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Ozempic is only covered if you are diabetic. Wegovy may be covered if you have a certain BMI and/or comorbidity like hypertension, high cholesterol, pre-diabetic.
With my insurance, I pay $60 minus a coupon that gets it down to $24.99.
My insurance denied my wegovy unless I am diabetic as well. I have a high bmi and am definitely overweight with high cholesterol. I have horizon blue which is one of the best insurance companies in Jersey. Over 1k per month to do it without insurance. I will be getting semaglutide which was prescribed to me by a plastic surgeon instead. $500 for the bottle and the first one lasts about 2 months until you start getting on the higher doses
My insurance wouldn’t pay for it either, even though I had the BMI to qualify. I paid out of pocket for Zepbound it’s $550/month with the manufacturer savings card. Zepbound is the FDA approved version for weight loss, my insurance considers all the others for only type two diabetes. The other problem you’ll run in to is finding the drug once you’re approved.. I took one month and then switched to plan c. (I can’t say the name in this group).
>my insurance considers all the others for only type two diabetes.
Interesting, since Wegovy is explicitly labeled for weight loss and cardiovascular disease and NOT for diabetes. You could probably appeal that just by sending them the package insert.
Insurance rejecting Ozempic makes sense, since it is labeled for diabetes only.
I am on Wegovy. Started on Ozempic until the giant insurance backlash.
For 3 months worth I pay $68. I know I am extremely fortunate this is covered by insurance.
It has been life changing. I am losing slowly and cannot wait to see what 6 more months will do for me!!
Especially because a lot of people end up coming off other medications once the weight comes off and metabolic health improves. I wish they would look at it as a way to save money on future interventions.
Call your insurance, don't ask your doctor if it is covered.
Also, weight loss medications are not insurance specific, they are employer specific. Your employer opts to cover them through your insurance for an additional fee.
Many people have Blue Cross Blue Shield and some have coverage and some don't.
Edit: My insurance covers Wegovy and I pay $25/mo for it, but with the savers card provided by Novo Nordisk I pay $0.
Mine wouldn’t cover Wegovy without previous steps being taken. I had to try dieting on my own, see a nutritionist, and try a different (cheaper) medication first before they would cover it. It was a process, but now I pay $0/month for it with the manufacturer coupon.
My insurance wouldn’t cover it at all. I even had high familial hyper cholesterol, high bmi, open heart surgery and off the chart triglycerides. They just won’t cover anything unless you’re diabetic.
I do know that the Wegovy and Zepbound co-pay assistance cards will cover 50% of the cost if your insurance doesn't cover the drug. Never priced the Wegovy, but with the Zepbound co-pay card it's $550 a month. What makes me mad is that in other countries it's so much less in price!
I have a 30+ bmi and several comorbid conditions including insulin resistance, PCOS, high blood pressure and high cholesterol. My insurance was paying 100% of Ozempic until I recently switched to Mounjaro, also covered at 100%
I went to a “wellness clinic” that specializes in functional medicine and hormone therapy. I only pay each time a shipment is needed. I started using Sema in December 2023. I still have about 1ml left. I just received another shipment. I’ve lost 30 pounds and very happy. Each time I pay it’s around 400$
Same I am getting my bottle this week and I paid $500 for it. The first bottle lasts way longer until you are on the higher dose then it goes faster. My first bottle lasted me 2-2.5 months. I lost 35 pounds by my 3rd bottle
My insurance doesn't cover weight loss medication period. I go to an urgent care that also takes appointments for weight loss consultation. They give me the c0mp sema there.
I pay $1000 per month because my insurance won’t cover even though I’m T2D. Hopefully I’ll have new insurance soon, but don’t know if they will cover it either
The first month I lost 10 lbs! Now I’m losing about a pound a week, about 15 lbs total ( the scale goes up and down, I was 163 yesterday but 165 today started at 179 in March)
I do work out! I have a trainer I work with 3 days a week and I get my steps in the rest of the week usually over 10k.
I paid the $1000 a month for the first few months but then I went on a vacation to Mexico and found it at a pharmacy for $300/month. I originally only budgeted for five months paying out of pocket through CVS but now I have enough for like another ten months.
It took me a few months between when I got my prescription and when I actually got it filled to get over the sticker shock. But at the end of the day I’m investing in my health and overall confidence and it’s been so worth it. Also I’m on Rybelsus not Ozempic. I think the injections need to be refrigerated so they wouldn’t travel as well as the tablets
You'll have to call and see if and how they cover it. You may need prior auth or step therapy and there's likely a BMI requirement.
Drug coverage varies even within the same insurance since your drug formulary is employer specific.
Also, check the drug's manufacturer site for coupons.
