Navigating insurance coverage for weight loss medications can be complex. This article provides a detailed overview of Regence coverage for Semaglutide (Wegovy), a medication approved for weight management. It also explores alternative options and strategies for managing the costs of weight loss treatments.
Regence Coverage for Wegovy
Regence may cover Semaglutide (Wegovy) for weight management if it is deemed medically necessary. A prior authorization process is often required. Coverage might depend on your specific insurance plan. It is also covered for individuals with a BMI of 27 kg/m² or greater who have been diagnosed with at least one weight-related comorbidity. Coverage is subject to periodic reassessment to ensure ongoing benefit from therapy.
How to Determine Your Coverage
The easiest way to find out if your Regence plan covers Wegovy is through your personalized member account. Sign in, select Pharmacy in the left side navigation, and then Find a drug under Check costs and coverage to check drug costs.
Prior Authorization
If your insurance requires prior authorization, your healthcare professional will need to fill out a form and submit it to the insurance company. The insurer will review the prior authorization to determine whether they will cover the medication under your insurance plan. They will then communicate their decision to you and/or your healthcare professional.
What to Do if Coverage is Denied
If your coverage is denied, you may submit an appeal or request for coverage with the help of your health care professional.
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Strategies for Managing Wegovy Costs
Wegovy can be an expensive medication, so it's essential to explore all available options to manage costs.
Patient Assistance Programs and Discounts
Patients are encouraged to seek patient assistance programs or discounts to help mitigate costs.
Novo Nordisk Savings Card
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.
Compare Pharmacy Prices
Medication prices can vary among pharmacies. To save money, it’s best to get your prescriptions filled at a pharmacy in your network.
Home Delivery
Trade the trips to your pharmacy for convenient home delivery.
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Understanding Wegovy and Semaglutide
Wegovy (semaglutide) is the first weight loss medication approved by the Food and Drug Administration since 2014. It is a weekly injection in a class of medications called glucagon-like peptide-1 (GLP-1) agonists that stimulate the production of insulin to reduce blood sugar and slow the digestion process. GLP-1 agonists are also believed to interact with parts of the brain that reduce appetite and signal fullness.
Wegovy vs. Ozempic
While both are weekly injections, Wegovy generally has higher dosing than Ozempic (up to 2.4mg vs. Though similar, they serve distinct medical purposes.
Clinical Trial Results
Clinical trials demonstrate that Semaglutide (Wegovy) helps individuals lose a significant amount of weight. Results vary, with some losing more and others less.
Important Safety Information
It is crucial to be aware of potential side effects and warnings associated with Wegovy.
Possible Side Effects
- Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
- Inflammation of your pancreas (pancreatitis). Stop using Wegovy® and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting.
- Gallbladder problems. Wegovy® may cause gallbladder problems, including gallstones. Some gallstones may need surgery.
- Increased risk of low blood sugar (hypoglycemia), especially those who also take medicines for diabetes such as insulin or sulfonylureas. This can be a serious side effect.
- Kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse.
- Severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use Wegovy®.
- Serious allergic reactions.
- Change in vision in people with type 2 diabetes.
- Increased heart rate. Wegovy® can increase your heart rate while you are at rest.
- Depression or thoughts of suicide. You should pay attention to any mental changes, especially sudden changes in your mood, behaviors, thoughts, or feelings.
- Food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation).
Who Should Not Take Wegovy
- Are pregnant or plan to become pregnant. Wegovy® may harm your unborn baby.
- Are breastfeeding or plan to breastfeed.
Drug Interactions
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Wegovy® may affect the way some medicines work and some medicines may affect the way Wegovy® works. Tell your healthcare provider if you are taking other medicines to treat diabetes, including sulfonylureas or insulin.
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Alternative Weight Loss Medications and Options
If Wegovy is not covered or too expensive, there are alternative options to consider.
Other Prescription Weight Loss Medications
Keep in mind that there are other prescription weight loss medications, like Saxenda, that your health insurance plan may cover if it doesn’t cover Wegovy. Some medications, like Mounjaro, are approved for managing blood sugar levels in adults with Type 2 diabetes, but they are sometimes prescribed off-label for weight loss.
Compounded Semaglutide
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.
Lifestyle Changes
Alongside medication, lifestyle changes such as diet and exercise are crucial for successful weight management.
Curex: An Alternative Approach to Allergy and Related Conditions
While not directly related to Wegovy coverage, Curex offers comprehensive care for those suffering from allergies, asthma, and eczema, which can sometimes be related to weight management journeys due to underlying health conditions.
Curex Services
This includes customized sublingual immunotherapy, at-home concierge allergy testing, and symptom management. Curex serves adults and children as young as 5 years old. Certain tests and treatments may be limited for younger kids. Start by answering the quiz, so that our clinicians can recommend the best testing and treatment options.
Conditions Treated by Curex
Curex currently treats allergies to food, tree, weed, grass pollens, pet allergies, dust mites, mold and cockroach. We do not treat metal, or venom allergies.
Insurance and Payment Options with Curex
While it is difficult to estimate out-of-pocket costs prior to a claim being submitted, our team will work with you to make sure your treatment is as affordable as possible. The average patient responsibility is $200/year and depends on your plan (deductibles, coinsurance, telemedicine benefit). In addition, Curex accepts HSA and FSA.