Does Harvard Pilgrim Health Care Cover Semaglutide (Wegovy)

Explore Harvard Pilgrim coverage for Semaglutide (Wegovy), reasons for denial, how to get coverage, costs without insurance, and FAQs.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage for Semaglutide (Wegovy)

 

  • Harvard Pilgrim Health Care may cover Semaglutide (Wegovy) primarily for chronic weight management. Coverage is subject to specific criteria and medical necessity.
  •  

  • Members usually need a diagnosis indicating a BMI of 30 or greater, or 27 with weight-related comorbidities such as hypertension or type 2 diabetes.
  •  

  • Prior authorization is typically required. Providers must submit medical documentation demonstrating previous weight-loss attempts and the clinical necessity for Wegovy.
  •  

  • Patients must adhere to the prescribed dosage and follow healthcare provider instructions. Regular follow-ups are necessary to evaluate efficacy and adherence.
  •  

  • Coverage policies can vary and are subject to change, so it is essential to check with Harvard Pilgrim directly for the most current and specific plan-related information.

 

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Semaglutide (Wegovy) Coverage with Harvard Pilgrim Health Care

 

Check Your Plan Details

 

  • Visit the Harvard Pilgrim Health Care website and log into your member area to review your specific health plan details.
  •  

  • Search for information regarding prescription drug coverage and confirm if Semaglutide (Wegovy) is included in the covered drugs list.
  •  

  • Download or view the formulary list to understand any requirements or restrictions for covering this medication.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your interest in Semaglutide (Wegovy) for weight management or any other related health issues.
  •  

  • Your provider can determine if this medication is appropriate for your condition and can discuss potential benefits and risks.
  •  

  • If Semaglutide (Wegovy) is deemed suitable, request your provider to initiate a prescription and any required prior authorization forms.

 

Submit Prior Authorization (If Necessary)

 

  • Many insurance providers, including Harvard Pilgrim, require prior authorization for certain medications like Semaglutide (Wegovy).
  •  

  • Your healthcare provider should submit the required prior authorization form along with any necessary documentation supporting the medical need for this treatment.
  •  

  • Ensure all paperwork is complete and submitted to avoid processing delays.

 

Contact Harvard Pilgrim Customer Service

 

  • Once your provider has submitted the necessary forms, contact Harvard Pilgrim’s customer service to confirm receipt and inquire about any outstanding steps.
  •  

  • Verify your prescription coverage details, including any co-payments or out-of-pocket costs associated with Semaglutide (Wegovy).
  •  

  • Request information on the expected timeline for prior authorization approval, if applicable.

 

Follow-Up and Collect Documentation

 

  • Stay in communication with your healthcare provider and Harvard Pilgrim to monitor the status of your prior authorization request.
  •  

  • Once approved, obtain written confirmation from Harvard Pilgrim Health Care detailing your coverage for Semaglutide (Wegovy).
  •  

  • Pick up your prescription at a preferred pharmacy location, ensuring that you understand any financial commitments required at the time of dispensing.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Harvard Pilgrim Health Care Cover Semaglutide (Wegovy)

Explore Harvard Pilgrim coverage for Semaglutide (Wegovy), reasons for denial, how to get coverage, costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Semaglutide (Wegovy) Covered by Harvard Pilgrim Health Care

 

Coverage for Semaglutide (Wegovy)

 

  • Harvard Pilgrim Health Care may cover Semaglutide (Wegovy) primarily for chronic weight management. Coverage is subject to specific criteria and medical necessity.
  •  

  • Members usually need a diagnosis indicating a BMI of 30 or greater, or 27 with weight-related comorbidities such as hypertension or type 2 diabetes.
  •  

  • Prior authorization is typically required. Providers must submit medical documentation demonstrating previous weight-loss attempts and the clinical necessity for Wegovy.
  •  

  • Patients must adhere to the prescribed dosage and follow healthcare provider instructions. Regular follow-ups are necessary to evaluate efficacy and adherence.
  •  

  • Coverage policies can vary and are subject to change, so it is essential to check with Harvard Pilgrim directly for the most current and specific plan-related information.