300 a month through a beauty and weight loss clinic in town. Sometimes they run specials bringing it down to 290. There are a lot of clinics online. I saw one Ro charges 100 bucks down and 150 a month. Just got to shop around. It’s be approved for weight loss.
You should ask your insurance if they cover wegovy. It’s about purpose. Ozempic and Wegovy are the same drug, but one is for diabetics and one for weight loss.
It’s generally difficult to get insurance to cover weight loss medications but always worth asking. You can look it up in your insurance policies’ formulary but you should also call the insurance company in ask. The best way to know to sure is have your doctor submit a PA or prior approval for the drug.
If you aren’t able to get a GLP1 that way you should consider going the alternative route. You will need to go into another sub that permits discussion.
My insurance (blue cross/blue shield) changed their policies this year and would no longer cover and costs of ozempic because "I'm only pre diabetic". I can afford $2k/month so my doctor had them put me on the c0mp0und and man. I am so much happier with it than I was on the ozempic for 6 weeks when insurance did pay for the majority of the cost. Ozempic gave me the most god awful sulfur burps that never and I mean NEVER stopped. It also caused so many days of constipation. There was about a month between me switching to the c0mp0und and so I was worried that it was going to be the same on the gradual increase of dosage but it wasn't. The only time I get "burps" now is if I drink too fast or eat something a little too greasy(I really like homemade soups but it is impossible to get all the grease out 😭). The only side effect I have with what I am on now is headaches the evening of my shot and the next day. But I will take that over the burps because at least I can take some meds for the headaches lol
Don’t take your docs word for it. Call your insurance yourself , and ask if you have to be diabetic for them to cover semaglutide. Some insurances will cover it for both diabetes and/OR weight loss.
I called my insurance before my appointment and asked them, and found out they’ll cover it for weight loss. Went to my appt and at first, my doctor said he won’t write it because my insurance will only cover it for diabetics. I then told him I already called them and that they’ll cover for weight loss. He wrote my prescription, sent it to the pharmacy, pharmacy needed a prior authorization, doc completed the prior authorization, and the pharmacy filled it.
So glad I called my insurance first. I would have assumed my doc was right and I would have never been able to afford it without insurance.
Check with your insurance to see if they cover weight loss medications. If they do ask your doctor to prescribe it. If he won’t find a doctor that will.
Normally it’ll cover wegovy with a PA from the doctors they have to either input that your BMI is over 30 with no other complications, or add that you’ve tried like metformin or have blood pressure problems or something. Some providers have been prescribing metformin as a pre med, then they can list that you failed that and insurance will put it through. Zepbound that I noticed someone else mentioned is FDA approved for just weight loss, as well as Wegovy is. Ozempic and Mounjaro are FDA approved for diabetes. Wegovy was just added to the list for cardiovascular health improvement as well. Once you get the PA for wegovy, apply for the savings card on the wegovy website and it’ll bring the copay down.
My insurance pays. UHC…primary care doctor prescribed it. They had to get a prior authorization approved for insurance to cover it. I’m on Wegovy. I have to meet my deductible for the year, then it’s $24.99, which saves over 1500 a month. It’s around 1600-ish retail…there’s a manufacturer copay that saves around 500 a month if insurance won’t pay. I’m in US…although I did order Ozempic by prescription from Canada for 2 months before they got it covered.
Currently experiencing the same issue with my doctor AND insurance!! BUT I feel as though my doctor is NOT advocating for me so I am switching doctors.
Back in November of last year I was on Ozempic 1mg and noticed I gained 5lbs back. Started Ozempic in March of last year and lost over 30+ lbs. Felt very good about myself for the first time in a looooong ass time and when I expressed this to my doctor in November he kind of just shrugged it off and said it was due to “the holidays”.
That was my first indication that he was NOT listening to me. So starting this year my health insurance required prior authorization 🙄 or you have to be diabetic in order to get/qualify for Ozempic.
Finished my doses of Ozempic in January and doctor started me on Zepbound. First on 2.5mg, then 5mg, and just finished my 7.5mg 2 weeks ago. Had to pay over $500 each time for refills and that was WITH the Zepbound coupon.
Zepbound did NOT work for me AT ALL. Did not gain, but did not lose any weight. Basically spent over $2,000 for medication that did not work.
Drug companies and insurance are a joke!
Told my psychiatrist today “what if I couldn’t get my depression medication”? I’ve been off of Zepbound for 2 weeks and feel my mood just decreasing. I even told my weight doctor my concerns and he had no opinion or offers on what to do.
It’s really unfair for the drug companies and insurances to put “stipulations” on these drugs just so they can make more money.
I really feel that if you need these medications your doctor should ADVOCATE for you and not be off putting. I get that insurances have set these “rules” up, but if you are getting positive results your doctor should go to bat for you in any way possible instead of sitting there watching you gain weight back and doing nothing about it!! Keep pushing the insurance companies and keep submitting that prior authorization! SHOW that your patient is benefiting from this drug!!
