Does Geha Cover Wegovy? Criteria, Copay, How to Appeal
GEHA covers Wegovy for weight loss with prior authorization.
- For weight loss
- Covered with PA
- For type 2 diabetes
- Covered
- Prior authorization
- Required
- Self-pay if denied
- $149 a month
A quick look at Wegovy
A half-life of about 1 week means half is gone after 7 days, and about 3% remains after five half-lives (35 days).
In STEP 1 at 68 weeks, the body-weight figure reached 14.9%, versus 2.4% for the placebo group.
The maker's price page lists monthly price points in US dollars for both list price and self-pay offers
Sources: FDA label (DailyMed), healthsystemtracker.org, prnewswire.com 1 2.
Does GEHA provide Wegovy coverage?
| Medicine | Approved for | Status | Prior authorization |
|---|---|---|---|
| Wegovy | Weight loss, heart risk and MASH liver disease | Covered with PA | Required |
Sources: TrumpRx, NovoCare, CMS, medicare.gov.
The policy as published
GEHA: federal employee plan
- lists the formulary tier as: Non-preferred
- Policy updated: October 1, 2026
Read the policy itself at geha.com
Source: geha.com.
A prior authorization checklist
- Diagnosis: Another approved Wegovy use covers MASH liver disease and heart-related risk. Your chart shows that use or the weight diagnosis the plan requests.
- Records: Your records cover the diet and activity program you tried, measured height and weight, and conditions related to weight.
- Who files it: Your prescriber sends the prior authorization request. You do not send it.
If you are denied: the appeal process
| Denial reason | What to send or ask |
|---|---|
| Criteria not met | Ask your prescriber to send a new request with all weight-related conditions in your chart and your measured BMI. |
| The drug is not on the plan's list | Request a formulary exception, and ask the plan which GLP-1 it prefers |
- Get the denial letter because it names the exact rule that was not met.
- Your prescriber files the appeal with chart notes that answer the rule
- If the plan's appeal does not succeed, request an external review from an independent reviewer.
State and plan variation
| Plan | For weight loss | Prior authorization |
|---|---|---|
| Medicare | Bridge program only | Required |
| Medicaid | Varies by state | Required |
 Aetna | Employer option | Required |
 Cigna (Evernorth / Express Scripts) | Plan dependent | 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 |
 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. Today, 10 states provide coverage for GLP-1s used for weight loss. See the states.
Other options when 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. Every price points to the page it comes from.
Sources: TrumpRx, NovoCare, CMS, medicare.gov.