Wegovy, containing semaglutide, is an injectable medication approved for chronic weight management in adults and children aged 12+ with obesity or overweight plus weight-related conditions. It also reduces cardiovascular risks in eligible adults. Many seek it for significant weight loss, but high costs drive questions about insurance support.
Coverage varies widely by plan type, indication, and policy changes in 2026. Commercial plans often cover it with strict prior authorization, while exclusions for weight-loss-only use have increased. Medicare generally excludes pure weight loss but covers for approved non-weight indications.
This article outlines current coverage across major insurance types, requirements like prior authorization, savings programs, and steps to check eligibility. It helps patients navigate options effectively. Consult your doctor and insurer for personalized guidance, as rules evolve.
What Is Wegovy?
Wegovy is a once-weekly subcutaneous injection in prefilled pens with doses from 0.25 mg to 2.4 mg. It mimics GLP-1 hormone to regulate appetite, slow gastric emptying, and improve insulin response. The maintenance dose is typically 2.4 mg.
FDA approvals include chronic weight management and cardiovascular risk reduction in those with established heart disease plus obesity/overweight. A pill form exists in some strengths, but injection remains primary. Treatment combines with reduced-calorie diet and increased activity.
Doctors start low and titrate up to minimize side effects. Regular monitoring tracks progress and safety.
How Much Does Wegovy Cost Without Insurance?
Retail prices for Wegovy injection average $1,300–$1,500 monthly without discounts. Cash-pay options through manufacturer programs offer lower rates for eligible patients. The Wegovy pill form ranges $149–$299 monthly depending on strength and promotions.
In 2026, uninsured patients access limited-time offers like $149–$199 for certain doses through April. Full retail applies afterward for higher strengths. Pharmacy discounts rarely drop below $1,000 without programs.
These figures highlight why coverage matters. Savings cards and manufacturer support provide relief for many.
Commercial Insurance Coverage for Wegovy
Many commercial plans cover Wegovy for approved indications, often requiring prior authorization. Criteria typically include BMI ≥30 or ≥27 with comorbidities like hypertension or diabetes. Step therapy may mandate failed lifestyle changes or other meds first.
In 2026, some employers and plans exclude weight-loss coverage entirely, affecting millions. Others maintain it with higher tiers or copays. Manufacturer reports 90% of covered commercial patients pay $0–$25 monthly.
Check your plan’s formulary and PA rules early. Employer-sponsored plans vary most.
Medicare and Medicaid Coverage in 2026
Medicare Part D excludes Wegovy for weight loss alone due to federal law. Coverage applies for cardiovascular risk reduction in those with heart disease plus obesity/overweight. Recent negotiations and pilots offer limited access for qualifying beneficiaries.
Medicaid coverage differs by state. Some end adult weight-loss coverage in 2026, while others require PA for specific uses. Pediatric coverage often continues.
Patients should verify Part D plan details. Appeals or exceptions help in select cases.
Prior Authorization Requirements
Most plans demand prior authorization for Wegovy. Providers submit documentation of BMI, comorbidities, and prior attempts at weight management. Letters of medical necessity strengthen requests.
Common criteria include:
- BMI ≥30 (or ≥27 with conditions)
- Documented lifestyle efforts
- No contraindications like history of thyroid cancer
Denials occur from incomplete info or exclusions. Appeals with added evidence often succeed.
Work closely with your prescriber for accurate submissions.
Comparing Coverage Across Major Plans
Coverage varies significantly by payer and use. Here’s a snapshot for 2026.
| Insurance Type | Weight Loss Coverage | Cardiovascular/Other Indications | Typical Patient Cost with Coverage |
|---|---|---|---|
| Commercial/Private | Often covered with PA; some exclusions | Usually covered | $0–$25 for many; higher tiers possible |
| Medicare Part D | Excluded for weight loss alone | Covered if CV risk reduction | Varies; caps apply |
| Medicaid (varies by state) | Limited/excluded in many states | Covered for approved uses | Low or no copay |
Commercial plans offer broadest access but with hurdles. Government programs focus on non-weight indications.
Savings Programs and Manufacturer Support
Novo Nordisk provides a savings card for commercially insured patients. Eligible users pay as little as $25 monthly, with caps on savings. Government insurance excludes this.
Cash-pay programs offer $149–$199 for select doses through mid-2026. NovoCare Pharmacy handles direct shipments.
Apply online or via text. These bridge gaps when coverage falls short.
Tips for Getting Wegovy Covered
Verify coverage through your plan or NovoCare tool early. Provide complete records for PA submissions. Appeal denials with additional documentation.
Explore employer advocacy if excluded. Use manufacturer offers for affordability. Track refills to avoid gaps.
- Check Coverage: Use online tools or call insurer.
- Prepare Documents: BMI proof, medical history, prior efforts.
- Follow Up: Monitor PA status; respond quickly to requests.
- Savings Backup: Activate card if eligible.
Persistence improves access chances.
When to Contact Your Doctor or Insurer
Discuss coverage concerns before starting. Ask about alternatives if denied. Report side effects promptly.
Call your plan for specific criteria or appeals. Pharmacists verify benefits at fill. Regular check-ins ensure continued support.
Conclusion
Wegovy provides valuable weight management and cardiovascular benefits, but insurance coverage in 2026 remains inconsistent—stronger for approved non-weight uses, limited or excluded for weight loss alone in many plans. Commercial insurance often covers with prior authorization and low copays via savings, while Medicare and some Medicaid restrict to specific indications. Explore all options, including manufacturer programs, and collaborate with your healthcare team to secure affordable access tailored to your needs.
FAQ
Does commercial insurance cover Wegovy?
Many plans cover Wegovy with prior authorization for approved uses. Criteria include BMI and comorbidities. In 2026, some exclude weight-loss coverage, but 90% of covered patients pay $0–$25 monthly with savings card.
Is Wegovy covered by Medicare in 2026?
Medicare Part D excludes Wegovy for weight loss only. Coverage applies for cardiovascular risk reduction in those with heart disease plus obesity/overweight. Check your plan for formulary status and exceptions.
What are the prior authorization requirements for Wegovy?
Most plans require documented BMI ≥30 (or ≥27 with conditions), failed lifestyle efforts, and medical necessity. Providers submit forms; appeals help denials. Requirements vary by insurer.
How can I get Wegovy if my insurance doesn’t cover it?
Use the manufacturer savings card for $25 monthly if commercially insured. Cash-pay offers provide lower rates like $149–$199 for select doses. Discount programs help uninsured patients.
Does Medicaid cover Wegovy in 2026?
Coverage varies by state. Many limit or exclude adult weight-loss use starting 2026. Pediatric and specific indications may continue. Check your state’s policy and PA rules.
What savings options exist for Wegovy?
Novo Nordisk savings card offers low copays for eligible commercial patients. Direct pharmacy programs provide discounted cash prices. These exclude government plans.
Can I appeal if Wegovy coverage is denied?
Yes, appeal with additional medical evidence and letters of necessity. Many succeed on appeal. Your doctor assists with resubmission and documentation.
Dr. Usman is a medical content reviewer with 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic health topics. His work is based on trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Usman is for educational purposes and does not replace professional medical advice.