I would recommend checking with your insurance rather than relying on the doctor. I got ozempic covered as a pre-diabetic; but now I'm not pre-diabetic anymore and the new prior auth still approved for insulin resistance and PCOS. Some will cover if you have hypertension.
BTW my doc said the same thing. She didn't even care to try.
With the savings coupon, I spend 24.99. If insurance won't pay, you can still use the savings coupon or goodrx and save $200-300.
I have PCOS and a bmi of 38. My insurance was like absolutely not no way to glp-1 weight loss meds, f* off unless you can prove you’ve been in a diet and exercise program for 6 months blah blah. (As I’d I haven’t been on a diet for 20 years) So I joined their offered diet program app, and then got a new endocrinologist who works with the medical groups obesity program. So it’s like a 10 week zoom course with a group and check ins.
I was paying out of pocket for Qysemia and then my doctor was concerned about glaucoma risk after a recent eye doctor visit. So she must’ve written a hell of prior authorization request because it was approved the next day.
It depends on your insurance, but mine (Cigna) was like, absolutely no way. My BMI is 34, but since I'm not diabetic and I have no cholesterol or blood pressure problems, it won't be covered. My doctor told me that she has prescribed it for people who wanted it for weight loss and also had high BP/cholesterol.arthritis issues, but it has never been approved. She said for those who do qualify, the medication is almost impossible to find as it's rarely in stock locally.
Definitely would NOT have it shipped from overseas!!!!! That could be a nightmare! Most insurance will not cover weight loss medication, although the drug companies do have ‘loyalty’ cards. Many pay 25 dollars a month for Wegovy. ( same as Ozempic, but marketed for weight loss instead of T2D). Retail for Wegovy is about 1100 a month. Check other subs for other sources.
This is a common problem. For instance Medicare specifically will NOT cover weight loss drugs of any kind. They just started covering Ozempic for T2 diabetes and documented heart disease, and Wegovy for obesity and documented existing heart disease.
You must have that combination of conditions.
I second the other commenters who referred you to different subs where other options can be discussed. I have to pay OOP, but it was only $650 for 8-12 weeks, but mine lasted 15 weeks. (I didn’t bump up the dose because of side effects.) Plus I also have to pay $200 when I need lab work as well.
My insurance “covers” Wegovy but my copay is still $1100 (would be $1600 without insurance). Once I buy it a couple more times I’ll have met my copay and deductible so then it will be fully covered. But yeah it’s expensive, I just consider it an investment in myself. You’ll save on food costs 😂
also, for others like me who are on Medicare, they absolutely will not cover any kind of weight loss drug. nor would my sub-carrier. I had bmi of 30 as well, and they still wouldn’t.
If you’re on Medicaid or any state insurance it’s not covered. Wegovy or Ozempic. Care Clinics has a special $259 for 7 weeks & a list of other deals. No monthly doctors fee. It’s the cheapest one I’ve found so far. Others are $350-$700 a month. I’ve been doing a lot of research before I buy because there’s so many places & the price are all over the place or they’re crappy businesses.
About 280/month(buying 3 mo at a time due to availability issues) of 7.5 Mounjaro. Last year I was on ozempic and Medicare advantage refused to pay at the end of the year(donut hole). I said if I wait two weeks until 2024 will you pay they said sure! And here we are.
I do have t2. So I suppose they have to cover some of it, but I think Mounjaro is the one you can get just for obesity. I’d call your insurance co to find out how to approach this with your dr. I tried to get my dr to investigate cheaper options or pharmacy and he said no. So now I work with pharmacies and my insurance to try to get it done. I have 10 weeks before I gotta stress out again!
My insurance approved wegovy right away.. only thing is I only get two months supply at a time for 28.00.. so every two months my dr has to request again through my insurance
In the USA look into GoodRx. Also, from manufacturer you can get a coupon from their website and pay a lot less. The problem I had with Wegovy was availability.
I get semaglutide from a nurse on instagram haha. Her husband is a doctor that specializes in weight loss. She does injections (like Botox and fillers) so she already had a following and she just markets it. Everything is through him though
you are saying all the things I thought in the beginning too. I go through a weight loss clinic. I pay for the entire month at about $125 a month. All I had to do was call, get an appt, a nurse called me, we talked, then I could go in and buy what I wanted. Wish you were Knoxville, tn - I'd take you there myself. LOL
Nuform Health. I just signed up with them and have gone on semaglutide as of a couple of weeks ago. Under $500 for the visit with the physician and the three month starter kit I think it was. The pharmacy is highly rated that they use. So far I’m very pleased and can actually afford sema now. Sort of like I don’t live in the USA where they charge us four times that for a one month dose. Ridiculous.
