Blue Cross Blue Shield
- Drugs covered
- Wegovy, Zepbound, oral Wegovy, Foundayo
- BMI criteria
- ≥30, or ≥27 + comorbidity
- Typical copay
- $25-100/mo
- Prior auth
- Required, 7-14 days
- Notes
- Coverage varies by state plan. Anthem BCBS expanded coverage Q1 2026.
Aetna
- Drugs covered
- Wegovy, Zepbound, oral Wegovy
- BMI criteria
- ≥30, or ≥27 + comorbidity + 6mo lifestyle documented
- Typical copay
- $25-80/mo
- Prior auth
- Required, peer-to-peer common
- Notes
- Stricter lifestyle-intervention requirement than BCBS.
Cigna
- Drugs covered
- Wegovy, Zepbound, oral Wegovy, Foundayo
- BMI criteria
- ≥30, or ≥27 + comorbidity
- Typical copay
- $30-100/mo
- Prior auth
- Required
- Notes
- Express Scripts mail-order preferred ($75/90-day fill).
UnitedHealthcare
- Drugs covered
- Wegovy, Zepbound, oral Wegovy
- BMI criteria
- ≥30, or ≥27 + comorbidity
- Typical copay
- $40-100/mo
- Prior auth
- Required + step therapy
- Notes
- May require phentermine/metformin trial first.
Humana
- Drugs covered
- Wegovy, Zepbound
- BMI criteria
- ≥30, or ≥27 + comorbidity
- Typical copay
- $50-100/mo
- Prior auth
- Required
- Notes
- Foundayo + oral Wegovy added to formulary July 2026.
Kaiser Permanente
- Drugs covered
- Limited — Wegovy + Zepbound for severe cases only
- BMI criteria
- ≥35 typically required
- Typical copay
- $25-75/mo
- Prior auth
- Required, internal protocol
- Notes
- Stricter than commercial plans. Kaiser physicians have own decision protocol.
Medicare GLP-1 Bridge
- Drugs covered
- Wegovy, Zepbound, oral Wegovy, Foundayo
- BMI criteria
- ≥30, or ≥27 + comorbidity
- Typical copay
- $50/mo flat
- Prior auth
- Required, 3-5 business days
- Notes
- Demonstration program July 1 2026 → Dec 31 2027.
State Medicaid (13 states)
- Drugs covered
- Varies
- BMI criteria
- Per-state
- Typical copay
- $0-50/mo
- Prior auth
- Required
- Notes
- Covered: CA, CT, DE, KS, MA, MN, NH, NC, PA, RI, VT, VA, WI. Discontinued: IA, TX, FL, GA.
Insurance denied?
Use our free prior auth letter generator + appeal guide. 60-80% of GLP-1 denials are overturned with proper documentation.
Generate PA letter →FAQ
- Does my insurance cover Wegovy in 2026?
- Most commercial plans cover Wegovy if you have BMI ≥30 (or ≥27 + comorbidity) and submit prior authorization. Coverage details vary by employer/individual plan even within the same insurer.
- What is the cheapest path if my insurance denies?
- Hims oral Wegovy $149/mo (self-pay), LillyDirect Foundayo $349-499/mo, Wegovy savings card $499/mo (if commercially insured). All beat retail $1,000-1,350/mo.
- How do I appeal an insurance denial?
- Three-level process: internal review → peer-to-peer → external state review. 60-80% of appeals win with proper documentation. Use our prior auth letter generator + appeal guide.
- Does my employer plan affect coverage even if it's through Aetna/BCBS?
- Yes significantly. Employer self-funded plans choose their own formularies. Two people on "Aetna" can have very different GLP-1 coverage. Check your specific plan documents.