Key takeaways
- Insurance coverage for Wegovy may depend on whether a doctor prescribes it for an approved use or for an off-label use.
- Several other factors can influence insurance coverage, including the drug’s placement in your plan’s formulary tiers, which determines the amount you pay out of pocket.
- To determine if your insurance covers Wegovy, review your plan’s formulary, contact your insurance provider directly, or consult the coverage guide provided by Wegovy’s manufacturer.
Overview
Wegovy is a brand-name prescription medication that may help some people lose weight and reduce the risk of serious cardiovascular problems.
Doctors prescribe Wegovy, along with exercise and a low calorie diet, to help:
- reduce the risk of heart problems in adults with cardiovascular disease who have overweight or obesity
- with weight loss and long-term weight management in:
- adults and children ages 12 years and older who have obesity
- adults who are overweight and have a health condition related to weight
- treat noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH)
Your health insurance company may cover all or part of the cost for Wegovy. How much is covered will depend on your specific insurance plan. Even if your insurance covers most of the cost of Wegovy, you may still have out-of-pocket costs, depending on your benefits plan.
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When will insurance cover Wegovy?
Without insurance, Wegovy costs $1,349.02 for a 28-day supply, as of 2025. However, if you have insurance coverage, the cost may be much lower.
Insurance companies may cover the cost of Wegovy if a doctor has prescribed it for its FDA-approved use. For adults, the requirements to qualify for a Wegovy prescription are that you have one of the following:
- obesity, which typically involves a body mass index (BMI) of 30 kg/m2 or greater, or overweight, which involves a BMI of 27 kg/m2 or greater. For reference, BMI is calculated as weight in kilograms (kg) divided by the square of height in meters (m2)
- at least one weight-related co-occurring condition, such as high blood pressure, type 2 diabetes mellitus, or high cholesterol
- heart disease, or your doctor considers you to be at risk for cardiovascular problems (such as heart attack and stroke)
- noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis (a kind of scarring)
For adolescents ages 12 years and older to qualify for Wegovy for weight loss, their BMI must be at or above the 95th percentile for their age and sex. This is based on growth charts that doctors use.
Each insurance plan has a list of prescription drugs that it covers, called a formulary. The formulary is usually divided into levels of coverage based on the type or use of the medication. These levels are called tiers.
So even if your plan does cover Wegovy, the amount you will pay out of pocket depends on which tier Wegovy is in. In a plan where Wegovy is a tier 2 drug, for example, you may have to pay more out of pocket than you would for a tier 1 drug.
If your plan has never covered Wegovy, it is also possible to request an exception. For this, you will need to show that other medications won’t work as well or will cause negative side effects.
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Get free cardWhat factors can affect insurance coverage for Wegovy?
Many factors can affect whether an insurance company will cover the cost of Wegovy and how much it will cover, including:
- A low cost or generic version of the drug exists: Some insurers won’t cover brand-name medications if a generic version is available. But currently, a generic version of Wegovy is not available.
- You have tried different, low cost treatments: Some insurers may want evidence that you’ve tried other, cheaper treatments first before they cover the cost of a more expensive medication. This is often called step therapy.
- You have prior authorization: Some insurance companies may require prior authorization before they cover the cost of Wegovy. In this case, your doctor will communicate with your insurance company regarding your prescription for Wegovy. The insurance company will decide whether to cover the medication.
- Your insurer has decided to stop covering the drug: Sometimes, an insurance plan will initially cover a drug like Wegovy, but then stop paying for the medication. If this happens, you can get a one-time refill. You can also ask the insurer to keep covering the drug by filing an appeal.
Even if Wegovy appears in your drug plan’s formulary or list of covered medications, you may still have to pay some money out of pocket. Your costs might include your plan’s deductible, as well as a copay or coinsurance.
How to find out if your insurance plan covers Wegovy
Here are a few ways that can help you find out whether your insurance plan covers Wegovy and whether you’ll need prior authorization. For instance, you can:
- Visit your insurance company’s website: This can help you locate the formulary of your specific plan.
- Review your plan’s summary of benefits and coverage: You can request this information from your insurer or view a copy online.
- Review any materials your plan provider emailed you: This should include information on what drugs are covered under your plan.
- Call your insurance company: You can use the general number for plan members. You can ask the agent whether your plan covers a certain medication.
Sometimes the information given online or in the materials mailed to you by an insurance company can be difficult to understand. If you contact your insurance company, they should be able to help you understand these materials better.
The manufacturer of Wegovy has also created a guide to help you check with your insurance provider for coverage.
How can Optum Perks help?
A prescription discount card is a great way to save money on your medication. While you cannot use it in combination with your health insurance, you can compare both to see which option will give you the biggest savings.
Optum Perks offers a free discount card that could help you save money on prescription drugs, such as Wegovy. You can search for a specific drug to see how much you could save on your medication.
Summary
Your insurance company may cover the cost of Wegovy if doctors prescribe it to help you lose weight and reduce your risk of serious cardiovascular problems or a weight-related health condition. You may still have out-of-pocket costs, depending on your insurance plan and benefits.
Other factors could also affect your insurance coverage. Some insurance companies may require prior authorization or step therapy before they agree to cover Wegovy.
You can talk with your insurance company to find out if they cover Wegovy, and if you’ll have any out-of-pocket costs.
Download the free Optum Perks Discount Card to save up to 80% on many prescription medications. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.