally cover Wegovy for both of these conditions. While some Medicaid plans specifically do not cover Wegovy for weight loss, they do cover Wegovy when it is prescribed for heart disease or fatty liver disease.

Yes, you need prior authorization for Wegovy. When Anthem plans cover Wegovy, prior authorization is required, meaning Anthem needs to approve your Wegovy treatment plan before it will cover it. To get prior authorization on Anthem, your healthcare provider must submit paperwork to Anthem showing that Wegovy is a medically necessary treatment for you.

Prior authorization for Wegovy for weight loss on Anthem

If your Anthem plan covers Wegovy for weight loss, your prior authorization paperwork must include documentation showing that you:

• Meet the clinical criteria for Wegovy: When prescribed for weight loss, Wegovy is FDA-approved for weight loss and management in people who have either obesity (body mass index, or BMI, of 30 or higher) or who have overweight (BMI of 27 or higher) and a weight-related health condition, such as type 2 diabetes.

• Plan to implement lifestyle changes: Wegovy is FDA-approved for weight loss and management when used alongside diet and exercise.

Prior authorization for Wegovy for other uses on Anthem

If your Anthem plan covers Wegovy for cardiovascular disease or fatty liver disease, your prior authorization paperwork will also need to show that you a) meet the clinical criteria for Wegovy and b) plan to use the medication in combination with diet and exercise.

For example, if you are prescribed Wegovy for fatty liver disease, your prior authorization must include medical records that show you:

• Have a diagnosis of MASLD (metabolic dysfunction-associated steatotic liver disease) or MASH (metabolic dysfunction-associated steatohepatitis)

• Have a BMI of 18.5 or higher

• Have received lifestyle counseling

• Do not have an HbA1c level of 9.5% or higher, do not excessively drink alcohol, and do not have other conditions that might make Wegovy unsafe for you to take

Here are three ways to check if your Anthem plan covers Wegovy.

1. Contact Anthem directly. Call the Pharmacy Member Services number on your insurance card to be connected with an Anthem representative who can verify your coverage details.

2. Sign in to the Anthem website. In the member portal, you can search for Wegovy to confirm coverage and find out your expected copay.

3. Use Ro’s free GLP-1 insurance coverage checker. Complete the online form using the information on your insurance card. Ro will contact Anthem for you and send you a personalized report explaining your coverage for injectable GLP-1s.

The cost of Wegovy depends on how you pay for your prescription:

• If you have an employer-sponsored plan through Anthem, Wegovy is usually covered as a Tier 2 medication. These medications have a higher copay than low-cost generic medications. You may also be eligible to get Wegovy for $25 using the manufacturer savings offer.

• If you have a Medicare plan through Anthem, Wegovy has a $50 copay when prescribed for weight loss through the Medicare GLP-1 Bridge. The copay for other conditions will depend on the details of your Medicare plan.

• If you pay cash for Wegovy on Ro, the Wegovy pill costs $149–$299 per month, and the Wegovy injection costs $199–$399 per month, depending on the dose.*

• If you fill Wegovy at the pharmacy without any discounts or insurance, it can cost $1,349.02 per month.

*Prices may reflect limited-time offers and are subject to change; see more here.

If Anthem won’t cover Wegovy, you still have options. For example, you can:

• Opt for self-pay. You can pay cash for Wegovy on Ro without insurance. The Wegovy pill costs $149–$299 per month, and the Wegovy injection costs $199–$399 per month, depending on the dose.*

• See if you qualify for another covered condition. Some Anthem plans won’t cover Wegovy for weight loss, but may cover it when prescribed for cardiovascular disease or fatty liver disease.

• Ask Anthem to add Wegovy to their drug formulary. If Wegovy is not included in your plan's drug list, you or your healthcare provider can request an addition using this form on the Anthem website.

• Consider another medication. Even if your Anthem plan does not cover GLP-1s, it might cover a prescription weight loss pill, such as Xenical (orlistat) or Qsymia (phentermine/topiramate).

• Switch insurance plans. If you've exhausted all your options, you can switch to another insurance plan that does cover Wegovy. However, be aware that insurance plans can stop covering Wegovy at any time. 

*Prices may reflect limited-time offers and are subject to change; see more here.

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Similar to other insurance companies — such as Blue Cross Blue Shield, Kaiser Permanente, and Humana — Anthem’s coverage of Wegovy varies depending on the plan. Here’s what to remember:

• Wegovy coverage varies among employer-sponsored Anthem plans and Anthem Medicaid plans, especially when prescribed for weight loss.

• Anthem Medicare Part D plans generally cover Wegovy for weight loss, cardiovascular disease, and fatty liver disease.

• When Anthem does cover Wegovy, prior authorization is required showing that you meet the clinical criteria (i.e. BMI and diagnosis requirements) and plan to take it alongside diet and exercise.

• You can check if your Anthem plan covers Wegovy by calling the number on your ID, signing in to the member portal, or using Ro's free GLP-1 insurance coverage checker.

• If Anthem doesn’t cover Wegovy, you can opt for self-pay on Ro, see if you qualify for another covered condition, or consider another medication (or insurance plan).