Navigating VA healthcare benefits can be tricky, especially for newer medications like Wegovy. Veterans and their families often wonder about coverage for weight loss drugs.
This article breaks down whether the VA covers Wegovy in 2025. It uses clear language to explain eligibility, costs, and processes.
What Is Wegovy?
Wegovy is a prescription drug used for chronic weight management. It contains semaglutide, which helps control appetite and supports weight loss.
The FDA approves it for adults with obesity or weight-related health issues. It’s a weekly injection paired with diet and exercise.
Wegovy also reduces cardiovascular risks in adults with heart disease. It’s not a quick solution but part of a structured health plan. Veterans must consult a VA provider before starting. The drug’s benefits make it appealing for those struggling with obesity.
VA Pharmacy Benefits Overview
The VA provides pharmacy benefits to enrolled veterans. These cover medications listed in the VA National Formulary.
Wegovy is available but comes with specific requirements. Coverage depends on medical necessity and VA criteria.
The VA prioritizes cost-effective drugs. Non-formulary drugs like Wegovy need extra approval. Veterans can access prescriptions through VA pharmacies or Meds by Mail. Understanding these benefits helps clarify coverage for Wegovy.
Will the VA Cover Wegovy for Weight Loss?
The VA covers Wegovy for weight management under strict conditions. It’s listed as a non-formulary drug, requiring prior authorization. Veterans must meet specific health criteria to qualify. A VA provider must document medical necessity.
Coverage isn’t guaranteed. The VA often requires veterans to try other weight loss options first. Due to supply shortages, new prescriptions may be limited. Always check with your VA provider for availability.
Eligibility Requirements for Wegovy
To qualify for Wegovy through the VA, veterans must meet these criteria:
- Have a BMI of 30 or higher (obesity) or 27 with conditions like diabetes or hypertension.
- Have participated in the VA’s MOVE! program or a similar lifestyle intervention.
- Have tried other weight loss drugs, like phentermine, without success.
Your VA provider must verify these conditions. Documentation is key to approval.
Prior Authorization and Step Therapy
The VA uses step therapy for Wegovy. Veterans must try formulary drugs like naltrexone/bupropion or orlistat first. If these fail, the VA may approve Wegovy. This process ensures cost-effective treatment.
Prior authorization is mandatory. Your provider submits a form to the VA, detailing why Wegovy is needed. Approval can take days or weeks. Delays may occur due to shortages or formulary reviews.
Costs of Wegovy with VA Benefits
Wegovy’s cost through the VA varies by pharmacy type. VA pharmacies and Meds by Mail offer the lowest copays. Retail pharmacies may cost more. Copays depend on your VA priority group.
For most veterans, a 90-day supply through Meds by Mail costs $20-$30. VA pharmacies may have no copay for high-priority veterans. Check with your VA facility for exact costs.
Here’s a cost breakdown for Wegovy:
| Pharmacy Option | Copay for 90 Days | Notes |
|---|---|---|
| VA Pharmacy | $0-$10 | Free for Priority Group 1 veterans |
| Meds by Mail | $20-$30 | Cost-effective for most veterans |
| Retail Pharmacy | $50-$100 (30 days) | Higher costs, varies by location |
Costs are estimates for 2025 and may vary.
Wegovy for Cardiovascular Risk Reduction
The VA covers Wegovy for veterans with heart disease and obesity. This aligns with its FDA approval for reducing cardiovascular events. Prior authorization is still required. Your provider must confirm the diagnosis.
This coverage is separate from weight loss use. The VA evaluates each case individually. Veterans with heart conditions may have a stronger case for approval. Discuss this with your VA doctor.
Challenges with Wegovy Supply
Wegovy has faced global shortages, impacting VA coverage. Low-dose starter prescriptions are often unavailable. Existing patients may continue, but new patients face delays. The VA prioritizes those already on the drug.
