Wegovy Cost with Insurance: Real Prices & Coverage in 2025

The actual cost of Wegovy varies wildly depending on your insurance type, tier placement, and whether prior authorization applies. This guide breaks down real-world prices and shows you exactly what to ask your insurance company.

How Much You'll Pay: Commercial Insurance

Most people under 65 with employer or marketplace insurance fall here. Your actual cost depends on three things:

• Your plan's drug formulary tier (how high is Wegovy on it?)
• Whether you meet the insurance company's medical criteria
• Whether you qualify for the Novo Nordisk savings card

Understanding Your Formulary Tier

Insurance companies bucket drugs into tiers. Higher tiers = you pay more out of pocket.

• Tier 1 (Generic): Usually $10–$25 copay. Wegovy rarely sits here.
• Tier 2 (Preferred Brand): Usually $30–$60 copay. Some plans place Wegovy here.
• Tier 3 (Non-Preferred Brand): Usually $80–$150 copay. Many plans place Wegovy here.
• Tier 4 (Specialty): Usually $200–$300+ copay. This is where Wegovy often lands without prior auth or medical criteria met.

Your exact copay appears in your plan's formulary (searchable on your insurance company's website). Search "semaglutide" or "Wegovy." If it shows Tier 3 or 4, don't panic—read on.

Prior Authorization: The Real Timeline

Many insurers require prior authorization for Wegovy, especially if you don't have T2D or if your BMI is under 30. Here's what happens:

1. Your prescriber submits a form to your insurance company with diagnosis, BMI, weight loss attempts, and medical justification.
2. Insurance reviews it (usually 3–10 business days).
3. Insurance approves, denies, or requests more info. If they need more, your prescriber submits additional documentation.
4. Once approved, you fill your first prescription. Your copay applies.

Important: Don't fill your prescription until you get the approval letter. If you pay cash upfront, insurance may deny reimbursement later. Some telehealth providers (like Ro, Hims) will hold your script while prior auth is pending at no charge.

The Novo Nordisk Copay Card: $0–$25/Month

If Wegovy is approved and you have commercial insurance, you can apply for the Novo Nordisk Wegovy savings card. Here's the real details:

• Your copay drops to $0–$25 per month per prescription (up to 12 refills/year).
• Eligibility: Must have commercial (not Medicare, Medicaid, TRICARE, or VA) insurance; must be a U.S. resident; income limits apply (varies by state, roughly $40k–$70k single).
• How to apply: Visit WegovyWorks.com or ask your prescriber to help. Takes 5–10 minutes online.
• Timing: Card is usually approved in 24 hours. You get a digital card number or physical card in the mail.
• Catch: You still need insurance to be primary payer. The card covers the difference between your copay and full price.

Real talk: If you qualify for this card, Wegovy becomes extremely affordable. Many patients pay $25/month for all four doses in a month's cycle.

Real-World Cost Breakdown: Tier-by-Tier

Brand Wegovy vs. Compounded Semaglutide: Cost Comparison

When to consider compounded: If your insurance denies brand Wegovy after an appeal, or if you're uninsured. Work with your prescriber to find a reputable compounding pharmacy.

Medicare: Coverage for Semaglutide

As of 2023, Medicare covers semaglutide for weight loss, but with a big caveat: only if you have T2D. Obesity as a standalone condition is not covered.

• Medicare Part D (prescriptions): Most plans cover it now, usually on Tier 3 or 4. Copays range from $35–$300+ per month depending on which plan you're on.
• Dual Eligible (Medicare + Medicaid): Varies by state. Some cover it; others don't. You'll need to check your specific state program.
• Medicare Advantage: Coverage varies. Some plans cover semaglutide for T2D; others require prior auth. Check your plan's formulary.

If you're on Medicare and have T2D, ask your doctor about Medicare coverage. If you don't have T2D, Wegovy likely won't be covered (but you can still get it cash or through telehealth).

Medicaid: State-by-State Variation

Medicaid is run by states, so coverage is all over the place. Some states cover semaglutide for T2D and/or obesity; others don't cover it at all.

