Is saxenda covered by insurance?

Are you interested in losing weight and wondering if insurance will cover Saxenda? Well, sit back, relax, and enjoy the ride as we unravel this mystery together!

What is Saxenda?

Saxenda is an injectable medication used to manage weight. It works by mimicking your body’s natural hormone GLP-1 that regulates appetite. This not only helps promote satiety but can also slow down digestion.

How Effective is it?

Studies have shown that when combined with a low-calorie diet and physical activity, daily usage of saxenda(Liraglutide) led to significant weight loss in obese patients.

However, like most medications, its efficacy varies from individual to individual.

Is it Expensive?

Of course, no one wants to break the bank trying to lose weight. Luckily, most insurances do offer coverage for Saxenda at varying degrees depending on your plan’s prescription drug formulary( A list of drugs covered under your plan).

The average retail price of 5 ML solution pens (each pen contains about eight doses)is around $1400,but with insurance coverage,you could pay between $30-$400 out-of-pocket!

Depending on whether or not you have met your monthly deductible, you may even pay nothing at all for Saxenda prescriptions- Yep! You read that correctly. No cost!

Before rushing off excitedly though, keep reading as there are different types of health plans which provide varying levels of coverage for prescription drugs.

Under What Conditions Does Insurance Cover Saxenda?

Insurance companies typically adopt some degree of selective criteria while evaluating claims made on obesity treatments such as surgery or pharmaceuticals; this implies they determine under what circumstances These services or products are medically necessary.

There exist various factors considered by these insurers before authorizing medical care delivery/coverage.
These include:

Body Mass Index

A patient’s body mass index (BMI) is a relatable measure of how healthy their weight/dimensions are.

Most insurers recognize obesity as an pre-existing medical condition and authorize coverage for saxenda based on each plan’s specified BMI level threshold.

The most commonly occurring range is 30-40 BMI; however,individual plans could be higher or lower.

History Of Weight Loss Efforts

It is fair to say that insurance companies don’t want subscribers flocking in with unreasonable demands. They try to ensure reduced chances for abuse by necessitating documented and monitored prior efforts at losing weight before approving further medication like Saxenda.

These include verified visits/support from nutritionists, wellness counsellors or other medically trained professionals.

So How Do I Get Saxenda Covered By Insurance?

Here are steps you can take:

  1. Find out if your health insurance provider covers prescription medication.
  2. Verify whether they cover Liraglutide (Saxenda).
  3. Ascertain your plan’s specific criteria for authorization of treatment(such as BMI requirements).
  4. Consult primary care physicians-endocrinologists, gastroenterologists about starting liraglutide-based therapy which phycisians may endorse better.
    5.Review all possible options available under your policy while ensuring the prescribing physician adheres to sanction rules(Taking note of dosage limits etc).

Finally,you should know that People who do not possess any form of health insurances will have to pay full cash price for Saxenda prescriptions reaching up to $1400 per package!

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