Hey everyone, I’ve been researching options for Ozempic and Wegovy, and these drugs are so expensive without good insurance coverage! I’m looking for tips on how to make them affordable. Has anyone found effective ways to get better pricing or figured out insurance tricks that help?
I know, right? Full price for Ozempic is around $936 per month and Wegovy is even higher at $1,349. If you have insurance, it might go down to about $281 for Ozempic or $405 for Wegovy, depending on coverage. Insurance can be really picky about these drugs, though.
@Colby
Totally! I had to look into this because my insurance was only covering it partially. There’s also the NovoCare Savings Card for Ozempic, which can lower costs to about $131 if your insurance pays part of it. They even have a patient assistance program that could make it free if you qualify based on income.
@Rowan
Thanks for the details! I’ll check out NovoCare. Seems like some programs lower it significantly, especially if you have low income or specific insurance plans.
For anyone with diabetes, getting these covered is a bit easier since Ozempic is approved for diabetes. Wegovy is tougher because it’s specifically for weight loss, so insurance companies are stricter about it. With Ozempic, if you’re only looking to lose weight, you might have to get it ‘off-label’ without coverage.
@Nori
Yep, and with off-label prescriptions, a lot of insurance plans refuse coverage since the FDA only approved Ozempic for diabetes, not weight loss. Medicare, for instance, won’t pay for it unless it’s specifically for diabetes treatment.
@Hadley
Exactly! Medicare has strict rules here. Most private plans also require ‘prior authorization,’ meaning your doctor has to justify why it’s medically necessary. A hassle, but might help with approval.
If you’re trying to get insurance coverage, sometimes plans require you to try cheaper drugs like metformin before covering Ozempic or Wegovy. I know UnitedHealthcare often wants you to go this route, and Blue Cross sometimes does too.
@Cameron
I’ve heard about that too. Insurance companies see these weight loss drugs as last-resort options because they’re pricey. Some people have been asked to try other meds or even lifestyle programs first.
@Ari
Yeah, it’s like they want you to prove you’ve exhausted other options. In some cases, they’ll only cover a certain amount or limit coverage to a few months.
Does anyone know about discounts for Wegovy? I’ve heard they have a coupon that might reduce costs to around $180, but only if you have insurance. It’s still high but could help!
Oaklan said:
Does anyone know about discounts for Wegovy? I’ve heard they have a coupon that might reduce costs to around $180, but only if you have insurance. It’s still high but could help!
Yes, the Wegovy Savings Card from the manufacturer can save you between $225 and $500 monthly, whether or not you have insurance. But the exact amount depends on your insurance coverage tier, like if it’s listed as a ‘preferred’ or ‘non-preferred’ drug.
@Sam
Interesting! Preferred drugs usually cost less in terms of copay, right? Non-preferred status could mean paying a higher share of the price, though.
If you’re switching insurance or shopping on HealthCare.gov, keep in mind that only some marketplace plans cover these drugs for weight loss. Blue Cross Blue Shield has decent coverage for some weight loss drugs, and with some plans, it can even count towards preventive care so your deductible might not apply.
@LizCampbell
Blue Cross also has a few good wellness programs, like discounts for WeightWatchers or gym memberships, and some of their plans let you avoid the deductible for specific meds.
Nico said:
@LizCampbell
Blue Cross also has a few good wellness programs, like discounts for WeightWatchers or gym memberships, and some of their plans let you avoid the deductible for specific meds.
Right! But be careful since it varies a lot by state. Michigan’s Blue Cross plan, for instance, stopped covering Wegovy for some employers recently. It really depends on your location.
I read that Mounjaro and Zepbound are alternatives with similar ingredients but different uses (diabetes vs. weight loss). Anyone tried these? I’ve seen Mounjaro costs about $1,069/month without insurance.
@Taliesin
Yep, Zepbound has the same ingredient (tirzepatide) and is aimed at weight loss, while Mounjaro is for diabetes. Zepbound is around $1,060 a month too. Without insurance, it’s expensive, but there’s a discount program that could drop Mounjaro’s cost to around $497 if insurance won’t cover it.
@Blake
Thanks! So Mounjaro might be an option for people with diabetes, while Zepbound could be the weight-loss version with similar costs. Good to know both exist.
For those without insurance, Rybelsus might be cheaper. It’s the same main ingredient as Ozempic but in pill form. Costs are around $936 per month, but with insurance and a discount, it might go as low as $10 monthly.