Many health insurance plans still won’t cover Wegovy despite new approval

Health insurance - RX Meds Denied

Even though the drug has received approval for heart wellness use, not just weight loss, it’s frequently not covered.

In the United States, Wegovy was previously only approved for use as a weight loss drug and was commonly not covered by health insurance plans.  Now, the headline-making drug has also been approved in the country for heart health, but this isn’t expected to broaden availability for its coverage.

The Novo Nordisk drug is taken by injection on a weekly basis

As a prescription weight loss drug – one of only a handful that have received approval as obesity treatments in the United States – Wegovy is not broadly covered by health insurance plans. While some might assume that this will change now that the drug has also been approved for heart health, it is unlikely to be the case, at least for the first while.

Health insurance - Medication Expenses

Some plans and employers are still not keen to provide coverage for Wegovy because it is exceptionally expensive.  A monthly supply of the medication is $1,350, which insurers and plans say will be hard on budgets.  Moreover, they are also awaiting further data, such as the length of time a typical patient will continue to use the drug.

Some health insurance benefit to the new Wegovy approval

Even if some plans continue to refuse to cover Wegovy for the moment, the new approval for use for heart health will at least have insurers taking another look at this medication and will likely encourage them to begin assessing whether these treatments should be covered the next time they conduct a formulary update.

As a result, for the next while, some insurers will cover the medication while others won’t, making coverage a bit more complicated for consumers to find.

Pressure to cover weight loss drugs

“The more benefits that come from weight loss drugs, I think the greater the pressure is going to be to start including those drugs in a formulary and cover them in standard insurance plans,” said Corporate Synergies Senior Vice President John Crable. “But my gut tells me it’s going to take more to convince some insurers.”

Wegovy works by mimicking the hormone naturally produced in the digestive system to suppress the appetite and improve blood sugar regulation. Medications that function in this way are a part of the GLP-1s drug class.  Coverage for that class of medication is hit-or-miss.

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