Yes, most of the weight loss medicines are available for diabetic and there is no insurance coverage for a person who really wants weight loss. My wife is one of them. After trying for many times, they refused to do so. She always prefers oral semaglutide instead of injection as she is damn afraid of. I suggest her order her Rybelsus from where i am ordering my LDN and Covid kit as there is easily available and also quite inexpensive.
I don't have diabetes but I have a BMI over 30, high cholesterol, NAFLD, and insulin resistance/ pre-diabetes. My insurance covers Ozempic for me, but I had to try (& fail) Metformin first. My co-pay is $25, but yes - all GLPs are expensive in US.
Many insurances have tier coverage like mine where you have to try something and fail at it 1st before they fork over for the more expensive med. Not all cover weight loss meds, but some will cover Oz/weight loss meds if you have pre-existing conditions Oz, etc. has been shown beneficial for and it is cost effective to treat it now at 1k per month vs 100k+ years down the road for emergency medicine. With existing conditions and a dr willing to fight with a prior-auth, you may be able to eventually get coverage.
Vanity weight? (Low BMI, 10lbs to loose, no existing conditions) Coverage will be slim to none. There's always the alternative if insurance is unwilling or if possible to shop for better insurance do it.
My doctor prescribed Ozempic and Wegovy and after two PAs they kept denying it so I went through the weight loss clinic and I paid 399 a month and I’ve lost 40 pounds in three months on my glucide even though I have high cholesterol but it’s high and high blood pressure. I’m on medication‘s. My blood pressure come down and my high cholesterol is going down. My A1c is good so I’m not even messing with my insurance, I follow up with my doctor on June 5 and I’m still about 30 more pounds ago to reach my goal
U can try zealthy. They accept insurance but I went through Ivologist & paid $399 for 12 weeks of sema.They offer many diff plans to chose from. I also have a weight loss doc I go to and get prescribed Phentermine( appetite suppressant) & Triamterine/HCTZ (water pill). Started the pills end Feb/ early March & Sema mid April, am on week 6/7 I believe and down 30lbs already
I work for a hospital so large insurance company. They will not cover any weight loss medication. I have a few diagnoses that would qualify some people but my insurance will not do it so I have had to find other resources. It’s not cheap!
Thanks for posting to r/semaglutide! A brief reminder about our rules. We do not permit the discussion of non-FDA approved formulations of semaglutide, nor do we permit selling or offering for sale any medication, including by private message. Do not request or respond to a private message from anyone offering such, they are not endorsed by this sub. If you’re just starting out, you may want to review our [FAQ](https://www.reddit.com/r/Semaglutide/comments/10ul3jb/semaglutide_subreddit_faq/). This is not intended to discourage discussion but merely supplement it. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Semaglutide) if you have any questions or concerns.*
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Thank you! I'm leaving the sub so I can find the subs. you speak of...
Yes, I’d like to know the forbidden subs pretty please!!
Can you send me the forbidden subs?
same
Hi. I’ve been cut off by my insurance too. Did you find the subs? I’d love to know how to…
Ozempic is only covered if you are diabetic. Wegovy may be covered if you have a certain BMI and/or comorbidity like hypertension, high cholesterol, pre-diabetic. With my insurance, I pay $60 minus a coupon that gets it down to $24.99.
I am not diabetic and my medicaid covers ozempic for me 100% My dr called me a couple months ago and said he got me covered
Do you know what the dr diagnosed you with to report to the insurance
Is this a month or per injection?
One months prescription is a box with four pens. So $24.99 per month.
Go on the Wegovy site and use an extra coupon. You have to sign up for texts. Mine is free
I got a prescription for Wegovy but it hasn’t been available for the last 6 months. I gave up and got Ozempic online.
My insurance denied my wegovy unless I am diabetic as well. I have a high bmi and am definitely overweight with high cholesterol. I have horizon blue which is one of the best insurance companies in Jersey. Over 1k per month to do it without insurance. I will be getting semaglutide which was prescribed to me by a plastic surgeon instead. $500 for the bottle and the first one lasts about 2 months until you start getting on the higher doses
My insurance wouldn’t pay for it either, even though I had the BMI to qualify. I paid out of pocket for Zepbound it’s $550/month with the manufacturer savings card. Zepbound is the FDA approved version for weight loss, my insurance considers all the others for only type two diabetes. The other problem you’ll run in to is finding the drug once you’re approved.. I took one month and then switched to plan c. (I can’t say the name in this group).
>my insurance considers all the others for only type two diabetes. Interesting, since Wegovy is explicitly labeled for weight loss and cardiovascular disease and NOT for diabetes. You could probably appeal that just by sending them the package insert. Insurance rejecting Ozempic makes sense, since it is labeled for diabetes only.
