Who’s Eligible for Wegovy Coverage?
Wegovy is a weight-loss medication available to adults with obesity (BMI ≥30) or overweight (BMI ≥27) with weight-related health issues such as type 2 diabetes or high blood pressure.
Coverage Options under Tufts Health Plan
To determine if Wegovy is covered under your Tufts Health Plan, you can:
- Check the Preferred Drug List (PDL): This list contains covered medications.
- Call Member Services: Contact the number on your insurance card for assistance.
Approval Process for Wegovy Coverage
If Wegovy isn’t listed on the PDL, you can apply for an exception:
- Get a Prescription: Obtain a prescription from your doctor.
- Submit an Exception Request: Complete the Tufts Health Plan exception request form and submit it to your doctor.
- Doctor’s Recommendation: Your doctor will provide medical reasons for your Wegovy need.
- Tufts Health Plan Review: Tufts Health Plan will evaluate the request and determine coverage eligibility.
Cost Considerations
The cost of Wegovy may vary based on your plan and dosage. You may have to pay a copayment, coinsurance, or deductible.
Effectiveness and Safety Data
Wegovy has been found to help people lose significant weight and maintain it long-term. It has also shown to reduce the risk of heart disease and type 2 diabetes.
Conclusion
Tufts Health Plan covers Wegovy, but coverage may vary depending on your specific plan. Following the steps outlined in this guide can help you navigate the approval process and access Wegovy to support your weight loss journey.