Does Blue Cross Blue Shield cover Wegovy?

You’ve probably heard a lot about Wegovy, but you may not realize that insurance coverage for Wegovy (semaglutide) isn’t always guaranteed.

If you have insurance through Blue Cross Blue Shield and you’ve been prescribed Wegovy, you’re probably wondering if the drug will be covered and how much it may cost you. 

Blue Cross Blue Shield may cover Wegovy based on the plans we reviewed. However, getting BCBS coverage for Wegovy isn’t as effortless as it can be for some other prescription drugs. You may have to jump through a few hoops first. Read on as we explain.

It’s hard to say for sure whether Blue Cross Blue Shield (BCBS) covers Wegovy, since that depends on the details of the specific plan, shared Dr. Beverly Tchang, MD, an endocrinologist who treats patients with obesity, and an advisor to Ro. According to the BCBS drug formularies we reviewed, Wegovy can be covered. But prior authorization is usually required, and, if approved, the copay may be higher than for other generic or non-preferred drugs.

To check if BCBS covers Wegovy, contact your plan. You can usually find their number on the back of your insurance card. You can also use NovoCare, a free insurance concierge offered by Novo Nordisk, the maker of Wegovy, to get the details on your insurance coverage for Wegovy.  

When you call BCBS, here are a few questions you may want to ask.

Do you meet the eligibility criteria for Wegovy? 

“If they cover the medication, insurances typically cover [Wegovy] for FDA-approved indications,” shared Dr. Tchang. The US Food & Drug Administration (FDA) has approved Wegovy, along with diet and exercise, for two indications (specific uses), as follows:

1. To reduce excess body weight and maintain weight reduction long term in people ages 12 and older with obesity and in people with overweight and have at least one weight-related condition, such as high blood pressure.

2. To reduce the risk of heart attack, stroke, or cardiovascular death in adults with existing heart disease and obesity/overweight

When it comes to prescribing Wegovy, health providers will measure your body mass index, or BMI, to determine if you have obesity or overweight. While BMI is an imperfect tool, health providers and insurance plans still use it to determine eligibility for certain medications, like Wegovy. 

• Obesity is defined as a BMI of 30 or greater

• Overweight is defined as a BMI of 27 or greater

If you meet the indication criteria, you may be a good fit for Wegovy, and your BCBS plan may be more likely to cover the drug. However, it’s worth noting that weight loss drugs notoriously run into more roadblocks getting covered by insurance plans. For example, Blue Cross Blue Shield of Massachusetts has a separate Pharmacy Medical Policy for weight loss drugs like Wegovy. While Wegovy is covered, health providers need to submit paperwork requesting coverage before BCBS will consider approving it (this is a process known as prior authorization). 

However, now that the FDA has approved Wegovy for an additional indication besides weight loss, it may be easier for patients to get insurance coverage, said Dr. Tchang. “With the recent FDA approval for cardiovascular disease for Wegovy and its inclusion on Medicare's approved indications list, we may see additional commercial insurances cover Wegovy for this disease.”

What drug tier is Wegovy included in?

It’s common for health insurance plans to organize prescription drugs into various tiers. Different tiers come with different copay and coverage limits. Blue Cross Blue Shield’s drug tiers can range from plan to plan, but they generally follow this sort of structure:

• Generic drugs

• Preferred brand drugs

• Non-preferred brand drugs

• Generic specialty drugs

• Preferred brand specialty drugs

• Non-preferred brand specialty drugs

The drugs that fall into these various tiers can vary from plan to plan. Without getting too into the weeds, there are a few basic rules of thumb you can rely on with prescription drug coverage: 

• Drugs in lower tiers have lower copays than drugs in higher tiers.

• Generics are less expensive than preferred brand drugs, which are less expensive than non-preferred brand drugs and specialty drugs.

To find out how your BCBS plan categorizes Wegovy, review your plan’s drug formulary. It’s a list of covered medications that you can usually find on the BCBS website for your specific plan. BCBS updates its drug formularies regularly, so you’ll want to ensure you have the most up-to-date one. The formulary should have a date listed on the front. 

Based on its drug tier, Wegovy may come with a higher copay. BlueCross BlueShield of Texas categorizes Wegovy as a Non-Preferred Brand drug. Blue Cross Blue Shield of Michigan also includes Wegovy in its Non-Preferred Brand drug tier. 

Is prior authorization required for Wegovy?

If your BCBS plan covers Wegovy, prior authorization will likely be required. This means that your healthcare provider will need to fill out a document on your behalf and submit it to your BCBS health plan, requesting that they cover Wegovy and confirming that you meet the eligibility requirements for the medication. 

The document could be one question or up to two pages, depending on the plan, said Dr. Tchang. “Oftentimes, they ask for confirmation that the patient has tried diet and exercise previously or plans to continue lifestyle therapies along with the anti-obesity medication, and some prior authorizations will ask for a list of prior anti-obesity medications that have been tried.”

Of the BCBS plans we reviewed that covered Wegovy, all required prior authorization. 

Are there coverage limits for Wegovy?

If you call your BCBS plan administrator and they confirm that your plan covers Wegovy, that’s great news. But, you’ll still want to get a few more answers about how long it is covered for and how much you can expect to pay to fill your prescription. Consider asking these questions:  

• How long is Wegovy covered? (One BCBS plan we found only covered Wegovy for 6 months.)

• How often can I refill my prescription? (The plans we looked at only allowed 1 refill per month, which is standard.)

• How much is my copay for Wegovy?

• Do I need to meet my deductible or out-of-pocket limit first? Once I meet those limits, how much will my copay be?

• Can I get a longer supply of Wegovy, such as a 90-day supply? Is it cheaper to do that?

Sometimes, a drug may not be covered by your plan at all. These are called “non-formulary drugs.” In these cases, your healthcare provider can submit paperwork requesting that your BCBS plan covers Wegovy. Novo Nordisk offers a sample “Coverage Request Letter” on their website that your health provider can use.

Some Blue Shield of California plans classify Wegovy as a “non-formulary drug.” To get coverage, your healthcare provider will need to submit paperwork demonstrating that the drug is medically necessary and that BCBS should make an exception on your behalf. 

The list price for Wegovy is $1,349.02 for a month’s supply of the medication, according to Novo Nordisk, the drug’s manufacturer. However, that’s just a starting point, and you may pay more or less. Your price for Wegovy can depend on your insurance coverage, the pharmacy you use, and whether you are eligible for any Wegovy savings programs or pharmacy discounts.

If your BCBS insurance won’t cover Wegovy, there are still ways to save on Wegovy. For example:

• The Wegovy Savings Offer cuts the cost of Wegovy in half, for those who are eligible. You can learn more here. 

• Sites like GoodRx, SingleCare, and Optum Perks offer prescription discount cards for various pharmacies.

• Enrolling in a clinical trial may give you free access to Wegovy, but depending on the trial terms, you may not know if you are getting Wegovy or a placebo.

• Compounded semaglutide may be an option during a drug shortage. Though they are not approved by the FDA, compounded medications are allowed under federal law. Companies such as Ro offer compounded semaglutide if you qualify. 

Wegovy can be expensive, especially if you have to pay out-of-pocket. If your BCBS plan doesn’t cover Wegovy, it might cover a cheaper alternative for weight loss. Talk to your plan administrator and your healthcare provider about your options.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

July 18, 2024

Written by

Amelia Willson

Fact checked by

Patricia Weiser, PharmD

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About the medical reviewer

Patricia Weiser, PharmD

Patricia Weiser, PharmD, is a licensed pharmacist, health content writer, and medical reviewer with more than a decade of clinical experience in community and hospital pharmacy.