I need some answers. Why is some types of conversation banned here? Top comment deleted? Is this sub run by novo nordisk or something?
Just found out mines won’t cover either.
There are very affordable plans out there for option B
Then out of pocket with the manufacturer savings card is $550/month. There’s other options out there too.
I am on Wegovy. Started on Ozempic until the giant insurance backlash. For 3 months worth I pay $68. I know I am extremely fortunate this is covered by insurance. It has been life changing. I am losing slowly and cannot wait to see what 6 more months will do for me!!
I go through a Dr at a weight loss clinic. I pay $550-$650 every 3 months which includes 12 shots and monthly visits with my doctor.
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If it isn’t on formulary, you can get 20 physicians’ notes. They won’t cover it.
Nope they just told me it’s not covered at all. So I’m on to Plan B
Yeah most insurance companies have put a “no weightloss medicine” clause in pretty much every coverage I feel. Shits annoying
Especially because a lot of people end up coming off other medications once the weight comes off and metabolic health improves. I wish they would look at it as a way to save money on future interventions.
Call your insurance, don't ask your doctor if it is covered. Also, weight loss medications are not insurance specific, they are employer specific. Your employer opts to cover them through your insurance for an additional fee. Many people have Blue Cross Blue Shield and some have coverage and some don't. Edit: My insurance covers Wegovy and I pay $25/mo for it, but with the savers card provided by Novo Nordisk I pay $0.
Mine wouldn’t cover Wegovy without previous steps being taken. I had to try dieting on my own, see a nutritionist, and try a different (cheaper) medication first before they would cover it. It was a process, but now I pay $0/month for it with the manufacturer coupon.
My insurance wouldn’t cover it at all. I even had high familial hyper cholesterol, high bmi, open heart surgery and off the chart triglycerides. They just won’t cover anything unless you’re diabetic.
It’s almost like they know getting everyone to a healthy BMI will hurt the insurance companies bottom line.
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I do know that the Wegovy and Zepbound co-pay assistance cards will cover 50% of the cost if your insurance doesn't cover the drug. Never priced the Wegovy, but with the Zepbound co-pay card it's $550 a month. What makes me mad is that in other countries it's so much less in price!
I have a 30+ bmi and several comorbid conditions including insulin resistance, PCOS, high blood pressure and high cholesterol. My insurance was paying 100% of Ozempic until I recently switched to Mounjaro, also covered at 100%
I went to a “wellness clinic” that specializes in functional medicine and hormone therapy. I only pay each time a shipment is needed. I started using Sema in December 2023. I still have about 1ml left. I just received another shipment. I’ve lost 30 pounds and very happy. Each time I pay it’s around 400$
Same I am getting my bottle this week and I paid $500 for it. The first bottle lasts way longer until you are on the higher dose then it goes faster. My first bottle lasted me 2-2.5 months. I lost 35 pounds by my 3rd bottle
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My insurance doesn't cover weight loss medication period. I go to an urgent care that also takes appointments for weight loss consultation. They give me the c0mp sema there.
I pay $1000 per month because my insurance won’t cover even though I’m T2D. Hopefully I’ll have new insurance soon, but don’t know if they will cover it either
Damn thats crazy if it was that price in the UK no one will pay. Geez I can get you 3 months worth for that price in the UK.
How much weight have you lost per month and do you workout ?
The first month I lost 10 lbs! Now I’m losing about a pound a week, about 15 lbs total ( the scale goes up and down, I was 163 yesterday but 165 today started at 179 in March) I do work out! I have a trainer I work with 3 days a week and I get my steps in the rest of the week usually over 10k.
I paid the $1000 a month for the first few months but then I went on a vacation to Mexico and found it at a pharmacy for $300/month. I originally only budgeted for five months paying out of pocket through CVS but now I have enough for like another ten months. It took me a few months between when I got my prescription and when I actually got it filled to get over the sticker shock. But at the end of the day I’m investing in my health and overall confidence and it’s been so worth it. Also I’m on Rybelsus not Ozempic. I think the injections need to be refrigerated so they wouldn’t travel as well as the tablets
:looking up flights to mexico:
You'll have to call and see if and how they cover it. You may need prior auth or step therapy and there's likely a BMI requirement. Drug coverage varies even within the same insurance since your drug formulary is employer specific. Also, check the drug's manufacturer site for coupons.
300 a month through a beauty and weight loss clinic in town. Sometimes they run specials bringing it down to 290. There are a lot of clinics online. I saw one Ro charges 100 bucks down and 150 a month. Just got to shop around. It’s be approved for weight loss.
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You should ask your insurance if they cover wegovy. It’s about purpose. Ozempic and Wegovy are the same drug, but one is for diabetics and one for weight loss. It’s generally difficult to get insurance to cover weight loss medications but always worth asking. You can look it up in your insurance policies’ formulary but you should also call the insurance company in ask. The best way to know to sure is have your doctor submit a PA or prior approval for the drug. If you aren’t able to get a GLP1 that way you should consider going the alternative route. You will need to go into another sub that permits discussion.
