Wegovy and Zepbound for weight management are covered by 30-50% of commercial insurance plans in 2026 — coverage has improved as employers add GLP-1 benefits, but most plans still require prior authorization (PA).
A typical PA requires: BMI ≥30 (or ≥27 with comorbidity), documented attempt at lifestyle intervention (often 3-6 months), and clinician attestation. Some plans add step-therapy requirements (try phentermine or orlistat first).
Medicare currently does NOT cover weight-loss-only indications under Part D (federal statutory exclusion). It does cover Ozempic and Mounjaro for type 2 diabetes, and as of late 2024, Zepbound for obstructive sleep apnea in patients with obesity.
Medicaid coverage varies state-by-state — about 20 states cover weight-management GLP-1s as of 2026. Check your specific plan formulary or use the insurance coverage checker.