What is ‘prior authorization’ for Wegovy (semaglutide) insurance coverage?

Prior authorization is paperwork requested by your insurance carrier to justify the use of Wegovy®. Some insurance plans will require a prior authorization to be completed in order to cover the cost of Wegovy. Your healthcare provider will complete the paperwork. Unfortunately, this is not a guarantee of coverage.

Different insurance plans and providers may have different criteria as to what is needed for prior authorization of Wegovy, which can include:

• Proof that the medication is working (patient lost at least 5% of their body weight within the first 3 months of taking Wegovy)
• Proof that the patient has – and follows – a lifestyle & diet plan in addition to taking Wegovy
• Proof that the patient made lifestyle changes prior to starting Wegovy

Many doctors have the authority to prescribe medication such as Wegovy. However, without following a standardized treatment schedule and laying out a treatment plan, the prescription may not pass the authorization for coverage.

At Form Health, we always recommend working with reputable doctors that will construct a holistic lifestyle and health improvement plan for you as opposed to just giving you a prescription. In turn, this will also help your case if your insurance plan requests prior authorization paperwork.

Learn more about how Form Health doctors prescribe Wegovy to help patients achieve their weight loss goals.