New Options for Wegovy and Zepbound
Wegovy: $499 / Month || Zepbound: $499 / Month
As both Wegovy (semaglutide) and Zepbound (tirzepatide) are coming out of shortage, both manufacturers announced new options for cash-pay patients to expand access to these new weight loss treatments.
If you are interested in pursuing Wegovy or Zepbound for weight loss, read on to understand your options!
1. First, Check with your insurance carrier on whether or not you have coverage for Wegovy or Zepbound for weight loss.
Coverage for Wegovy and Zepbound varies by insurance carrier. Whether or not you have coverage is generally determined by your employer. Here in Colorado, weight loss medications are EXCLUDED on most plans, unless the employer opts in. However, in some other states, there is broader availability. If you work for a large employer, you have better chances at having coverage. The first step is to call your health insurer directly, see if you have coverage, what that coverage looks like (cost), and the requirements for coverage (BMI, behavioral program first, who can prescribe it, etc.)
If you have determined that you have coverage, AND you meet all the requirements that will be asked for on prior-authorization, let us know at your next provider visit. We are happy to prescribe and complete the required prior authorization process.
Keep in mind prior authorizations can be arduous for us to complete oftentimes taking us hours for just one. For this reason, we kindly request that YOU check first, so we don’t spend hours on this just to learn you have a plan exclusion. If it is not part of your plan, we can not get it approved.
2. If you do NOT have coverage, Wegovy and Zepbound are available for on-label prescribing at $499 per month
We can now prescribe Wegovy directly through Novocare and have it delievered to our patients for $499 per month. This requires an on-label diagnosis (obesity or overweight with compelling complication like high blood pressure, high cholesterol, or pre-diabetes). All 5 strengths of Wegovy are available, and it comes in simple to use auto-injector pens.
Similarly, we can also prescribe the first 4 strengths of Zepbound direct through Lilly. The higher doses are similarly priced at $499 / month. Instead of the auto-injector, the Zepbound cash pay program sends you the medication in vials, and you can draw up and inject with low dose insulin syringes, which they can also provide.
3. Other avenues for Wegovy and Zepbound for weight loss
In addition to the above, brand new programs, our providers can often find other ways to help you control the cost (sometimes saving as much as 50% of the above costs). Again, this is very individualized.
If you have been considering a GLP-1 weight loss medication, consider whether one of these programs might be right for you! This has opened up lots of treatment options for patients whom until now have been excluded, including Medicare, Medicaid, State / Federal plans, Colorado plans, and even Kaiser patients.