 

A weight management program tailored to you

Start with Curex

Harvard Pilgrim Health Care's Approved Criteria for Semaglutide (Wegovy) Coverage

 

Eligibility Criteria for Semaglutide (Wegovy) Coverage

 

  • Candidates must have a body mass index (BMI) of 30 kg/m² or greater, indicating obesity.
  •  

  • Adults with a BMI of 27 kg/m² or greater, categorized as overweight, may qualify if they have at least one weight-related comorbid condition, such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

  • Patients must have attempted to manage weight through a structured diet and exercise program, documented within the past 6 months.
  •  

  • Medical records should demonstrate that the patient has gained or maintained weight following or during previous treatments with other anti-obesity medications, if applicable. This implies a need for alternative therapy such as Wegovy.

 

Documentation and Prescription Requirements

 

  • A healthcare provider specializing in obesity management, endocrinology, or a related field must document the patient's BMI and associated comorbidities.
  •  

  • The prescriber must provide a documented rationale for choosing Wegovy over other weight management therapies, emphasizing Wegovy's potential benefits tailored for the patient.
  •  

  • The prescription for Semaglutide must adhere to Wegovy's FDA-approved dosing regimen.

 

Continued Coverage Criteria

 

  • Continued use of Semaglutide is contingent upon achieving and maintaining a clinically significant weight loss, defined as a reduction of at least 5% from baseline body weight within the first 12 weeks on the maintenance dose.
  •  

  • Ongoing treatment requires documentation of patient adherence to both the medication and prescribed lifestyle modifications, including diet and exercise.
  •  

  • Regular follow-up visits must be scheduled and documented, aligning with medical best practices for obesity management, to evaluate treatment efficacy and adjust the regimen as needed.

 

Approval Process

 

  • Initial requests for coverage must include comprehensive clinical documentation, outlining the necessity for treatment, patient history, and previous treatment outcomes.
  •  

  • Renewal requests should include updated patient progress reports and evidence of weight loss maintenance or further reduction.
  •  

  • The insurance approval team will evaluate each application based on medical necessity, safety, and adherence to established clinical criteria for Wegovy use.

 

Why Harvard Pilgrim Health Care Might Deny Semaglutide (Wegovy) Coverage

 

Situations Where Harvard Pilgrim Health Care Might Deny Semaglutide (Wegovy) Coverage

 

  • Requests for coverage outside the FDA-approved indications or usage. Wegovy is specifically approved for certain weight management scenarios, and usage beyond these indications is not covered.
  •  

  • Lack of documentation or insufficient evidence demonstrating the necessity of the medication for the patient's condition. Comprehensive medical documentation is required to justify the prescription of Wegovy.
  •  

  • Failure to meet specific eligibility criteria related to Body Mass Index (BMI) thresholds or other health conditions. Patients must meet specified BMI guidelines along with weight-related comorbidities as prerequisites for coverage.
  •  

  • Non-compliance with the health plan's step therapy requirements, which might require patients to try and fail other traditional weight management options before Wegovy is covered.
  •  

  • Requests for coverage when a patient is concurrently using other weight management drug treatments that are not allowed for concurrent use with Wegovy.
  •  

  • Denial based on age restrictions if the patient does not fall within the specified age range approved for Wegovy's usage.
  •  

  • Incomplete submission of prior authorization requests, resulting in a lack of necessary documents to support the medical necessity for Wegovy treatment.
  •  

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Semaglutide (Wegovy) Cost without Insurance?

 

Approximate Cost of Semaglutide (Wegovy) Without Insurance

 

  • The price of Semaglutide, commonly known as Wegovy, without insurance can be substantial, typically ranging between $1,200 and $1,400 for a supply that lasts approximately one month.
  •  

  • This medication is designed for long-term weight management, thus planning financially for sustained use is important if paying out of pocket.
  •  

  • It's important to note that prices can vary based on the pharmacy, geographic location, and available discounts or pharmacy loyalty programs.
  •  

  • Patients are encouraged to seek patient assistance programs or discounts to help mitigate costs. Some pharmaceutical manufacturers offer discount cards or assistance programs to help with the cost of prescription medications like Wegovy.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Semaglutide (Wegovy) Coverage with Harvard Pilgrim Health Care

