Coverage varies by carrier and indication. Most commercial plans cover Ozempic/Mounjaro for T2D; Wegovy/Zepbound for weight is variable.
By indication
| Indication | Drug | Coverage |
|---|---|---|
| T2D | Ozempic, Mounjaro, Trulicity | Most commercial cover; PA common |
| Weight management | Wegovy, Zepbound, Saxenda | Variable; many plans exclude. Medicare: $50 GLP-1 Bridge for eligible Part D enrollees, July 2026 to December 2027 |
| CV (BMI ≥27 + CVD) | Wegovy | Varies by plan; Medicare Part D plans may cover it for this use |
| OSA (BMI ≥30 + mod-severe) | Zepbound | Some plans post-Dec 2024 |
Typical PA criteria
- BMI ≥30 OR BMI ≥27 with comorbidity
- Documented lifestyle intervention 3–12 months
- Documented obesity-related condition
- No contraindications
- Some plans require step therapy
By carrier
· UnitedHealthcare · Anthem BCBS · Aetna · Cigna · Kaiser · Medicare Part D · TRICARE
If plan excludes weight drugs
- Check other indications (CV for Wegovy; OSA for Zepbound; T2D if newly diagnosed)
- Ask HR about adding coverage next plan year
- Cash-pay compounded or manufacturer programs
- Appeal denials with medical-necessity documentation