Wegovy Prior Authorization: What You Need to Know Before Getting Covered

When you’re trying to get Wegovy, a brand-name weight loss medication containing semaglutide, approved for chronic weight management in adults with obesity or overweight with at least one weight-related condition. Also known as semaglutide for weight loss, it’s one of the most effective drugs for shedding pounds—but getting it covered isn’t automatic. Most insurance plans in India don’t cover weight loss medications like Wegovy outright. Instead, they require prior authorization, a process where your doctor must submit medical records and proof of necessity before the insurer agrees to pay. This isn’t just bureaucracy—it’s a gatekeeping step that can delay treatment by weeks if not done right.

Why does this happen? Insurers see Wegovy as expensive—costing over ₹20,000 per month—and they want to make sure you’ve tried other methods first. They’ll ask for proof of BMI over 30, documentation of failed diet or exercise attempts, and sometimes lab results showing related conditions like high blood pressure or prediabetes. If you’re switching from Ozempic (which is the same drug but approved for diabetes), they’ll want to know why you’re now using it for weight loss. Express Scripts, a major pharmacy benefit manager that handles prescriptions for many Indian insurers. and similar services follow strict rules. Even if your doctor approves it, the insurer can still deny coverage unless every box is checked.

Many people get stuck here. They’re told their plan doesn’t cover weight loss meds, but that’s not always true. Some plans cover it under obesity treatment, others under metabolic syndrome. The key is knowing what your insurer considers a valid medical reason. If your claim gets denied, don’t give up. You can appeal—with help from your doctor’s office, who can write a detailed letter explaining why Wegovy is medically necessary. Some patients also qualify for manufacturer savings programs that cut the cost by up to 70% while they wait for approval.

What you’ll find below are real cases from people who’ve been through this process. Some got approved on the first try. Others spent months fighting denials. A few switched to alternatives like metformin or berberine when Wegovy wasn’t an option. You’ll see what paperwork actually works, which insurers are easier to deal with, and how to talk to your doctor so they know exactly what to submit. This isn’t about guessing—it’s about knowing the system so you don’t waste time or money.