Does Humana Cover Semaglutide (Wegovy)

Explore Humana's coverage of Semaglutide (Wegovy), reasons for denial, steps to secure coverage, cost 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

 

Does Humana Cover Semaglutide (Wegovy)?

 

  • Humana often covers Semaglutide (Wegovy) for weight management in adults with a body mass index (BMI) ≥30, or ≥27 with related conditions like hypertension or type 2 diabetes, pending effective weight loss programs' documented failure.
  •  

  • Insurance approval requires preauthorization, where healthcare providers send a coverage request, including medical necessity evidence and previous weight management attempts.
  •  

  • Coverage specifics can vary by policy; members should confirm with Humana for clarity, ensuring alignment with individual plan terms and criteria.

 

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 Humana

 

Verify Coverage Requirements

 

  • Begin by reviewing your specific Humana insurance plan details to see if Semaglutide (Wegovy) is listed as a covered medication. You can usually do this online through your Humana member account or by calling customer service.
  •  

  • Check for any specific criteria or prerequisites needed for coverage, such as a prior authorization or a qualifying diagnosis.

 

Consult with Your Healthcare Provider

 

  • Speak with your doctor about your interest in Semaglutide (Wegovy) and discuss if it is an appropriate treatment option for you based on your medical history and weight management goals.
  •  

  • Ask your doctor if they have experience with helping patients get coverage for medications like Semaglutide and discuss any necessary medical documentation that might be required by Humana.

 

Initiate Prior Authorization Process

 

  • If prior authorization is needed, work with your healthcare provider to initiate the process. This often involves your doctor's office submitting a request to Humana with details supporting the medical necessity of Semaglutide.
  •  

  • Gather necessary documentation such as your medical history, previous treatments, and a letter of medical necessity if required.

 

Contact Humana Customer Service

 

  • Reach out to Humana's customer service for guidance on the steps required for getting Semaglutide covered. They can provide specifics on the process and any additional paperwork needed.
  •  

  • Ask explicitly about timeframes and what to expect during the prior authorization review process. Getting an idea of how long it may take will help you plan accordingly.

 

Submit Claims and Follow Up

 

  • Once your healthcare provider has submitted the necessary documentation, ensure that Humana has received it by following up either online or through customer service. Having a confirmation prevents potential processing delays.
  •  

  • Continually monitor the status of your prior authorization request. Staying proactive can expedite the process and address any issues promptly if they arise.

 

Appeal If Necessary

 

  • If your request for Semaglutide coverage is denied, review the denial letter for specific reasons. Understanding the cause can help guide the appeals process.
  •  

  • Work with your healthcare provider to gather any additional information or supporting evidence that addresses the denial reasons, and submit a formal appeal to Humana.

 

Consider Additional Resources

 

  • If you encounter difficulties in getting coverage, explore additional resources such as prescription assistance programs or patient advocacy groups that specialize in insurance appeals and medication access.
  •  

  • Check if there are any pharmaceutical assistance programs offered by the manufacturer of Wegovy that might help reduce out-of-pocket expenses if insurance coverage is a challenge.

 

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 Humana Cover Semaglutide (Wegovy)

Explore Humana's coverage of Semaglutide (Wegovy), reasons for denial, steps to secure coverage, cost without insurance, and FAQs.
Curex allergy drops unboxing

Is Semaglutide (Wegovy) Covered by Humana

 

Does Humana Cover Semaglutide (Wegovy)?

 

  • Humana often covers Semaglutide (Wegovy) for weight management in adults with a body mass index (BMI) ≥30, or ≥27 with related conditions like hypertension or type 2 diabetes, pending effective weight loss programs' documented failure.
  •  

  • Insurance approval requires preauthorization, where healthcare providers send a coverage request, including medical necessity evidence and previous weight management attempts.
  •  

  • Coverage specifics can vary by policy; members should confirm with Humana for clarity, ensuring alignment with individual plan terms and criteria.

 

A weight management program tailored to you

Start with Curex

Humana's Approved Criteria for Semaglutide (Wegovy) Coverage

 

Eligibility Criteria for Coverage of Semaglutide (Wegovy)

 

  • Patient must be an adult aged 18 years or older with a body mass index (BMI) of 30 kg/m² or greater (classified as obese).
  •  

  • Alternatively, patient has a BMI of 27 kg/m² or greater (classified as overweight) with at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia.

 

Prescriber Requirements

 

  • Must be prescribed by a healthcare provider experienced in the management of obesity or endocrinology.
  •  

  • A complete set of medical records documenting the need for treatment with Semaglutide (Wegovy), including previous weight management efforts, must be provided.

