Does insurance cover Semaglutide?

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If you, like many others are interested in potentially trying to lose weight via prescription Semaglutide, one of the first questions that probably comes to your mind is how much does it cost and whether or not it is covered by insurance. The cost of the medication will vary, depending on several factors, such as the brand, your dose and location.  Normally medications like Ozempic or Wegovy, the 2 main name brand versions of Semaglutide, are used to treat type two diabetes and/or obesity.  Like with most medication the costs typically will change overtime so it’s best to check with your local pharmacy or healthcare provider to get the most up-to-date pricing information.  It’s often very confusing when you go to a website like Groupon and see various advertisements which will make the cost of treatment seem substantially lower than what you’re actually going to pay.  This can be because they are offering smaller doses, or diluted concentrations of medication.  Some advertisements will give you what it would cost for a weeks supply but you need to purchase 8 weeks worth of medication.  When you actually compare apples to apples, the costs are all approximately in the same range, between $1,000-1,500 per month.  

Well, Does Insurance Cover The Cost of Semaglutide? 

There’s good news and bad news.  The bad news is that currently insurance will not cover Semaglutide for weight loss for most patients. Even though obesity is clearly associated with a high number of adverse health risks, insurance providers will rarely cover the cost of weight loss medication, which, in the case of Semaglutide can exceed $1000 for a single months supply.  However, there is some hope on the horizon in that clinical trials are currently being conducted to determine whether popular weight loss medications like Ozempic and Wegovy may be able to provide additional health benefits other than just weight loss for people with obesity. If it’s determined that the benefits exceed more than just losing weight, it’s possible that insurance providers may cover the cost of these medication in the future.

Cleveland clinic endocrinologist Dr. Peminda Cabandugama said, “the reason why it’s not covered is because there is a perception that obesity is considered a cosmetic issue as opposed to a chronic disease… but these medication’s not only help with weight loss, but give cardiac benefits, help with blood pressure, help cholesterol, and kill sleep apnea.”

With so many benefits, it seems that it would only be a matter of time before enough. Clinical trials can convince the insurance providers to start covering the medication.

Another barrier to coverage is a law from 2003, which prohibits Medicare from covering weight loss medication’s which cuts off a very large group of potential patient’s private insurance companies usually take their cues about what they will cover from Medicare so until the government doesn’t about face, the insurance companies will typically follow their lead.

Why are so many people taking Semaglutide?

The answer is simple… because it works.  Both Ozempic and Wegovy are Semaglutide, just in different doses.  Dr Shauna Levy, the Director of the Tulane bariatric center in New Orleans stated “these anti-obesity medications are the best we’ve ever seen”

According to the centers for disease, control and prevention, 70% of Americans are obese/overweight, which causes an increased risk for type two diabetes, as well as heart disease. Both of these conditions are preventable and medication like Semaglutide may be the key.

So how much weight can you lose on Semaglutide?

The amount of weight-loss someone can experience on Semaglutide will vary from one person to the next. It’s a medication that can be prescribed to help with weight loss and clinical trials have shown it to lead to a significant reduction in unwanted, fat, and BMI. Often in the range of 10 to 15% of total body weight.  However, it should be stated that individual results will differ in the effectiveness of the medication will depend on several factors like diet, exercise, and individual physiology/genetics. It’s extremely important to work with healthcare providers to determine if this medication is suitable for your weight loss goals, as well as to monitor your progress along your journey.  If someone is motivated enough, and they stick to a well-established diet and exercise program. Along with the medication, they can expect to see significant results, however, weight loss may or may not be maintained in individuals that make no changes to the lifestyle habits that allowed them to become overweight to begin with.  If a sedentary lifestyle and poor diet led to someone becoming obese, and then they lose weight with Semaglutide, it’s likely the weight will return after they stop taking the medication if they continue to eat fast food, and not exercise.  

What is Wegovy.

The generic name is Semaglutide which is an injection of 2.4 mg and is a prescription medication that may help adults and children over 12 years of age with obesity.  For adults with a BMI over 30 and the 95th percentile for age and sex in children, or some adults that have excessive weight and a BMI over 27 who also may have weight related medical issues help them lose weight and keep it off.  Wegovy works best when used with a reduced calorie diet and exercise plan.  It’s important to know that Wegovy is a prescription medication and will require a consultation from a licensed physician.

It’s extremely important to consult with your doctor before taking any medication, making any dietary changes or starting any exercise routines.

What is Ozempic?

Ozempic, Semaglutide injection, 0.5 mg, 1 mg or 2 mg are also injectable prescription medications used along with Dan exercise to improve blood glucose levels and adults that have type two diabetes as well as reduce the risk of major cardiovascular events like heart attack, stroke, or death and adults with type two diabetes that have known heart disease.  The difference between the two medications is that Ozempic is not FDA approved for weight loss due to its dosing.  However, compounded Semaglutide can be prescribed and dosed accordingly to patients and has shown remarkable results.

Novo Nordisk, the maker of both medications said that 81% of their patients on Wegovy are female.  They have been furiously ramping up production of both medications due to such high demand.  Fortunately, many local compounding pharmacies are able to fill prescriptions, but you may need to go through a physician or a clinic in order to obtain it.  There are many online telehealth providers for weight loss which offer very convenient access to the medication.  Novo Nordisk recently invested $1.6 billion to expand capacity and address the shortage of Ozempic, which technically is not approved for weight loss, unlike Wegovy.  

As stated before, Semaglutide is a prescription medication and you will need to get a prescription from a healthcare provider like a physician, or endocrinologist to obtain it. It is used to treat conditions such as type two diabetes and obesity and getting a prescription from a licensed experience Dr ensures that it will be used appropriately and safety under the proper medical supervision required.  As with all medication, there are potential side effects and contraindications, which is why it’s so important to speak with your doctor before beginning any new medication to discuss the possibility of any adverse reactions or side effects as a result of taking the prescription drugs.

For more info in Semaglutide prescriptions of to speak with a licensed and experienced physician, please call or text (561) 277-8260 and we will be happy to answer any questions or schedule a time to speak with our doctor

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