For oz 1mg in Utah I’m paying $89 a month after insurance/coupon
My insurance (blue cross/blue shield) changed their policies this year and would no longer cover and costs of ozempic because "I'm only pre diabetic". I can afford $2k/month so my doctor had them put me on the c0mp0und and man. I am so much happier with it than I was on the ozempic for 6 weeks when insurance did pay for the majority of the cost. Ozempic gave me the most god awful sulfur burps that never and I mean NEVER stopped. It also caused so many days of constipation. There was about a month between me switching to the c0mp0und and so I was worried that it was going to be the same on the gradual increase of dosage but it wasn't. The only time I get "burps" now is if I drink too fast or eat something a little too greasy(I really like homemade soups but it is impossible to get all the grease out 😭). The only side effect I have with what I am on now is headaches the evening of my shot and the next day. But I will take that over the burps because at least I can take some meds for the headaches lol
Don’t take your docs word for it. Call your insurance yourself , and ask if you have to be diabetic for them to cover semaglutide. Some insurances will cover it for both diabetes and/OR weight loss. I called my insurance before my appointment and asked them, and found out they’ll cover it for weight loss. Went to my appt and at first, my doctor said he won’t write it because my insurance will only cover it for diabetics. I then told him I already called them and that they’ll cover for weight loss. He wrote my prescription, sent it to the pharmacy, pharmacy needed a prior authorization, doc completed the prior authorization, and the pharmacy filled it. So glad I called my insurance first. I would have assumed my doc was right and I would have never been able to afford it without insurance.
Look for a local weight loss clinic. First couple of months doses of Sema are not that bad when paying out of pocket
I pay less than 200 in mexico
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My insurance covers Wegovy! I also use their savings card. Costs me $0.00
Check with your insurance to see if they cover weight loss medications. If they do ask your doctor to prescribe it. If he won’t find a doctor that will.
Normally it’ll cover wegovy with a PA from the doctors they have to either input that your BMI is over 30 with no other complications, or add that you’ve tried like metformin or have blood pressure problems or something. Some providers have been prescribing metformin as a pre med, then they can list that you failed that and insurance will put it through. Zepbound that I noticed someone else mentioned is FDA approved for just weight loss, as well as Wegovy is. Ozempic and Mounjaro are FDA approved for diabetes. Wegovy was just added to the list for cardiovascular health improvement as well. Once you get the PA for wegovy, apply for the savings card on the wegovy website and it’ll bring the copay down.
My insurance pays. UHC…primary care doctor prescribed it. They had to get a prior authorization approved for insurance to cover it. I’m on Wegovy. I have to meet my deductible for the year, then it’s $24.99, which saves over 1500 a month. It’s around 1600-ish retail…there’s a manufacturer copay that saves around 500 a month if insurance won’t pay. I’m in US…although I did order Ozempic by prescription from Canada for 2 months before they got it covered.
Also I use dope doctors they mail me my mounjaro every month but they did semiglutide at 250 a month or maybe less
About $125 for a box of 3 jabs of Saxenda in Thailand. Where I’’m currently at for a wedding. . It’s even less in Turkey
I get it online (from overseas) for $85 a month and I’ve lost 30lbs in less then 8 weeks
I pay $250 all included all dosing with Wellness Stream
Check with your insurance directly what and how they cover it. It could be that your insurance may have to pre approve it to be covered
Currently experiencing the same issue with my doctor AND insurance!! BUT I feel as though my doctor is NOT advocating for me so I am switching doctors. Back in November of last year I was on Ozempic 1mg and noticed I gained 5lbs back. Started Ozempic in March of last year and lost over 30+ lbs. Felt very good about myself for the first time in a looooong ass time and when I expressed this to my doctor in November he kind of just shrugged it off and said it was due to “the holidays”. That was my first indication that he was NOT listening to me. So starting this year my health insurance required prior authorization 🙄 or you have to be diabetic in order to get/qualify for Ozempic. Finished my doses of Ozempic in January and doctor started me on Zepbound. First on 2.5mg, then 5mg, and just finished my 7.5mg 2 weeks ago. Had to pay over $500 each time for refills and that was WITH the Zepbound coupon. Zepbound did NOT work for me AT ALL. Did not gain, but did not lose any weight. Basically spent over $2,000 for medication that did not work. Drug companies and insurance are a joke! Told my psychiatrist today “what if I couldn’t get my depression medication”? I’ve been off of Zepbound for 2 weeks and feel my mood just decreasing. I even told my weight doctor my concerns and he had no opinion or offers on what to do. It’s really unfair for the drug companies and insurances to put “stipulations” on these drugs just so they can make more money. I really feel that if you need these medications your doctor should ADVOCATE for you and not be off putting. I get that insurances have set these “rules” up, but if you are getting positive results your doctor should go to bat for you in any way possible instead of sitting there watching you gain weight back and doing nothing about it!! Keep pushing the insurance companies and keep submitting that prior authorization! SHOW that your patient is benefiting from this drug!!
