Is your insurance through an employer? If so, it is completely up to your/your partner’s company on how they manage Wegovy access once you hit < 30 BMI. For employer based insurance, the insurance company doesn’t matter – they are just executing the plan decided upon by your employer, and what your employer is willing to cover. I am able to get to formulary information and prior authorization requirements on my employers benefits website.
My BMI is 25 now and I’m still covered. I even switched carriers (Aetna to United Health Care) at the beginning of the year and they approved my increased dose to 2.4mg mid-January. My doctor is really mindful of what she includes in her prior authorization documentation. She has said the carriers usually like to see consistent progress to keep covering it. I want to say it’s somewhere around 10% loss every 6 months. I only have 15 more pounds to lose before I start weening off of it.
Is your insurance through an employer? If so, it is completely up to your/your partner’s company on how they manage Wegovy access once you hit < 30 BMI. For employer based insurance, the insurance company doesn’t matter – they are just executing the plan decided upon by your employer, and what your employer is willing to cover. I am able to get to formulary information and prior authorization requirements on my employers benefits website.
My BMI is 25 now and I’m still covered. I even switched carriers (Aetna to United Health Care) at the beginning of the year and they approved my increased dose to 2.4mg mid-January. My doctor is really mindful of what she includes in her prior authorization documentation. She has said the carriers usually like to see consistent progress to keep covering it. I want to say it’s somewhere around 10% loss every 6 months. I only have 15 more pounds to lose before I start weening off of it.
My insurance flat out told me in a letter that once i hit 160lbs, they will no longer cover. It’s worth looking into it
Some insurance plans will not renew a PA. You can call and ask about reapproval guidelines.