 

Prior Authorization Process

 

  • Submission of required documentation, including patient history of comprehensive lifestyle interventions such as diet and exercise, and their outcomes.
  •  

  • Evidence that the patient is motivated and committed to maintaining a healthy lifestyle, as Wegovy is intended to be used alongside lifestyle changes.

 

Monitoring and Compliance

 

  • Regular follow-up appointments to monitor the patient’s progress, adherence to medication, and any side effects are necessary for continued coverage.
  •  

  • Annual reassessment to determine continued eligibility based on treatment efficacy and patient’s health status improvements.

 

Why Humana Might Deny Semaglutide (Wegovy) Coverage

 

Criteria Where Humana Might Deny Wegovy Coverage

 

  • **Non-Medical Necessity:** Humana might deny coverage if the use of Semaglutide (Wegovy) is not deemed medically necessary according to their guidelines. This could mean that the prescription is not aligned with approved usage for weight management or obesity treatment as per their policy.
  •  

  • **Lack of Prior Authorization:** Coverage may be denied if prior authorization was not obtained. Humana often requires that healthcare providers obtain approval from the insurance company before prescribing certain medications.
  •  

  • **Inadequate Documentation:** If there's insufficient documentation supporting the medical reasons for prescribing Wegovy, Humana might deny the claim. This includes a lack of records showing a consistent history of failed weight management efforts or relevant health conditions.
  •  

  • **Exclusion in Policy:** The insurance plan held by the policyholder might have specific exclusions regarding weight management drugs or treatments, including Semaglutide (Wegovy), leading to a denial of coverage.
  •  

  • **Off-Label Use:** Humana may deny claims for prescriptions of Wegovy if it is intended for off-label use, which means it’s used in a manner not specified in the FDA's approved packaging label.
  •  

  • **Absence of Covered Obesity Diagnosis:** If a patient does not have an adequate diagnosis of obesity or a related condition that meets Humana's criteria for coverage, the medication might be denied.
  •  

  • **Non-Compliance with Treatment Guidelines:** If the treatment does not adhere to the guidelines set forth by Humana, which could involve specific BMI thresholds or concomitant health conditions, they might deny coverage.

 

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 Humana

 

Verify Coverage Requirements

 

  • Begin by reviewing your specific Humana insurance plan details to see if Semaglutide (Wegovy) is listed as a covered medication. You can usually do this online through your Humana member account or by calling customer service.
  •  

  • Check for any specific criteria or prerequisites needed for coverage, such as a prior authorization or a qualifying diagnosis.

 

Consult with Your Healthcare Provider

 

  • Speak with your doctor about your interest in Semaglutide (Wegovy) and discuss if it is an appropriate treatment option for you based on your medical history and weight management goals.
  •  

  • Ask your doctor if they have experience with helping patients get coverage for medications like Semaglutide and discuss any necessary medical documentation that might be required by Humana.

 

Initiate Prior Authorization Process

 

  • If prior authorization is needed, work with your healthcare provider to initiate the process. This often involves your doctor's office submitting a request to Humana with details supporting the medical necessity of Semaglutide.
  •  

  • Gather necessary documentation such as your medical history, previous treatments, and a letter of medical necessity if required.

 

Contact Humana Customer Service

 

  • Reach out to Humana's customer service for guidance on the steps required for getting Semaglutide covered. They can provide specifics on the process and any additional paperwork needed.
  •  

  • Ask explicitly about timeframes and what to expect during the prior authorization review process. Getting an idea of how long it may take will help you plan accordingly.

 

Submit Claims and Follow Up

 

  • Once your healthcare provider has submitted the necessary documentation, ensure that Humana has received it by following up either online or through customer service. Having a confirmation prevents potential processing delays.
  •  

  • Continually monitor the status of your prior authorization request. Staying proactive can expedite the process and address any issues promptly if they arise.

 

Appeal If Necessary

 

  • If your request for Semaglutide coverage is denied, review the denial letter for specific reasons. Understanding the cause can help guide the appeals process.
  •  

  • Work with your healthcare provider to gather any additional information or supporting evidence that addresses the denial reasons, and submit a formal appeal to Humana.

 

Consider Additional Resources

 

  • If you encounter difficulties in getting coverage, explore additional resources such as prescription assistance programs or patient advocacy groups that specialize in insurance appeals and medication access.
  •  

  • Check if there are any pharmaceutical assistance programs offered by the manufacturer of Wegovy that might help reduce out-of-pocket expenses if insurance coverage is a challenge.

 

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