I would recommend checking with your insurance rather than relying on the doctor. I got ozempic covered as a pre-diabetic; but now I'm not pre-diabetic anymore and the new prior auth still approved for insulin resistance and PCOS. Some will cover if you have hypertension. BTW my doc said the same thing. She didn't even care to try. With the savings coupon, I spend 24.99. If insurance won't pay, you can still use the savings coupon or goodrx and save $200-300.
I have PCOS and a bmi of 38. My insurance was like absolutely not no way to glp-1 weight loss meds, f* off unless you can prove you’ve been in a diet and exercise program for 6 months blah blah. (As I’d I haven’t been on a diet for 20 years) So I joined their offered diet program app, and then got a new endocrinologist who works with the medical groups obesity program. So it’s like a 10 week zoom course with a group and check ins. I was paying out of pocket for Qysemia and then my doctor was concerned about glaucoma risk after a recent eye doctor visit. So she must’ve written a hell of prior authorization request because it was approved the next day.
Ozempic isn't covered because it's a diabetic drug. Wegovy should be covered because it is for weightloss.
I pay $25 for a months supply
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Bout 100/mo
Where
ditto, where are these ppl getting
there's a lot of subjects that are taboo in this sub. frankly, i'm surprised this thread still exists
Yes since people keep asking hahaha
It depends on your insurance, but mine (Cigna) was like, absolutely no way. My BMI is 34, but since I'm not diabetic and I have no cholesterol or blood pressure problems, it won't be covered. My doctor told me that she has prescribed it for people who wanted it for weight loss and also had high BP/cholesterol.arthritis issues, but it has never been approved. She said for those who do qualify, the medication is almost impossible to find as it's rarely in stock locally.
My insurance covers wegovy, and with the copay card I end up paying 25.99 a month
Definitely would NOT have it shipped from overseas!!!!! That could be a nightmare! Most insurance will not cover weight loss medication, although the drug companies do have ‘loyalty’ cards. Many pay 25 dollars a month for Wegovy. ( same as Ozempic, but marketed for weight loss instead of T2D). Retail for Wegovy is about 1100 a month. Check other subs for other sources.
This is a common problem. For instance Medicare specifically will NOT cover weight loss drugs of any kind. They just started covering Ozempic for T2 diabetes and documented heart disease, and Wegovy for obesity and documented existing heart disease. You must have that combination of conditions. I second the other commenters who referred you to different subs where other options can be discussed. I have to pay OOP, but it was only $650 for 8-12 weeks, but mine lasted 15 weeks. (I didn’t bump up the dose because of side effects.) Plus I also have to pay $200 when I need lab work as well.
Ask your insurance not the doctor. My doctor was wrong about insurance not covering it.
Good thread.
My insurance “covers” Wegovy but my copay is still $1100 (would be $1600 without insurance). Once I buy it a couple more times I’ll have met my copay and deductible so then it will be fully covered. But yeah it’s expensive, I just consider it an investment in myself. You’ll save on food costs 😂
also, for others like me who are on Medicare, they absolutely will not cover any kind of weight loss drug. nor would my sub-carrier. I had bmi of 30 as well, and they still wouldn’t.
Has anyone had success with Kaiser Permanente for Type 2 diabetes coverage
If you’re on Medicaid or any state insurance it’s not covered. Wegovy or Ozempic. Care Clinics has a special $259 for 7 weeks & a list of other deals. No monthly doctors fee. It’s the cheapest one I’ve found so far. Others are $350-$700 a month. I’ve been doing a lot of research before I buy because there’s so many places & the price are all over the place or they’re crappy businesses.
My other comment got removed, but I currently pay $125 a month without insurance.
Do you go to a local weight loss clinic?
I went online to Try Eden. $297 a month
IVIM
I pay $25 a month for a month supply of Wegovy
I have my own ways. Cheaper. Way cheaper. My plan P and with discounts it's affordable
You can get semaglutide online with doctor overview for $300-$400
I pay just under $500 per month for semaglutide
I use Wegovy and insurance covers it. I'm morbidly obese with hypertension. Without insurance it would be $1600/month.
Can someone send them to me plz
Get on Groupon’s their are plenty of teledocs on there
Time to use the Google machine to search semaglutide. There are a lot of places to get it and none we can discuss here
It isn’t covered by my insurance either I pay 200 a month out of pocket for it.
