Insurance guide · 2026
GLP-1 insurance coverage matrix (2026)
Coverage status for Wegovy, Zepbound, and Ozempic across the seven largest insurers in the United States — plus a prior-authorization checklist and appeal template.
| Insurer | Wegovy | Zepbound | Ozempic |
|---|---|---|---|
Blue Cross Blue Shield (most plans) Requires BMI ≥ 30 (or ≥ 27 + comorbidity), documented prior weight-management attempts (often 6 months), and clinician-monitored treatment plan. | Covered with PA | Covered with PA | Covered for T2D |
UnitedHealthcare Coverage varies significantly by employer group. Most large-group plans cover with PA; individual and marketplace plans frequently exclude weight-loss GLP-1s. | Plan-dependent | Plan-dependent | Covered for T2D |
Aetna PA criteria align with FDA labeling. Aetna requires re-authorization at 12 months with documented weight loss ≥ 5%. | Covered with PA | Covered with PA | Covered for T2D |
Cigna Cigna's PA requires participation in a lifestyle/behavior-change program documented by the prescribing clinician. | Covered with PA | Covered with PA | Covered for T2D |
Kaiser Permanente Kaiser internally manages prescribing through obesity-medicine clinics. External telehealth prescriptions are typically not honored. | Plan-dependent | Plan-dependent | Covered for T2D |
Medicare Part D Medicare statutorily excludes weight-loss medications. The 2025 CMS proposal to extend coverage was not finalized. Wegovy is covered only for cardiovascular indication after MI/stroke. | Not covered | Not covered | Covered for T2D |
Medicaid (most states) Most state Medicaid programs exclude weight-loss GLP-1s. A handful of states (e.g. NC, PA in pilot) are testing limited coverage. | Not covered | Not covered | Covered for T2D |
Prior-auth documentation checklist
- BMI ≥ 30, or BMI ≥ 27 with at least one weight-related comorbidity
- Documented prior weight-management attempts (diet, exercise, behavioral)
- Comorbidity documentation: hypertension, T2D, dyslipidemia, OSA, etc.
- Recent labs: A1C, lipid panel, comprehensive metabolic panel
- Treatment plan including lifestyle intervention alongside medication
- No contraindications: personal/family history of MTC or MEN 2
Appeal letter template
Use this skeleton when your clinician submits a first-level appeal:
Re: Appeal of denial for [Wegovy / Zepbound] Member: [Name, DOB, Member ID] Date of denial: [date] The denial cites [reason]. Per FDA labeling, my patient meets the indication: BMI [value] with [comorbidity]. Documented prior weight-management efforts include [list with dates]. Per ADA/AACE 2026 guidelines, pharmacotherapy is indicated when lifestyle alone fails to achieve clinically significant weight loss. Attached: BMI history, labs (A1C, lipids, CMP), prior intervention notes. Requesting reversal of denial and approval at [dose] for 6 months.
GLP-1 cost breakdown
What you'll pay in every common scenario — with and without coverage.
See pricing
Programs that accept insurance
Telehealth brands that handle PA paperwork and bill your insurer directly.
See ranking
FAQ
GLP-1 insurance questions
- Most large-group BCBS commercial plans cover Wegovy with prior authorization. Coverage on individual and marketplace plans varies by state and plan tier — verify your specific formulary.
Related coverage resources
Pricing, conditions, state rules, and head-to-head program reviews.
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By state
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State-specific insurance landscape and licensed brands.
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Head-to-head
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Head-to-head
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