If you’re exploring weight-loss medication options, you’ve likely come across Wegovy. Wegovy is a prescription medication containing semaglutide that helps patients manage their chronic weight issues. A common question among patients is, does Anthem cover Wegovy for weight loss? This article explains Anthem’s coverage and eligibility criteria, provides tips on how to get approval online, and explores alternative options.
Anthem Coverage Overview for Wegovy
Many Anthem insurance plans do cover Wegovy (semaglutide) for weight management, but it depends on your specific plan and medical eligibility. Because every Anthem plan is different, it’s important to always check your personal coverage before scheduling an appointment. Most policies require a prior authorization process, during which your provider can verify that you meet the medical guidelines set by Anthem.
Klarity Health recently expanded its network, and more than 100 providers accepting insurance have joined the platform. You can easily find a provider who accepts Anthem for online consultations.
Eligibility Criteria for Anthem Wegovy Coverage
Anthem usually covers Wegovy if you meet 1 or more of these criteria:
- Body mass index (BMI) of 30 or greater (classified as obesity)
- BMI of 27 to 29.9, plus at least 1 weight-related health condition (like diabetes, high blood pressure, or high cholesterol)
- Documented attempts at lifestyle interventions (diet and exercise)
- Prescription from a qualified healthcare provider (such as an endocrinologist, primary care provider, or obesity specialist)
Criteria can vary based on your state and your specific Anthem plan, so it’s important to review your plan’s prescription coverage guidelines.
Read also: Understanding Anthem's Weight Loss Benefits
Why Anthem Might Deny Wegovy Coverage
Coverage denial for Wegovy by Anthem often happens for these reasons:
- The BMI or health criteria haven’t been met
- Missing or incomplete documentation
- No prior authorization from your provider
- Use of Wegovy for non-covered purposes (like cosmetic weight loss)
If your prescription is denied, you can appeal with additional medical documentation.
Tips for Improving Your Chances of Approval
To improve your chances of Anthem approving Wegovy, follow these tips:
- Ask your provider to document your BMI and any related medical conditions.
- Get records of previous weight-loss attempts, including diet plans or exercise programs.
- Work closely with your provider to prepare any prior authorization documents.
- Consider support from your human resources (HR) or employer benefits department for self-funded plans.
Providers on Klarity Health regularly help patients complete the prior authorization process, making approval more straightforward.
Alternatives and Savings Options if Wegovy Isn’t Covered
Even if your Anthem plan denies Wegovy, you still have options:
Read also: Anthem Insurance and Weight Loss
- Manufacturer savings: Wegovy manufacturer Novo Nordisk often offers coupons and savings cards to reduce monthly medication costs.
- Other medications: Alternatives like Saxenda, Contrave, or even off-label Ozempic can be covered.
- Compounded semaglutide: Some specialty pharmacies offer compounded versions at lower costs (though typically not covered by Anthem).
Talk to your provider about these alternatives to find the best affordable option for your situation.
Does Anthem Cover Other Weight-Loss Medications Online?
Anthem may also cover other common weight-loss medications:
- Saxenda (liraglutide): Often requires prior authorization
- Contrave (naltrexone/bupropion): Coverage varies and often needs prior authorization
- Phentermine: Usually covered for short-term use with prior authorization
Always verify coverage and discuss options with your provider.
How to Secure Anthem Coverage for Wegovy Online
To secure Anthem coverage for Wegovy, you’ll need prior authorization. First, book an online appointment with a licensed provider. Providers on Klarity Health regularly guide patients through this step.
Your provider can document your BMI, health history, previous weight-loss efforts, and medical necessity and submit this documentation directly to Anthem. Approval typically takes 7 to 14 days but can be expedited with thorough, accurate records. Working closely with your provider is crucial to streamline this process.
Read also: Guide to Anthem's Weight Loss Surgery Policy
Next Steps to Get Wegovy Covered by Anthem Online
To find out if Anthem covers Wegovy on your specific policy, take the following steps:
- Log into your Anthem account online or call the Anthem Member Services line.
- Verify your plan’s prescription benefits and prior authorization requirements.
- Book an online consultation through Klarity Health with providers who accept insurance to discuss your eligibility and start the prior authorization process.
Klarity Health has expanded, and over 100 new providers who accept insurance are now available online.
Anthem Coverage for Qsymia
Anthem generally covers Qsymia for weight loss in cases where it's medically necessary. Anthem does not cover Qsymia for individuals who do not meet the necessary Body Mass Index (BMI) requirements. Coverage for Qsymia is denied if the individual has not participated in a lifestyle modification program such as diet, exercise, or behavior therapy. Discount programs or pharmacy coupons might offer lower prices, potentially reducing the cost to as low as $100 for a monthly supply. Contact Anthem customer service to verify your specific policy details. If required, ask your healthcare provider to initiate a prior authorization request with Anthem.
Additional Options and Considerations
- Curex for Allergy Treatment: While not directly related to weight loss, Curex offers comprehensive care for allergies, asthma, and eczema, which can indirectly impact overall health and well-being. They provide customized sublingual immunotherapy, at-home concierge allergy testing, and symptom management.
- Compounded Medications: Curex providers may prescribe compounded medications, including compounded semaglutide, tailored to individual needs and used in case of shortages. These are not FDA-approved for safety or effectiveness, and a prescription is required.
- Medication Delivery: Weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within a reliable network, ensuring timely access to treatment. Each pharmacy in the network undergoes rigorous third-party testing through FDA and DEA certified labs.
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