Does Blue Cross Blue Shield cover Wegovy?

If you have insurance through Blue Cross Blue Shield and have been prescribed Wegovy (semaglutide), you are probably wondering if the medication will be covered and how much it may cost you. Does Blue Cross cover Wegovy? It depends on the plan. Read on to learn how to get BCBS to cover Wegovy, and how to save if it does not.

It depends on the plan. Some Blue Cross Blue Shield (BCBS) plans explicitly exclude Wegovy (and other GLP-1s for weight loss) from coverage, while others cover both the Wegovy pill and injection. Some plans only cover the standard injection and pill, but not the higher-strength Wegovy HD pen.

When BCBS covers Wegovy, prior authorization is usually required, and, if approved, the copay may be higher than for other generic or non-preferred drugs.

Blue Cross Blue Shield is not a single insurance company. It is a federation of independent, locally operated companies — including Anthem, Highmark, and the state-specific Blue Cross Blue Shield plans cited throughout this article — that each set their own coverage rules under the shared Blue Cross Blue Shield Association brand. That is why Wegovy coverage can look completely different from one BCBS plan to the next.

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Does Blue Cross Blue Shield cover Wegovy for weight loss?

It depends on your plan. When BCBS covers Wegovy for weight loss, it is usually in a higher cost tier and requires prior authorization. Overall, BCBS plans appear less likely to cover Wegovy for weight loss than for other indications. Several plans explicitly exclude Wegovy from coverage when it is prescribed for weight loss alone, even if they cover it when prescribed for reducing the risk of heart-related events.

If you have a Medicare Part D plan through Blue Cross Blue Shield, Wegovy is covered for weight loss under the temporary GLP-1 Bridge program, which lasts through December 31, 2027 for eligible individuals.

Does Blue Cross Blue Shield cover Wegovy for heart disease and/or fatty liver disease?

It depends on your plan. Some Blue Cross Blue Shield plans offer broad coverage for Wegovy, while some only cover Wegovy for people with obesity plus heart disease. Other BCBS plans only cover GLP-1s for type 2 diabetes, so Wegovy is not covered no matter the reason for the prescription. If you have a Medicare Part D plan through BCBS, Wegovy may be covered with prior authorization.

You can check if BCBS covers Wegovy by: 

• Contacting your plan directly. You can usually find their number on the back of your insurance card.

• Reviewing your plan's drug coverage online. Sign in to the BCBS website and search for your drug list or formulary.

• Using Ro's free GLP-1 insurance coverage checker. After you answer a few quick questions, Ro will check your coverage for the Wegovy injection and send you a free email report with your results. 

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,” says Beverly Tchang, MD, associate professor of clinical medicine at Weill Cornell Medicine, Ro advisor, and triple board-certified physician in internal medicine, endocrinology, and obesity medicine. 

What are those indications? It differs for the Wegovy injection vs pill, but both are meant to be used along with diet changes and increased physical activity.

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

• Obesity is defined as a BMI of 30 or greater

• Overweight with 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 medication. However, it is worth noting that weight loss medications notoriously run into more roadblocks getting covered by insurance plans.

When Wegovy is covered, healthcare 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 additional indications besides weight loss, it may be easier for patients to get insurance coverage for Wegovy, says Dr. Tchang. 

What drug tier is Wegovy included in?

Wegovy may be considered a higher tier as a non-preferred brand drug, depending on the specific BCBS plan. It is common for health insurance plans to organize prescription drugs into various tiers. Higher tiers generally come with higher copays 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 medications that fall into these various tiers can vary from plan to plan. Without getting too into the weeds, there are a few basic basic guidelines you can rely on with prescription drug coverage:

• Medications 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 is 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 check the date to ensure you have the most up-to-date one.

Based on its drug tier, Wegovy may come with a higher copay. For example, Blue Cross Blue Shield of Arizona categorizes Wegovy as a Tier 4 medication, which has the highest cost. 

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 page or several pages, depending on the plan, says 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 reviewed for this article 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? 

• How often can I refill my prescription? (Plans reviewed for this article typically allowed one 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 medication 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 its website that your healthcare provider can use.

The list price for Wegovy is $1,349.02 per month, according to Novo Nordisk, the medication's manufacturer. However, that is just a starting point, and you may pay more or less. If your BCBS plan covers Wegovy, you will likely pay much less. If you pay cash for Wegovy on Ro, the Wegovy injection costs $199–$399 per month and the Wegovy pill costs $149–$299 per month, depending on the dose.*

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.

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

If your BCBS insurance will not cover Wegovy, you still have options. For example, you can:

• Pay cash for Wegovy. Paying with cash can allow you to get Wegovy at a lower price. On Ro, for example, you can get Wegovy for $149–$399 per month, depending on the dose and form.*

• Use a Wegovy coupon. Sites like GoodRx, SingleCare, and Optum Perks offer free prescription discount cards for various pharmacies. You can get one for free by visiting the website, searching for your dose of Wegovy, and downloading or printing the card for your preferred pharmacy.

• Ask if you qualify under another diagnosis. Even if your plan does not cover Wegovy for weight loss, it may cover it or another GLP-1 for something else, such as heart disease or fatty liver disease (Wegovy), obstructive sleep apnea (Zepbound), or type 2 diabetes (Ozempic, Mounjaro).

• Switch insurance plans. If you are not locked into your insurance plan, you may consider switching to another one that offers more reliable coverage for Wegovy. However, it is important to note that insurance plans can drop their coverage of Wegovy at any time.

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

See if you qualify

Whether Blue Cross Blue Shield covers Wegovy depends on your specific plan. Many BCBS plans offer coverage, but prior authorization is usually required, and copays may be higher than for preferred brand or generic drugs.

Here’s what to keep in mind:

• Overall, BCBS plans may be less likely to cover Wegovy for weight loss, even if they cover it for fatty liver disease or heart disease.

• Some BCBS plans list Wegovy as a non-preferred or higher-tier medication, which can mean higher out-of-pocket costs.

• Your healthcare provider will likely need to submit documentation proving medical necessity before Wegovy is approved.

• If your BCBS plan does not cover Wegovy, check if you qualify under another health condition or explore cash-pay options to reduce your cost. If you are prescribed Wegovy, contact your BCBS plan administrator to confirm your coverage and understand any prior authorization steps before heading to the pharmacy.