Can insurance cover Wegovy? It depends, says FSS in latest consumer advisory.

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Can insurance cover Wegovy? It depends, says FSS in latest consumer advisory.

Published: 16 Jul. 2025, 14:39 Updated: 16 Jul. 2025, 18:54

Audio report: written by reporters, read by AI

Wegovy products are displayed at a launch event in Seoul on Oct. 15 to mark Wegovy's arrival in Korea. [YONHAP]

A patient who wished to remain anonymous was recently diagnosed with hyperglycemia and prescribed Wegovy, a high-cost obesity drug known to suppress appetite and aid in weight loss.

The patient had private health insurance. So when their monthly medication costs ran into the hundreds of thousands of won, they filed a claim with their private insurer — only to be rejected. Apparently, obesity treatments are not covered under standard private policies.

Generally, as the insurer noted, weight-loss medications like Wegovy are not eligible for reimbursement. However, if such drugs are prescribed to treat obesity-related complications rather than obesity itself, policyholders may, in some cases, be able to claim reimbursement, the Financial Supervisory Service (FSS) said Tuesday.

In a consumer advisory issued Tuesday, the FSS clarified that weight-loss drugs such as Wegovy or Saxenda, as well as procedures like sleeve gastrectomy — in which a large portion of the stomach is removed — may be covered under private insurance if they are prescribed to treat comorbid conditions such as diabetes or hypertension.

“If the drug is prescribed solely for obesity but claimed as treatment for diabetes or hypertension, the insurance claim will not be accepted,” an FSS official said. “However, if the patient has a long-standing history of diabetes and the use of a weight-loss drug is medically necessary as part of that treatment, reimbursement may be possible.”

A pharmacist hands out the obesity treatment drug Wegovy at a pharmacy in Jongno District, central Seoul. [YONHAP]

The advisory also noted that if moisturizers are prescribed for dry skin, insurance will only cover one item per outpatient visit.

“The Supreme Court has ruled that only medical expenses arising directly from prescribed treatment can be reimbursed,” the FSS said. “Moisturizers beyond the prescribed quantity are not considered part of doctor-led medical treatment.” The agency also warned that reselling moisturizers purchased from medical institutions could violate relevant laws.

Regarding neuroplasty — a spinal procedure that alleviates pain by injecting medication — reimbursement depends on whether hospitalization was medically necessary. If a 2 million won ($1,450) neuroplasty procedure is deemed to require hospitalization, the claim may be reimbursed within the inpatient care limit of 50 million won. Otherwise, it will be subject to the outpatient limit of 300,000 won.

Unrelated photo of a pharmacy [NEWS1]

For policyholders who remain abroad for more than three consecutive months, the FSS said premiums paid during that period may be eligible for a refund. However, policyholders must provide evidence of a continuous overseas stay, and refunds may not be available if the policy is terminated, so it’s advised to that eligibility be confirmed with the insurer in advance.

Translated from the JoongAng Ilbo using generative AI and edited by Korea JoongAng Daily staff.
BY KIM NAM-JUN [[email protected]]