Free tool · 30 seconds

Which PBM handles your Wegovy or Zepbound?

Your PBM (pharmacy benefit manager), not your insurer, decides GLP-1 formulary placement. Enter your carrier and this tool returns the most-likely PBM plus its current Wegovy + Zepbound coverage stance. Especially useful if UnitedHealthcare's July 2025 Zepbound exclusion applies to your plan.

Enter your insurance carrier or plan name

Insurer→PBM mapping reflects mid-2026 default configurations. Self-funded employer plans can override the underlying insurer's PBM — the definitive source is always your insurance card Rx BIN/PCN plus a member-services call. Coverage stance columns are the same conclusions used in our formulary teardown research report.

Which insurers are covered?

UnitedHealthcare → OptumRx
Aetna → CVS Caremark
Cigna → Express Scripts
Anthem BCBS / Elevance → Other or unknown PBM
BCBS Blues plans (Prime-administered) → Prime Therapeutics
Kaiser Permanente → Kaiser Permanente Pharmacy
Humana → Humana Pharmacy Solutions
Molina Healthcare → MedImpact
Centene / Ambetter / Wellcare → Other or unknown PBM
Medicaid (state fee-for-service) → Other or unknown PBM

Frequently asked

What is a PBM and why does it matter for GLP-1 coverage?

A pharmacy benefit manager (PBM) sits between drug manufacturers, health insurers, and pharmacies. The PBM decides which drugs appear on the "formulary" a health plan uses, what tier they sit at, and what prior-authorization rules apply. For GLP-1 obesity coverage, the PBM formulary decision is often the actual bottleneck — even if your insurance nominally covers weight-loss drugs, the PBM formulary or PA rules can make Wegovy or Zepbound effectively inaccessible.

How do I find my PBM if it is not on the list?

Look at the back of your insurance card for "Rx BIN" and "Rx PCN" numbers — the PBM name is often printed alongside them. If not on the card, call member services and ask "which PBM administers my pharmacy benefit?" — the answer determines which formulary applies. Common PBMs not currently in this tool: WellDyne, EmpiRx, Navitus, CarelonRx (Elevance/Anthem-owned).

Can my employer override the default PBM?

Yes. Large self-funded employer plans (and increasingly mid-market plans) elect their own PBM independent of the underlying insurer carrier. If you work for a large employer, the PBM printed on your card is the authoritative one — not the default associated with the insurer name. The tool defaults to the insurer name because it is the best available signal without card details.

Why did OptumRx drop Zepbound?

Effective July 1, 2025, OptumRx removed Zepbound from the Premium commercial formulary as part of a preferred-status agreement with Novo Nordisk that placed Wegovy in a preferred rebated position. Employer plans that use OptumRx can elect a custom formulary that still includes Zepbound, but the default UnitedHealthcare commercial book of business shifted to Wegovy-only for the obesity indication. See our full PBM formulary teardown for the details.