Is saxenda covered by insurance?

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Is saxenda covered by insurance?

Saxenda, a branded medication, is designed for weight management in conjunction with a reduced-calorie diet and regular exercise.

It assists individuals with obesity in managing blood sugar, insulin levels, and digestion.

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The manufacturer indicates that Saxenda’s list price is $1,349.02 for a 30-day supply.

However, the actual cost for each patient can vary based on factors such as insurance plans, assistance programs, and other considerations.

This article will explore the varying costs of Saxenda, delve into details about health insurance coverage, and discuss additional factors influencing the overall expense.

Lastly, it will provide insights into obtaining discounts on Saxenda.

Contents show

How Much Does Saxenda Cost?

The retail price for a 30-day supply of Saxenda is $1,349.02. However, the actual expense you incur for Saxenda hinges on factors such as your insurance coverage, the pharmacy of choice, and eligibility for any savings or patient assistance programs.

saxenda medication
saxenda medication
Source : ukmeds

Novo Nordisk, the manufacturer of Saxenda, provides an online cost estimator for individuals to assess the anticipated expenses.

Completing an online form or contacting them at (888) 809-3942 allows you to estimate the specific cost based on your circumstances.

It’s advisable to have your prescription card on hand as certain details will need to be transferred.

Aside from the medication cost, it’s essential to factor in the expenditure for disposable needles used with the Saxenda pen.

A box containing 100 NovoFine or NovoTwist needles is priced at approximately $60, equating to 60 cents per needle.

Your healthcare provider will issue a separate prescription for these needles.

Depending on your location, you may also have the option to purchase these needles online without a prescription, but it’s crucial to consult your healthcare provider regarding their safety.

It’s noteworthy that Saxenda is currently exclusively available as a brand-name drug, contributing to its higher cost compared to generic alternatives. Brand-name drugs typically carry a higher price tag.

Does insurance cover Saxenda?

The coverage for Saxenda by insurance plans varies, and the best way to determine if your insurance covers it is to contact your insurance provider. Here is a summary of the general insurance coverage scenarios for Saxenda:

  • Private or Commercial Insurance through Employer:
    •  Some plans might necessitate prior authorization from your healthcare provider.
  • Medicare:
    • Generally, Medicare, including Medicare Part D, does not cover weight loss medications. However, if you have a Medigap or Medicare Advantage plan, Saxenda coverage might be a possibility. Contact your plan administrator for more information.
  • Medicaid:
    • Medicaid prescription drug coverage varies among states. Contact your state Medicaid program to determine if Saxenda is covered under your Medicaid plan.
  • Veterans Administration (VA):
    • The VA covers obesity, and you may be able to request coverage for Saxenda or other weight loss drugs.
  • TRICARE:
    • TRICARE does cover Saxenda in certain situations. If you have insurance through TRICARE, collaborate with your healthcare provider to request coverage for Saxenda.

For those without insurance, the Saxenda Savings Offer might provide a means to save on the medication.

Details about this option will be discussed further in the Saxenda Coupons section.

How to get insurance to cover Saxenda

Saxenda, a branded medication, is specifically formulated to aid in weight management when used alongside a reduced-calorie diet and regular exercise.

It assists individuals with obesity in managing blood sugar, insulin levels, and digestion.

Novo Nordisk provides a template letter that your healthcare provider can use for this purpose.

For individuals with workplace insurance, you may explore having your company’s benefits manager communicate with your insurance provider to request Saxenda coverage.

Novo Nordisk also offers a template letter that you can utilize for this purpose.

Factors that Affect the Cost of Saxenda

Similar to other medications, the cost of Saxenda is influenced by several factors. These factors include:

  • Your insurance coverage
  • Your treatment plan
  • The pharmacy you choose
  • Eligibility for a savings program
  • Your co-pay and/or deductible
  • Out-of-pocket maximum

4 Strategies to Lower Saxenda Expenses

Saxenda, a prolonged treatment for weight loss, can accumulate costs rapidly. Employ these approaches to save on Saxenda expenses:

Utilize Saxenda Coupons:

If eligible for the Saxenda Savings Offer by Novo Nordisk, individuals may pay as little as $25 for a 30-day supply.

This coupon is accessible to those with private or commercial insurance and a valid Saxenda prescription.

Opt for a 3-Month Supply:

Purchasing a 90-day (3-month) supply can be a more cost-effective option for certain medications, saving on both expenses and the inconvenience of frequent pharmacy visits.

The Saxenda Savings Offer also extends to a 3-day supply, potentially reducing the cost to as low as $75 for three Saxenda boxes.

Compare Prices Across Pharmacies:

Explore Varied Pharmacy Prices:

Drug prices, including Saxenda, can differ among pharmacies.

Conduct a local pharmacy price comparison to identify the most cost-effective option for Saxenda. Additionally, consider exploring mail-order or online pharmacies for potential cost savings and the convenience of home delivery, particularly for 90-day supplies.

Verify the pharmacy’s coverage under your insurance plan.

Consider Alternative Medications:

If the expense of Saxenda proves to be prohibitive, consult your healthcare provider about alternative medications within the GLP-1 drug class.

This category includes other diabetes and weight loss medications like Ozempic (semaglutide) and Wegovy (semaglutide).

While GLP-1 drugs are presently available only as brand-name drugs and can be similarly expensive to Saxenda, some alternatives may offer a more cost-effective approach for weight loss.

For instance, a 2023 cost analysis revealed that, on average, Ozempic yields more weight loss than Saxenda at a lower cost.

The analysis indicates that, on average, it costs over $3,200 to achieve a 1% reduction in body weight with Saxenda, while Ozempic accomplishes the same at a cost of only $1,845, resulting in savings exceeding $1,400. However, individual weight loss experiences may vary.

Another potential cost-saving option is Mounjaro (tirzepatide). Although currently FDA-approved solely for treating type 2 diabetes, tirzepatide might gain approval for obesity treatment by the end of 2023.

Clinical trials have shown substantial weight loss with Mounjaro, nearly 21% of body weight within a year and a half. While Mounjaro is pricier than Ozempic, it generally costs less than Saxenda.

Alternatively, discuss with your healthcare provider other prescription weight loss medications like Qsymia, Contrave, or Xenical.

Whether choosing Saxenda or another medication, engage in a conversation with your healthcare provider about the available options. Additionally, check your insurance plan to understand the coverage for different medications.

Conclusion

It is crucial to comprehend the process of accessing insurance coverage for Saxenda.

These medications can incur significant expenses, particularly with regular, long-term use spanning months or years.

Familiarizing yourself with available options is the most effective means to utilize any available assistance and reduce these costs whenever feasible.

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