• Call your state Medicaid office or check their formulary online to see if semaglutide is covered.
• If denied: You can appeal through your state Medicaid office. Some patients have successfully appealed by documenting failed diets and comorbidities.
• If covered: Your copay is usually $1–$5 (Medicaid copays are typically low).

No Insurance: Cash Prices & Alternatives

If you're uninsured, expect to pay full price unless you find a discount program.

• Brand Wegovy (full price): $935–$1,550/month depending on dose and local pharmacy.
• GoodRx discount: May save 10–20%; Wegovy is expensive even discounted.
• Novo Nordisk Patient Assistance Program: For uninsured patients with income below ~$40k/year. Free or reduced-cost Wegovy. Apply at NovoDirect.com.
• Compounded semaglutide: $100–$250/month. Cheaper, but less regulated.
• Telehealth GLP-1 programs (Ro, Hims, etc.): Usually offer compounded semaglutide. Around $199–$299/month.

How to Appeal a Denial: What Actually Works

Many patients get denied initially. The good news: appeals often succeed. Here's what works:

Checklist: What to Ask Your Insurance Company

Call your insurance company's customer service line (on the back of your card) and ask these exact questions:

• Is semaglutide (Wegovy) covered under my plan?
• What tier is it on? (Tier 2, 3, or 4?)
• Do I need prior authorization?
• What are the medical criteria for approval? (BMI, T2D diagnosis, etc.)
• What is my copay if it's approved?
• Is there a prior authorization or step therapy requirement?
• Can I appeal a denial, and what\'s the process?
• Are there quantity limits or refill restrictions?

Write down the representative's name, date, and time. If they say "no coverage," ask to escalate to a supervisor. Insurance reps sometimes don't have full information.

Real Cost Timeline: Your First 3 Months

Here's what most patients actually spend in their first 3 months, with average commercial insurance:

Why Drugs Sit on Different Tiers: The Business Behind It

You might wonder: why is Wegovy on Tier 4 while my blood pressure medication is Tier 2? Here's why:

• Negotiating power: Novo Nordisk charges insurers a high price for Wegovy. Insurers haven't negotiated it down as aggressively as older drugs (which is changing).
• Alternative availability: Insurers prefer to push patients toward older, cheaper GLP-1s (like generic semaglutide) or compounded versions to save money. They tier Wegovy high to discourage brand selection.
• Prior auth leverage: High tier + prior auth = fewer patients using it = lower costs for the insurer. This is intentional cost containment.
• Competitive positioning: As Mounjaro (tirzepatide) enters the obesity market, tiers are shifting. Your plan may offer better coverage for Mounjaro to compete with Novo Nordisk.

Translation: Tier placement is a business decision, not a medical one. If you meet medical criteria, appeals often win.

Brand Wegovy vs. Generic Semaglutide: Same Drug, Different Cost

Semaglutide is now available as a generic (though many insurance companies still list it under brand names). Here's the breakdown:

• Brand Wegovy: $935–$1,550/month (full price). Often on Tier 3/4.
• Generic semaglutide: $300–$600/month (full price, usually lower than brand). Many plans tier this lower.
• Compounded semaglutide: $100–$250/month. Not brand name, filled by compounding pharmacies.

All three are the same active ingredient. The difference is manufacturer, FDA oversight, and pricing. Ask your insurance if they cover generic semaglutide (might be cheaper than Wegovy). Ask your doctor if they're comfortable prescribing it.

Bottom Line

Your actual Wegovy cost depends on your insurance type, formulary tier, whether prior authorization is needed, and your eligibility for the Novo Nordisk savings card. With good insurance + the savings card, you could pay as little as $25/month. Without insurance, compounded semaglutide ($100–$250/month) is a realistic alternative to full-price brand Wegovy ($1,000+/month).

Don't accept the first "no" from insurance. Appeals work. And remember: telehealth programs and patient assistance programs exist if cost is your barrier.