 

Check Your Plan Details

 

  • Visit the Harvard Pilgrim Health Care website and log into your member area to review your specific health plan details.
  •  

  • Search for information regarding prescription drug coverage and confirm if Semaglutide (Wegovy) is included in the covered drugs list.
  •  

  • Download or view the formulary list to understand any requirements or restrictions for covering this medication.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your interest in Semaglutide (Wegovy) for weight management or any other related health issues.
  •  

  • Your provider can determine if this medication is appropriate for your condition and can discuss potential benefits and risks.
  •  

  • If Semaglutide (Wegovy) is deemed suitable, request your provider to initiate a prescription and any required prior authorization forms.

 

Submit Prior Authorization (If Necessary)

 

  • Many insurance providers, including Harvard Pilgrim, require prior authorization for certain medications like Semaglutide (Wegovy).
  •  

  • Your healthcare provider should submit the required prior authorization form along with any necessary documentation supporting the medical need for this treatment.
  •  

  • Ensure all paperwork is complete and submitted to avoid processing delays.

 

Contact Harvard Pilgrim Customer Service

 

  • Once your provider has submitted the necessary forms, contact Harvard Pilgrim’s customer service to confirm receipt and inquire about any outstanding steps.
  •  

  • Verify your prescription coverage details, including any co-payments or out-of-pocket costs associated with Semaglutide (Wegovy).
  •  

  • Request information on the expected timeline for prior authorization approval, if applicable.

 

Follow-Up and Collect Documentation

 

  • Stay in communication with your healthcare provider and Harvard Pilgrim to monitor the status of your prior authorization request.
  •  

  • Once approved, obtain written confirmation from Harvard Pilgrim Health Care detailing your coverage for Semaglutide (Wegovy).
  •  

  • Pick up your prescription at a preferred pharmacy location, ensuring that you understand any financial commitments required at the time of dispensing.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Semaglutide (Wegovy) FAQ

1. What are the common side effects of Semaglutide (Wegovy)?

 

Common Side Effects of Semaglutide (Wegovy)

 

  • Nausea  — Often occurs at the start of treatment and may decrease over time.
  •  

  • Vomiting  — Related to gastrointestinal upset; usually temporary.
  •  

  • Diarrhea  — Common and may vary in intensity.
  •  

  • Constipation  — It can occur alongside other digestive issues.
  •  

  • Abdominal Pain  — Includes discomfort or cramping sensation.
  •  

  • Headache  — Typically mild but can be persistent.
  •  

  • Dizziness  — May affect balance or result in vertigo-like symptoms.
  •  

  • Fatigue  — Some patients report general tiredness or lack of energy.

 

2. How much weight can I lose with Semaglutide (Wegovy)?

 

Potential Weight Loss with Semaglutide (Wegovy)

 

  • Clinical trials demonstrate that Semaglutide (Wegovy) helps individuals lose a significant amount of weight. On average, participants experienced a weight loss of about 15% of their initial body weight over 68 weeks.
  •  

  • Results vary, with some losing more and others less. Factors include adherence to medication, lifestyle changes, and individual metabolic responses.
  •  

  • Semaglutide should be part of a comprehensive weight management program, including a reduced-calorie diet and increased physical activity.
  •  

  • Consult with a healthcare professional for personalized advice and to discuss possible side effects like nausea or gastrointestinal issues.

 

3. Is Wegovy the same as Ozempic?

 

Differences Between Wegovy and Ozempic

 

  • Formulation: Both contain semaglutide, a GLP-1 receptor agonist, but are formulated for different purposes.
  •  

  • Indication: Wegovy is primarily for weight management in adults with obesity. Ozempic is prescribed for type 2 diabetes management.
  •  

  • Dosage: While both are weekly injections, Wegovy generally has higher dosing than Ozempic (up to 2.4mg vs. 1mg for Ozempic).
  •  

  • Side Effects: Common side effects overlap, including nausea, but may vary in intensity due to different dosages.

 

Conclusion

 

  • Though similar, they serve distinct medical purposes. Always consult your healthcare provider for personalized advice.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Made in Webflow