Veterans may need to wait for supply improvements. Some turn to compounding pharmacies, but the VA doesn’t cover these. Check with your VA pharmacist for updates on availability.
The VA’s MOVE! Program
The VA’s MOVE! program is a requirement for Wegovy coverage. It’s a behavioral weight management program offering coaching and group sessions. Veterans must participate to show commitment to lifestyle changes. MOVE! includes diet tracking and exercise guidance.
Participation is documented by your provider. It strengthens your case for Wegovy approval. The program is free and available at most VA facilities.
Steps to Get Wegovy Through the VA
Follow these steps to pursue Wegovy coverage:
- Enroll in the VA’s MOVE! program and attend sessions.
- Consult your VA provider to confirm eligibility (BMI, health conditions).
- Try formulary weight loss drugs if required by step therapy.
- Have your provider submit a prior authorization form.
- Fill the prescription at a VA pharmacy or through Meds by Mail.
Contact your VA facility for help with the process.
What If the VA Denies Coverage?
If the VA denies Wegovy coverage, your provider can appeal. They may need to submit additional medical evidence. You can also explore alternative VA-covered drugs. Contact the VA Patient Advocate for support.
Some veterans pay out-of-pocket at retail pharmacies. Novo Nordisk’s $25 copay card isn’t available for VA beneficiaries. Discuss options with your provider before deciding.
Side Effects and Safety Concerns
Wegovy can cause side effects like nausea, diarrhea, or vomiting. Rare but serious risks include pancreatitis or thyroid tumors. The VA monitors patients closely during treatment. Report any symptoms to your provider immediately.
Veterans with a history of thyroid cancer or MEN 2 shouldn’t use Wegovy. Your provider will review your medical history. Safety is a priority in VA prescribing.
Alternatives to Wegovy
The VA covers other weight loss drugs like orlistat or phentermine/topiramate. These are formulary options and often required before Wegovy. Saxenda, another non-formulary drug, may also be considered. Each has its own criteria and approval process.
The MOVE! program offers non-drug support. Dietitians and coaches help with lifestyle changes. These are often paired with medication for best results.
Updates for 2025
As of 2025, VA coverage for Wegovy remains unchanged. Shortages continue to limit new prescriptions. The VA is monitoring supply issues with Novo Nordisk. Veterans should verify coverage through the VA Formulary Advisor.
Check your enrollment status in DEERS to avoid delays. The VA’s open season (November 11 to December 10, 2024) allows plan updates. Stay proactive with your provider for the latest information.
Summary
The VA covers Wegovy for weight loss and cardiovascular risk reduction, but strict rules apply. Veterans need a BMI of 30 (or 27 with conditions), MOVE! program participation, and prior authorization.
Copays are low through VA pharmacies or Meds by Mail ($20-$30 for 90 days). Supply shortages may delay new prescriptions, so work closely with your provider. Use the VA Formulary Advisor to stay updated.
FAQ
Will the VA cover Wegovy for all veterans?
The VA covers Wegovy for veterans meeting specific criteria, like a BMI of 30 or higher. Participation in the MOVE! program and prior authorization are required. Consult your VA provider to confirm eligibility.
How much does Wegovy cost through the VA?
A 90-day supply costs $20-$30 via Meds by Mail or $0-$10 at VA pharmacies. Retail pharmacies may charge $50-$100 for 30 days. Costs vary by priority group.
Can the VA cover Wegovy for diabetes?
Wegovy is covered for weight loss or cardiovascular risk reduction, not diabetes. For diabetes, the VA covers Ozempic or Mounjaro with prior authorization. Check with your provider.
What if the VA won’t cover Wegovy?
If denied, your provider can appeal or suggest alternatives like orlistat. Contact the VA Patient Advocate for help. Paying out-of-pocket is an option but not covered by manufacturer discounts.
How do I check if Wegovy is available?
Use the VA Formulary Advisor online to check coverage and criteria. Contact your VA pharmacy for supply updates. Your provider can assist with prior authorization.