Does Blue Cross Blue Shield cover Wegovy?

Are you wondering, “Does Blue Cross Blue Shield cover Wegovy?” You’ve come to the right place! In this blog post, we will review what Blue Cross Blue Shield covers and doesn’t cover regarding Wegovy.

We’ll look at the coverage options supplied by Blue Cross Blue Shield for Wegovy and show you how to handle the insurance procedure. We also give you a few ideas on what steps you should take if your BCBS plan needs to cover it.

Let’s start with Wegovy.

What is Wegovy?

Wegovy is the brand name for semaglutide injection 2.4mg. It is a weight-loss medication used to treat obesity and overweight in adults. It is an injectable drug that mimics the hormone glucagon-like peptide-1 (GLP-1) in the body. Wegovy reduces appetite and increases feelings of fullness by activating GLP-1 receptors in the brain.

Does Wegovy really work for weight loss?

In clinical trials, Wegovy was found to reduce body weight by about 15% over 68 weeks in people with BMIs of 27 or above. Research studies show that people lost a total of 0.5% of their starting weight by week, 6% by 12 weeks, 10% by 20 weeks, and about 15% by the end of one year.

Is Wegovy a weight loss medication covered by Blue Cross Blue Shield?

Blue Cross Blue Shield (BCBS) is a significant health insurance company that covers all 50 states and the District of Columbia.

Unfortunately, Wegovy, the weight loss medication, is not covered by Blue Cross Blue Shield. The Blue Cross Standard Plan does not cover Wegovy. You must obtain a separate policy for weight loss if you are taking Wegovy. Your BCBS plan can only cover Wegovy if the doctor feels it is medically essential for you.

It is crucial to remember that BCBS covers some weight loss injections and drugs, such as Orlistat and Paxil. However, these are different from Wegovy and can require independent coverage.

Review your BCBS coverage to see what is and isn’t covered under your BCBS plan. Contact your health insurance provider directly and ask about coverage options for Wegovy.

Eligible Criteria for Wegovy 

Wegovy is not available to everyone. The FDA recommends Wegovy for those who are overweight or have a body mass index (BMI) of 30 or higher. It is also recommended for people with at least one weight-related medical condition due to their body weight. For example, type 2 diabetes, high cholesterol, and high blood pressure.

Wegovy medication may require prior authorization. The insurance company must approve coverage for the drug after your healthcare provider submits a request. Your doctor can advise whether Wegovy is a suitable option for you.

Some insurance plans have restrictions on the duration of Wegovy coverage. So, it is important to check the precise terms and conditions of your plan.

Wegovy may be risky for you because it is not suggested for people with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2. Finally, the decision to use Wegovy should be taken in cooperation with your doctor.

How can you determine the monthly cost of Wegovy?

The developer of Wegovy has a website where you can determine the monthly cost of the medication if you have insurance. You can also contact your insurance company. You can ask your doctor if you do not have insurance. The monthly cost of the medication depends on several factors, including your treatment plan and the pharmacy’s price.

How much is Wegovy cost?

Without insurance, Wegovy can be costly.

Mostly, without insurance, a dose of Wegovy costs roughly $270, although there are ways to pay less. The manufacturer offers savings cards to help you get this weight loss medication. Drug-saving cards can reduce the cost of a weekly dose by $40 to $230.

How to Check Your Coverage with Blue Cross Blue Shield 

Follow these steps to see if your Blue Cross Blue Shield plan supports Wegovy:

Examine your insurance policies

Review all the details of your insurance policy, including the summary of benefits and coverage. Check the coverage for prescription drugs and any specific exclusions.

Contact your insurance company

Contact your insurance provider directly if you need help finding the information in your policy documentation. The customer support representative can explain your coverage and answer any questions.

Consult with your doctor

Your healthcare professional can also guide you through the insurance application procedure. They can help you acquire prior authorization and provide evidence to support your coverage request.

Common side effects of Wegovy 

The common side effects of Wegovy may include heartburn, nausea, diarrhea, vomiting, constipation, headache, belching, tiredness, dizziness, gas, stomach, and a runny nose or sore throat.

There are some further serious side effects of using Wegovy: 

Stomach inflammation 

If you get severe stomach pain (abdomen) that won’t go away, stop using Wegovy. It may cause stomach pain or inflammation.

Increased risk of low blood sugar

BCBS Wegovy can increase the risk of low blood sugar (hypoglycemia) in type 2 diabetes patients, especially those using type 2 diabetes drugs such as sulfonylureas or insulin. You should monitor your blood sugar while taking Wegovy. The symptoms of low blood sugar may include dizziness, blurred vision, stress, irritability, weakness, sweating, slurred speech, sleepiness, shakiness, headache, fast heartbeat, or jitteriness.

Kidney disease (kidney failure)

Diarrhea, nausea, and vomiting in patients with kidney difficulties can cause a loss of fluids (dehydration), which may cause kidney disease. 

Allergic reactions

You should stop using Wegovy immediately if you develop any symptoms of a severe allergic reaction, including swelling of your face, lips, tongue, or throat, difficulty breathing or swallowing, severe rash, and fainting. You must drink water to reduce the risk of dehydration and extreme allergic reactions.

What should you do if your Blue Cross plan does not cover Wegovy?

If your Blue Cross plan does not cover Wegovy, you can take a few steps to receive the coverage you want.

Discuss with your doctor the various alternative drugs that are available. Many health insurance plans cover multiple forms of weight-loss medications and injections.

You can ask your provider if they offer Wegovy discounts through their network. You can save money on your prescriptions if you do this.

Find out if there are any other ways to get coverage for weight loss supplements. For example, some governments offer reduced prices for specific pharmaceuticals through unique government programmes.

Other Weight Loss Solutions

There are other weight-loss methods besides Wegovy that you may explore.

  • A balanced diet
  • Exercise routines 
  • Over the counter drugs like Alli or Xenical 
  • Weight loss surgery 
  • Behavioural treatment
  • Prescription drugs like phentermine or Contrave 

Whatever plan you choose, consult your doctor before starting any weight loss routine to make sure that you are taking the most secure way to your health goals.

Bottom line

Does Blue Cross Blue Shield cover Wegovy? The answer is only sometimes a straightforward yes or no. Blue Cross policies may include Wegovy coverage; however, this is only sometimes the case.

It is critical to consult with your medical insurance agent to determine what coverage options are available for this medicine and what steps you can take if your plan does not provide coverage.

Take a look at other weight-loss options that may be suitable for your lifestyle and budget.

FAQs

Does Blue Cross Blue Shield cover weight loss injections?

Yes, Blue Cross Blue Shield covers weight loss injections such as Orlistat and Paxil. But it only covers Wegovy if your doctor can prove that taking Wegovy is medically necessary. You should contact BCBS or other health insurance providers to determine coverage options.

What health insurance companies provide coverage for Wegovy?

Many private health insurance companies cover Wegovy, but coverage depends on your plan. Some insurance companies may need pre-authorization, while others may have particular qualifying requirements. Medicaid and some Medicare and Medigap plans may also cover Wegovy; however, eligibility limits may exist.

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