Does Cigna Cover Wegovy? Criteria, Copay, How to Appeal
Cigna covers Wegovy for weight loss only when your employer or plan has added weight-loss drugs. Where it is covered, you need a BMI of 27 or more with a weight-related condition.
- For weight loss
- Plan dependent
- For type 2 diabetes
- Covered on formulary
- Prior authorization
- Required
- Weight rule
- A BMI of 27 or more with a weight-related condition
- Self-pay if denied
- $149 a month
A quick look at Wegovy
Its half-life is about 1 week: half leaves after 7 d, and about 3% remains at five half-lives (35 d).
In STEP 1 over 68 weeks, 14.9% of body weight came off, against 2.4% on placebo.
In US dollars, the monthly price points are list price and self-pay offers. Each figure was taken from the maker's price page.
Sources: FDA label (DailyMed), healthsystemtracker.org, prnewswire.com 1 2.
Does Cigna cover Wegovy?
| Medicine | Approved for | Status | Prior authorization |
|---|---|---|---|
| Wegovy | Weight loss, heart risk and MASH liver disease | Plan dependent | Required |
Sources: TrumpRx, NovoCare, CMS, medicare.gov.
The published policy
Cigna, a commercial insurer
- Employer add-on: a monthly copay cap of $200
- This policy has been in force since September 1, 2026
See the policy itself on static.cigna.com.
Sources: reuters.com, static.cigna.com.
Prior authorization checklist
- Your chart records either the weight diagnosis the plan requests or another approved Wegovy use: heart risk, plus MASH liver disease.
- Lower weight requirement: With a weight-related condition, your BMI needs to be 27 or above
- Early progress check: 5% weight loss is the figure after 3 months
- Records: your height and weight as measured, the diet and activity program that you tried, and weight-related conditions
- Submission: Your prescriber files the prior authorization, not you.
Source: static.cigna.com.
If you are turned down: the appeal
| Denial reason | What to send or ask |
|---|---|
| The plan excludes weight-loss drugs | This is a plan design choice. Ask your employer's benefits team whether the plan will add weight-loss drugs at renewal. |
| Criteria not met | Ask your prescriber to resubmit, including your measured BMI and every weight-related condition recorded in your chart (With a weight-related condition, BMI of 27 or more is required). |
| Renewal denied | Send your starting and current weight. The rule: 5% weight loss after 3 months. |
| The drug is not on the plan's list | Ask which GLP-1 the plan prefers as an alternative, and request a formulary exception. |
- Get a copy of the denial letter; it points to the precise rule your request missed.
- Your prescriber sends the appeal, and adds chart notes that address the rule that was not met.
- If the plan's appeal fails, ask for an outside review by an independent reviewer.
Source: static.cigna.com.
Differences by state and plan
| Plan | For weight loss | Prior authorization |
|---|---|---|
| Medicare | Bridge program only | Required |
| Medicaid | Varies by state | Required |
 Aetna | Employer option | Required |
 UnitedHealthcare (Optum Rx) | Plan dependent | Required |
 Blue Cross Blue Shield | Plan dependent | Required |
 Kaiser Permanente | Plan dependent | Required |
 CVS Caremark | Plan sponsor choice | Required |
| VA (Veterans Health Administration) | Covered with criteria | Required |
 GEHA | Covered with PA | Required |
 Ambetter (Centene) | Excluded | Required |
| Express Scripts | Plan sponsor choice | Required |
| Optum Rx | Plan sponsor choice | Required |
 Humana | Bridge program only | Required |
| TRICARE | Prime and Select only | Required |
| ACA Marketplace plans | Rare | Required |
 Navitus | Plan sponsor choice | Not listed |
 Amerigroup (Elevance Medicaid) | Follows state Medicaid | Required |
Each state sets its own Medicaid rules. At present, coverage for GLP-1s used for weight loss applies in 10 states. View all states.
Other options if coverage says no
| Route | Who it is for | What you pay |
|---|---|---|
| NovoCare Pharmacy: Wegovy pill 1.5 mg | Self-pay, no insurance needed | $149 a month |
| TrumpRx listing (pill, starting) | Self-pay only, not with insurance | $149 a month |
Prices checked November 2026. Each price links to its source page.
Sources: TrumpRx, NovoCare, CMS, medicare.gov.