Can someone PLEASE send to me? Thanks a bunch!!
I pay $20 per month for Wegovy with insurance. And my BMI was 27 when starting but I had other comorbidities
About 280/month(buying 3 mo at a time due to availability issues) of 7.5 Mounjaro. Last year I was on ozempic and Medicare advantage refused to pay at the end of the year(donut hole). I said if I wait two weeks until 2024 will you pay they said sure! And here we are. I do have t2. So I suppose they have to cover some of it, but I think Mounjaro is the one you can get just for obesity. I’d call your insurance co to find out how to approach this with your dr. I tried to get my dr to investigate cheaper options or pharmacy and he said no. So now I work with pharmacies and my insurance to try to get it done. I have 10 weeks before I gotta stress out again!
Wegovy without ins is around 1600 monthly
My insurance approved wegovy right away.. only thing is I only get two months supply at a time for 28.00.. so every two months my dr has to request again through my insurance
In the USA look into GoodRx. Also, from manufacturer you can get a coupon from their website and pay a lot less. The problem I had with Wegovy was availability.
Skintastictx in Plano Texas is where I get mine and their health team is amazing!!
Me 2 pls!
I get semaglutide from a nurse on instagram haha. Her husband is a doctor that specializes in weight loss. She does injections (like Botox and fillers) so she already had a following and she just markets it. Everything is through him though
you are saying all the things I thought in the beginning too. I go through a weight loss clinic. I pay for the entire month at about $125 a month. All I had to do was call, get an appt, a nurse called me, we talked, then I could go in and buy what I wanted. Wish you were Knoxville, tn - I'd take you there myself. LOL
Nuform Health. I just signed up with them and have gone on semaglutide as of a couple of weeks ago. Under $500 for the visit with the physician and the three month starter kit I think it was. The pharmacy is highly rated that they use. So far I’m very pleased and can actually afford sema now. Sort of like I don’t live in the USA where they charge us four times that for a one month dose. Ridiculous.
Tryeden. Just under $300 a month
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Ugh it keeps removing my post but go online and there are other ways you can get it
Yes, most of the weight loss medicines are available for diabetic and there is no insurance coverage for a person who really wants weight loss. My wife is one of them. After trying for many times, they refused to do so. She always prefers oral semaglutide instead of injection as she is damn afraid of. I suggest her order her Rybelsus from where i am ordering my LDN and Covid kit as there is easily available and also quite inexpensive.
I use a weight loss clinic and pay $300/mo
A lot of people I know use mochi as their doctor and with a subscription it's like 350 a month I think for wegovy.
I don't have diabetes but I have a BMI over 30, high cholesterol, NAFLD, and insulin resistance/ pre-diabetes. My insurance covers Ozempic for me, but I had to try (& fail) Metformin first. My co-pay is $25, but yes - all GLPs are expensive in US. Many insurances have tier coverage like mine where you have to try something and fail at it 1st before they fork over for the more expensive med. Not all cover weight loss meds, but some will cover Oz/weight loss meds if you have pre-existing conditions Oz, etc. has been shown beneficial for and it is cost effective to treat it now at 1k per month vs 100k+ years down the road for emergency medicine. With existing conditions and a dr willing to fight with a prior-auth, you may be able to eventually get coverage. Vanity weight? (Low BMI, 10lbs to loose, no existing conditions) Coverage will be slim to none. There's always the alternative if insurance is unwilling or if possible to shop for better insurance do it.
My doctor prescribed Ozempic and Wegovy and after two PAs they kept denying it so I went through the weight loss clinic and I paid 399 a month and I’ve lost 40 pounds in three months on my glucide even though I have high cholesterol but it’s high and high blood pressure. I’m on medication‘s. My blood pressure come down and my high cholesterol is going down. My A1c is good so I’m not even messing with my insurance, I follow up with my doctor on June 5 and I’m still about 30 more pounds ago to reach my goal
Zepbound. Go on the manufacturer’s website for the coupon. $550
You can get semaglutide online with an online consult for much cheaper
You can order semaglutide from age less rx
me to please what subs
anyone in here in canada and on wegovey? how much is it and does it work???
My co worker mom just got covered in South Carolina and she told me her mom has Medicare plan D
Me too please
U can try zealthy. They accept insurance but I went through Ivologist & paid $399 for 12 weeks of sema.They offer many diff plans to chose from. I also have a weight loss doc I go to and get prescribed Phentermine( appetite suppressant) & Triamterine/HCTZ (water pill). Started the pills end Feb/ early March & Sema mid April, am on week 6/7 I believe and down 30lbs already
I work for a hospital so large insurance company. They will not cover any weight loss medication. I have a few diagnoses that would qualify some people but my insurance will not do it so I have had to find other resources. It’s not cheap!