Does WellCare Cover Semaglutide (Wegovy)

Explore WellCare's coverage for Semaglutide (Wegovy), reasons for denial, tips for approval, uninsured costs, and FAQs. Essential info for your health journey.
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Does WellCare Cover Semaglutide (Wegovy)?

 

  • WellCare may cover Semaglutide (Wegovy) for those with a diagnosis of obesity or a related condition, such as type 2 diabetes.
  •  

  • Coverage often requires prior authorization, meaning your healthcare provider must demonstrate medical necessity.
  •  

  • Patients might need to have tried other weight loss medications or treatments without success before qualifying for coverage.
  •  

  • Specific criteria might include a BMI over a certain number or documented health issues due to weight, such as high blood pressure or cholesterol.
  •  

  • Check with your specific WellCare plan details, as coverage can vary depending on your state and plan.

 

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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 WellCare

 

Begin with Assessing Your WellCare Plan

 

  • Review your WellCare insurance policy to understand coverage details for prescription medications, specifically for weight-loss drugs like Semaglutide (Wegovy).
  •  

  • Check if Semaglutide (Wegovy) is listed in the formulary of your WellCare plan as this greatly influences whether it will be covered.
  •  

  • Identify any special requirements or restrictions, such as prior authorization or step therapy, that your plan may have in place for Semaglutide (Wegovy).

 

Consult With Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the potential for Semaglutide (Wegovy) to be part of your obesity treatment plan.
  •  

  • Ensure that your doctor documents your medical necessity for Semaglutide (Wegovy), which is vital when applying for coverage under WellCare.
  •  

  • Ask your healthcare provider to write a detailed prescription that adheres to any WellCare guidelines he or she knows of.

 

Contact WellCare Customer Service

 

  • Call WellCare's customer service to confirm the process for getting Semaglutide (Wegovy) covered. Have your WellCare ID and prescription details ready.
  •  

  • Inquire about necessary documentation, processes for prior authorization, or any other prerequisites specific to your plan.
  •  

  • Ask for a step-by-step guide or checklist if available, and an estimated timeline for the approval process.

 

Complete Prior Authorization (If Required)

 

  • If prior authorization is needed, work with your healthcare provider's office to submit a prior authorization request to WellCare.
  •  

  • Fill out any necessary forms provided by WellCare, ensuring all health and prescription information is accurate and attached.
  •  

  • Follow up with WellCare to ensure they have received all required documentation and to verify the status of your request.

 

Explore Alternative Options

 

  • If initial coverage for Semaglutide (Wegovy) is denied, ask WellCare for a detailed explanation and documentation of the denial decision.
  •  

  • Consult your healthcare provider to reassess your medical records and determine whether an appeal is necessary for the denial decision.
  •  

  • Consider WellCare’s medication alternatives that might be similar to Semaglutide (Wegovy) and check for coverage under your plan.

 

File an Appeal, If Needed

 

  • If you decide to appeal, request a formal appeal submission form from WellCare and gather any supporting documents, including your doctor’s recommendation and medical necessity letter.
  •  

  • Detail your personal experience with weight management and emphasize the importance of Semaglutide (Wegovy) in your appeal letter.
  •  

  • Submit your completed appeal to WellCare, then proactively follow up to ensure it is being processed correctly.

 

Monitor and Follow-Up

 

  • After submitting an appeal or any coverage request, keep track of changes in your insurance plan or formulary updates that might affect your entitlement to Semaglutide (Wegovy).
  •  

  • Regularly follow up with WellCare for status updates on your coverage request or appeal until a final decision is reached.
  •  

  • Consider reaching out to a case manager or insurance advocate if you encounter prolonged delays or complexities in the process.

 

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FAQs

Does WellCare Cover Semaglutide (Wegovy)

Explore WellCare's coverage for Semaglutide (Wegovy), reasons for denial, tips for approval, uninsured costs, and FAQs. Essential info for your health journey.
Curex allergy drops unboxing

Is Semaglutide (Wegovy) Covered by WellCare

 

Does WellCare Cover Semaglutide (Wegovy)?

 

  • WellCare may cover Semaglutide (Wegovy) for those with a diagnosis of obesity or a related condition, such as type 2 diabetes.
  •  

  • Coverage often requires prior authorization, meaning your healthcare provider must demonstrate medical necessity.
  •  

  • Patients might need to have tried other weight loss medications or treatments without success before qualifying for coverage.
  •  

  • Specific criteria might include a BMI over a certain number or documented health issues due to weight, such as high blood pressure or cholesterol.
  •  

  • Check with your specific WellCare plan details, as coverage can vary depending on your state and plan.

 

A weight management program tailored to you

Start with Curex

WellCare's Approved Criteria for Semaglutide (Wegovy) Coverage

 

Eligibility Criteria for Semaglutide (Wegovy) Coverage

 

  • Patient must be at least 18 years of age or older.
  •  

  • Body Mass Index (BMI) requirements:
    • BMI of 30 kg/m2 or greater (obesity).
    •     <li>OR BMI of 27 kg/m<sup>2</sup> or greater (overweight) with at least one weight-related comorbidity, such as hypertension, type 2 diabetes mellitus, or dyslipidemia.</li>
      </ul>
      
  •  

  • Documented previous attempts with lifestyle modifications:
    • Evidence of participation in a structured weight loss program for at least 6 months, showing insufficient weight loss or weight regain.
  •  

  • Prescribed by or in consultation with an appropriate healthcare provider:
    • Endocrinologist, internist, or other healthcare professionals specialized in obesity management.
  •  

  • No contraindications to starting therapy with Semaglutide (Wegovy), including:
    • History of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2.

