South Carolina Medicaid coverage for Wegovy (semaglutide) depends on specific criteria. Individuals with obesity and at least one weight-related health condition may be eligible. Prior authorization is required, and coverage is limited to a one-year period. Additional conditions and restrictions may apply. To determine eligibility, individuals should contact their local Medicaid office or healthcare provider for more information.
Wegovy Weight Loss Medication
Wegovy is a prescription weight loss medication that has been approved by the U.S. Food and Drug Administration (FDA) for use in adults with obesity or overweight and at least one weight-related health condition.
How Wegovy Works
- Wegovy works by mimicking the effects of a hormone called glucagon-like peptide-1 (GLP-1). GLP-1 is a naturally occurring hormone that helps to control hunger and fullness, and it also slows down the rate at which food moves through the stomach.
- Wegovy is injected once a week. It is typically taken in conjunction with a healthy diet and exercise program.
Wegovy Dosing
- Wegovy is available in five different doses: 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, and 2.4 mg.
- The starting dose of Wegovy is 0.25 mg per week. The dose is gradually increased over time, until the patient reaches the recommended maintenance dose of 2.4 mg per week.
Wegovy Side Effects
- The most common side effects of Wegovy include nausea, vomiting, diarrhea, constipation, abdominal pain, headache, and fatigue.
- These side effects are usually mild and go away within a few weeks.
Wegovy Contraindications
- Wegovy is not recommended for people with a history of pancreatitis, diabetic ketoacidosis, or a personal or family history of medullary thyroid cancer.
- Wegovy should not be used during pregnancy or breastfeeding.
Wegovy Cost
- The cost of Wegovy varies depending on the dosage and the pharmacy where it is purchased.
- A one-month supply of Wegovy can cost between $1,300 and $1,600.
Wegovy Coverage
- Wegovy is covered by some insurance plans, including Medicare and Medicaid.
- The coverage for Wegovy varies depending on the insurance plan.
| State | Medicaid Coverage |
|---|---|
| Alabama | No |
| Alaska | No |
| Arizona | No |
| Arkansas | No |
| California | Yes |
South Carolina Medicaid Eligibility
To be eligible for Medicaid in South Carolina, you must meet certain requirements, which include:
- Being a U.S. citizen or a qualified non-citizen.
- Being a resident of South Carolina.
- Meeting income and asset limits.
- Meeting certain categorical requirements, such as being pregnant, disabled, or a child.
The income and asset limits for Medicaid in South Carolina vary depending on the type of coverage you are applying for. For example, the income limit for pregnant women and children is higher than the income limit for adults who are not disabled.
To apply for Medicaid in South Carolina, you can:
- Apply online through the South Carolina Department of Social Services (DSS) website.
- Apply in person at your local DSS office.
- Call the DSS at 1-888-549-0820 to request an application.
Does South Carolina Medicaid Cover Wegovy?
Yes, South Carolina Medicaid does cover Wegovy.
Wegovy is a prescription drug used to treat obesity. It is a brand name for the drug semaglutide. Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 is a hormone that helps control appetite and blood sugar levels.
Wegovy is covered by South Carolina Medicaid for adults who meet the following criteria:
- Have a body mass index (BMI) of 30 or higher.
- Have at least one weight-related health condition, such as type 2 diabetes, heart disease, or high blood pressure.
- Have tried and failed to lose weight through diet and exercise alone.
South Carolina Medicaid will cover up to 12 months of Wegovy treatment.
If you are a South Carolina Medicaid recipient and you meet the criteria for Wegovy coverage, you can talk to your doctor about getting a prescription for the drug.
Additional Resources
- South Carolina Department of Social Services Medicaid Page
- Access Carolina
- Novo Nordisk Wegovy Savings & Support
Coverage for Obesity Treatments
Obesity is a common condition that can lead to various health problems. Fortunately, there are several treatments available to help people manage their weight and improve their health. Some of these treatments, including Wegovy, may be covered by Medicaid in South Carolina.
- Medicaid Coverage for Obesity Treatments
Medicaid is a government-sponsored health insurance program that provides coverage to low-income individuals and families. In South Carolina, Medicaid covers a range of obesity treatments, including:
- Behavioral therapy
- Nutritional counseling
- Weight loss medications
- Surgery
The specific coverage for obesity treatments varies depending on the individual’s Medicaid plan. Some plans may cover all of the treatments listed above, while others may only cover some. To find out what obesity treatments are covered by your Medicaid plan, you should contact your plan provider.
- Wegovy
Wegovy is a prescription weight loss medication that is used to help adults with obesity or overweight lose weight and keep it off. Wegovy is covered by Medicaid in South Carolina for individuals who meet certain criteria. These criteria include:
- A body mass index (BMI) of 30 or higher
- At least one weight-related health condition, such as high blood pressure, type 2 diabetes, or sleep apnea
- A history of unsuccessful weight loss attempts
If you meet these criteria, you may be eligible for Medicaid coverage of Wegovy. To find out if you are eligible, you should contact your Medicaid plan provider.
| Treatment | Coverage |
|---|---|
| Behavioral therapy | Covered |
| Nutritional counseling | Covered |
| Weight loss medications | Covered (may vary by plan) |
| Surgery | Covered (may vary by plan) |
| Wegovy | Covered for individuals who meet certain criteria |
Prior Authorization Requirements
In general, prior authorization is not required for Wegovy coverage under South Carolina Medicaid.
However, prior authorization may be required in certain cases, such as:
- If the patient has a history of pancreatitis or cholelithiasis
- If the patient is taking other medications that may interact with Wegovy
- If the patient has a history of medication non-adherence
- If the patient is pregnant or breastfeeding
If prior authorization is required, the provider must submit a prior authorization request to the South Carolina Medicaid office. The request must include the following information:
- The patient’s name, date of birth, and Medicaid ID number
- The provider’s name, address, and phone number
- The diagnosis for which Wegovy is being prescribed
- The dosage of Wegovy that is being prescribed
- The length of time for which Wegovy is being prescribed
- Any relevant medical records that support the need for Wegovy
The South Carolina Medicaid office will review the prior authorization request and make a decision within 10 business days. If the request is approved, the provider will be notified and the patient will be able to fill their Wegovy prescription.
Please note that this information is subject to change. For the most up-to-date information, please contact the South Carolina Medicaid office.
| Situation | Prior Authorization Required |
|---|---|
| Patient has a history of pancreatitis or cholelithiasis | Yes |
| Patient is taking other medications that may interact with Wegovy | Yes |
| Patient has a history of medication non-adherence | Yes |
| Patient is pregnant or breastfeeding | Yes |
| None of the above | No |
Hey there! Before you head off, I just wanted to say thanks for hanging out and reading my article about whether or not South Carolina Medicaid covers Wegovy. I know it can be a lot to take in, especially if you’re dealing with all the insurance stuff, so I really appreciate you taking the time to learn more. If you have any more questions or if anything changes in the future, be sure to swing back by and check it out again. Until then, take care and stay healthy!