What is ‘prior authorization’ for Wegovy (semaglutide) insurance coverage?
Prior authorization is paperwork requested by your insurance carrier to justify the use of Wegovy®. Some insurance plans will require a prior authorization to be completed in order to cover the cost of Wegovy. Your healthcare provider will complete the paperwork. Unfortunately, this is not a guarantee of coverage.
Different insurance plans and providers may have different criteria as to what is needed for prior authorization of Wegovy, which can include:
- Proof that the medication is working (patient lost at least 5% of their body weight within the first 3 months of taking Wegovy)
- Proof that the patient has – and follows – a lifestyle & diet plan in addition to taking Wegovy
- Proof that the patient made lifestyle changes prior to starting Wegovy
Many doctors have the authority to prescribe medication such as Wegovy. However, without following a standardized treatment schedule and laying out a treatment plan, the prescription may not pass the authorization for coverage. Keep in mind that coverage and costs vary based on your specific insurance plan. To learn more about your exact costs for Wegovy or other medications, contact your insurance company using the phone number on the back of your insurance card.
At Form Health, we always recommend working with reputable doctors that will construct a holistic lifestyle and health improvement plan for you as opposed to just giving you a prescription. In turn, this will also help your case if your insurance plan requests prior authorization paperwork.
Some people choose to get compounded semaglutide medication instead of the brand name medication like Wegovy. Although they are often available at a lower cost, it’s important to know that these compounded weight loss medications come with real risks. The molecule has not been tested in clinical trials and approved by the FDA for safety and efficacy. Additionally, compounding facilities may not be FDA monitored and there is a risk of contaminants and patient dosing errors. Form is dedicated to providing quality evidence-based medical weight loss care. The National Obesity Medicine Association recently published an extensive position statement advising against using compounded peptides that also highlights the risk to individuals. Form Health is aligned with the Obesity Medicine Association’s position. We do not prescribe compounded medication.
Learn more about how Form Health doctors prescribe Wegovy to help patients achieve their weight loss goals.
Brooke Marsico, PA-C
Brooke Marsico completed her physician assistant training at Midwestern University in 2011. She began her practice in the field of Obesity Medicine at Northwestern Memorial Hospital in Chicago where she practiced from 2016 to 2021. She went on to treat patients living with obesity at Cleveland Clinic from 2021 to 2022 prior to joining the team at Form Health. Brooke is passionate about helping patients living with obesity achieve meaningful weight loss and improve their health. Her practice focuses on individualized behavioral and pharmacological intervention to help patients reach their goals. She is also experienced in managing patients who have a history of bariatric surgery.
