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 covers Wegovy for weight loss? This article explains Anthem’s coverage and eligibility criteria and provides tips on how to get approval online.
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.
Anthem may cover Wegovy for weight loss, but eligibility criteria and prior authorization requirements apply.
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. Good news: Klarity Health has expanded! Over 100 new providers who accept insurance are now available online.
Eligibility Criteria for Anthem Wegovy Coverage
Anthem usually covers Wegovy if you meet 1 or more of these criteria:
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- 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.
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.
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To secure Anthem coverage for Wegovy, you’ll need prior authorization. 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.
Alternatives and Savings Options If Wegovy Isn’t Covered
Even if your Anthem plan denies Wegovy, you still have options:
- Manufacturer savings: Wegovy manufacturer Novo Nordisk often offers coupons and savings cards to reduce monthly medication costs. It’s a platform from Novo Nordisk®-maker of Wegovy®, where you can check your insurance coverage for Wegovy® and access a savings offer.
- 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.
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Understanding Prior Authorization with Blue Cross Blue Shield (BCBS)
Blue Cross Blue Shield (BCBS) may cover the cost of the weight loss medication Wegovy, depending on your BMI and weight-related health conditions, but it may require prior authorization. Criteria for prior authorization approval of Wegovy for adults include a BMI of 30 or higher or a BMI of 27 or higher with at least one weight-related medical condition. Prior authorization approval can expire. Wegovy is a brand-name medication approved by the Food and Drug Administration (FDA) for weight loss in certain patients, including children 12 years and older. It is also approved to reduce cardiovascular risk in adults with obesity or who are overweight. Depending on your specific insurance plan, Blue Cross Blue Shield (BCBS) may cover Wegovy if you meet specific criteria. Some plans may require prior authorization before they cover Wegovy, meaning they’ll request more information from the prescriber before agreeing to cover the medication.
BCBS is one of the largest healthcare insurance companies in the United States. It comprises 34 independent, locally operated companies within the country. Each BCBS insurance plan varies in what it covers, including medications. In some cases, insurance plans require prior authorization-also known as pre-authorization-before they approve medical services, procedures, or medicines. This ensures the treatment is medically necessary for the patient. Prescription weight loss medications, such as Wegovy, often require prior authorization before they’re covered. So, there is a chance your BCBS plan will require prior authorization before it covers Wegovy. Different pharmacies offer different prices for the same medication. A prior authorization ensures a drug is being prescribed safely and is of medical necessity. In most cases, your healthcare provider will initiate the prior authorization for Wegovy and will work with your BCBS plan to complete the request. If the prior authorization is approved, the medication will be covered. However, it may only be covered for a certain length of time. After that period ends, your coverage may need reapproval, which, in most cases, will be handled by your pharmacy, insurance company, and healthcare professional. In order to meet the Wegovy pre-authorization criteria, patients will have to meet the eligibility requirements the FDA approved it for. The Blue Cross Blue Shield prior authorization form for Wegovy will vary by plan. Typically, the form may ask for your contact information, date of birth, prescriber’s information, the diagnosis for Wegovy (reason for taking it), and the dosage prescribed by your healthcare provider. The prior authorization form will also ask questions that help the plan determine if you meet its criteria for approval. Remember, your healthcare provider will complete the form and should be familiar with the process.
Navigating the BCBS Prior Authorization Process
Once a healthcare provider prescribes Wegovy, the prescription will be sent to the patient’s preferred pharmacy. If their Blue Cross Blue Shield plan requires prior authorization, the pharmacy will notify the member’s healthcare provider. The healthcare provider will then complete the prior authorization form and submit it to the insurance company. It can take up to 10 business days for BCBS to make a final decision. But, if approved, Wegovy will be covered according to the specifications of the plan, and the pharmacy will dispense the drug. If denied, BCBS will notify the prescribing healthcare provider. The patient can then choose to pay the full out-of-pocket cost or use an alternate medication prescribed by their healthcare provider. Wegovy costs an average of $1,850 for a 28-day supply without insurance or coupons. Costs vary by pharmacy and location, however, so you may pay more or less. If your Blue Cross Blue Shield plan covers Wegovy, the copay can vary depending on the plan. There may be other options to lower the cost of Wegovy, such as using a savings offer from the drug manufacturer or a prescription discount card. SingleCare offers a free Wegovy coupon that can help you save over $600, depending on your location and pharmacy. To find the most accurate price, enter the correct dosage and quantity for your Wegovy prescription on the SingleCare coupon page. Then, choose the coupon for your preferred pharmacy. The first step in determining if Wegovy is covered by your plan is to check your plan documents. These should provide information about coverage details and drug formularies, which are the prescription medications your plan covers.
Anthem's Specialty Pharmacy and Wegovy for Cardiovascular Treatment
The FDA has approved Wegovy, currently used to treat weight loss, for cardiovascular (CV) treatment, effective July 1, 2024. Anthem’s specialty pharmacy, CarelonRx will manage Wegovy for CV differently from Wegovy for weight loss and will treat Wegovy for CV similar to other CV drugs. Wegovy for weight loss will continue to be an excluded drug unless opted-in by the client. With strict clinical guidance, CarelonRx will ensure evidence-based, clinically appropriate use of Wegovy for CV by our members.
Utilizing Online Tools to Check Coverage
It’s a platform from Novo Nordisk®-maker of Wegovy®, where you can check your insurance coverage for Wegovy® and access a savings offer. Here, you’ll be asked some questions. To get started, you'll select if you're a patient or caregiver, and then move on to insurance details. After that, you’ll enter some key pieces of information including your name, date of birth, gender, and zip code. Once you've filled those out, go ahead and review them. If everything looks good, read the content and check the consent box at the bottom. Then, click the button underneath to continue. Here, you'll enter your health care professional's first and last name, city and state. Your health care professional is your prescribing physician, nurse practitioner or physician assistant. Based on the answers you submitted, you’ll find out if your insurance covers Wegovy®. If your insurance doesn't provide coverage, or is unable to provide immediate coverage details, we can share options that may help.
To help you talk to your health care professional about Wegovy® and your coverage options, we've created a downloadable guide. If you see this, don’t worry. It means that your health insurance company might need to approve your prescription. Your health care professional will fill out a prior authorization form and submit it to the insurance company. The insurer will look at the prior authorization to determine whether they will cover the medicine under your insurance plan. It will communicate its decision and rationale to you and/or your health care professional. If your result is not covered, you may submit an appeal or request for coverage with the help of your health care professional. Lastly, you could get a message saying that your coverage result is undetermined. This isn’t unusual, it just means that we need more information. If you have commercial insurance and are covered or covered with prior authorization, talk to your health care professional about whether Wegovy® could be right for you. The Wegovy® savings card can help lower those costs. Government insured patients cannot use any copay cards offered by the manufacturer.
Curex and Semaglutide Coverage
Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.
Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.
Understanding Compounded Medications
Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.
We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide. Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster. Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!
Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.
Curex and its pharmacy partners do not have any association with Novo Nordisk.
Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.
Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.
These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.
Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.
Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.
Streamlining the Approval Process
To simplify the process and boost your chances of approval:
- Check your coverage: Anthem typically requires a BMI of 30 or greater (or 27 or greater with additional health conditions) and documented weight-loss attempts.
- Get prior authorization: Providers on Klarity Health can help you get the right documents to secure approval.
- Explore savings alternatives: You can use manufacturer coupons, alternative medications, or compounded options if your coverage is denied