Does Anthem cover Wegovy for weight loss?

Key takeaway 

Anthem may cover Wegovy for weight loss, but eligibility criteria and prior authorization requirements apply. 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

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. Most policies require a prior authorization process, during which your provider can verify that you meet the medical guidelines set by Anthem. Because every Anthem plan is different, it’s important to always check your personal coverage before scheduling an appointment.

Tip: Klarity Health recently expanded its network, and more than 100 providers accepting insurance have joined the platform. You can easily find a provider who accepts Anthem for online consultations.

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Eligibility criteria for Anthem Wegovy coverage

Anthem usually covers Wegovy if you meet 1 or more of these criteria:

• 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.

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.
• 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.

How to get prior authorization from Anthem for Wegovy

To secure Anthem coverage for Wegovy, you’ll need prior authorization. First, book an online appointment with a licensed provider. 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.

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Next steps to get Wegovy covered by Anthem online

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.

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