 

Required Documentation

 

  • A complete physician's statement detailing the patient's condition, previous treatments, and response to those treatments.
  •  

  • Records of BMI measurements and any weight-related comorbidities.
  •  

  • Previously attempted weight management strategies and their outcomes.
  •  

  • Specific treatment plan with goals and monitoring details for the use of Semaglutide (Wegovy).

 

Follow-up and Monitoring Requirements

 

  • Regular follow-up visits with the prescribing healthcare provider to monitor weight loss progress and potential side effects.
  •  

  • Periodic reassessment of the therapy's effectiveness and patient's adherence to the treatment plan, typically every three to six months.

 

Why WellCare Might Deny Semaglutide (Wegovy) Coverage

 

Reasons Why WellCare Might Deny Semaglutide (Wegovy) Coverage

 

  • Non-Medically Necessary: If WellCare determines that Semaglutide (Wegovy) is not medically necessary for the patient's condition, coverage may be denied. The patient must meet specific medical criteria established by WellCare, which, if not met, can result in denial.
  •  

  • Off-Label Use: Usage of Semaglutide for conditions not approved by the Food and Drug Administration (FDA) or not supported by WellCare's clinical guidelines could lead to a denial of coverage.
  •  

  • Lack of Prior Authorization: If the patient or healthcare provider did not obtain the necessary prior authorization before beginning treatment with Semaglutide, WellCare may deny the claim.
  •  

  • Inadequate Documentation: Failure to provide sufficient medical documentation that justifies the prescription of Semaglutide might result in a denial. Documentation must clearly support the need for Semaglutide as prescribed.
  •  

  • Non-Compliance with Formulary Requirements: If Semaglutide (Wegovy) is not on WellCare's formulary list or if there are preferred alternatives, and these requirements are not fulfilled, coverage might be denied.
  •  

  • Non-Covered Indication: If the indication for which Semaglutide is prescribed is explicitly excluded from WellCare's policies, coverage will not be provided.

 

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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 WellCare

 

Begin with Assessing Your WellCare Plan

 

  • Review your WellCare insurance policy to understand coverage details for prescription medications, specifically for weight-loss drugs like Semaglutide (Wegovy).
  •  

  • Check if Semaglutide (Wegovy) is listed in the formulary of your WellCare plan as this greatly influences whether it will be covered.
  •  

  • Identify any special requirements or restrictions, such as prior authorization or step therapy, that your plan may have in place for Semaglutide (Wegovy).

 

Consult With Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the potential for Semaglutide (Wegovy) to be part of your obesity treatment plan.
  •  

  • Ensure that your doctor documents your medical necessity for Semaglutide (Wegovy), which is vital when applying for coverage under WellCare.
  •  

  • Ask your healthcare provider to write a detailed prescription that adheres to any WellCare guidelines he or she knows of.

 

Contact WellCare Customer Service

 

  • Call WellCare's customer service to confirm the process for getting Semaglutide (Wegovy) covered. Have your WellCare ID and prescription details ready.
  •  

  • Inquire about necessary documentation, processes for prior authorization, or any other prerequisites specific to your plan.
  •  

  • Ask for a step-by-step guide or checklist if available, and an estimated timeline for the approval process.

 

Complete Prior Authorization (If Required)

 

  • If prior authorization is needed, work with your healthcare provider's office to submit a prior authorization request to WellCare.
  •  

  • Fill out any necessary forms provided by WellCare, ensuring all health and prescription information is accurate and attached.
  •  

  • Follow up with WellCare to ensure they have received all required documentation and to verify the status of your request.

 

Explore Alternative Options

 

  • If initial coverage for Semaglutide (Wegovy) is denied, ask WellCare for a detailed explanation and documentation of the denial decision.
  •  

  • Consult your healthcare provider to reassess your medical records and determine whether an appeal is necessary for the denial decision.
  •  

  • Consider WellCare’s medication alternatives that might be similar to Semaglutide (Wegovy) and check for coverage under your plan.

 

File an Appeal, If Needed

 

  • If you decide to appeal, request a formal appeal submission form from WellCare and gather any supporting documents, including your doctor’s recommendation and medical necessity letter.
  •  

  • Detail your personal experience with weight management and emphasize the importance of Semaglutide (Wegovy) in your appeal letter.
  •  

  • Submit your completed appeal to WellCare, then proactively follow up to ensure it is being processed correctly.

 

Monitor and Follow-Up

 

  • After submitting an appeal or any coverage request, keep track of changes in your insurance plan or formulary updates that might affect your entitlement to Semaglutide (Wegovy).
  •  

  • Regularly follow up with WellCare for status updates on your coverage request or appeal until a final decision is reached.
  •  

  • Consider reaching out to a case manager or insurance advocate if you encounter prolonged delays or complexities in the process.

 

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.

 

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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.

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