CVS Health subsidiary. Coverage generally less generous than peer commercial insurers, with strict PA criteria for weight indications.
Type 2 diabetes coverage
Generally covered for T2D. Typical copay $30–$100/mo with PA.
Weight management coverage
Strict PA criteria. Many plans require documented 6+ months of lifestyle modification with weight outcomes before approving Wegovy/Zepbound. Some plans exclude weight management entirely.
CV indication coverage
Coverage under CV indication being added; PA still rigorous.
OSA indication coverage
Coverage of Zepbound for OSA following standard PA pathways for OSA indication.
Prior authorization (typical)
BMI ≥30 or BMI ≥27 with documented comorbidity; documented 6+ months of lifestyle modification with weight tracking.
How to verify
Call member services on your card and ask: (1) Is [Wegovy/Zepbound/Ozempic/Mounjaro] on my formulary? (2) What tier? (3) PA criteria? (4) Expected copay? Document the date, rep's name, and any reference number.
Cash-pay alternative
If insurance is unworkable, see our price index. Our editor's pick NexLife runs $145–$215/mo flat-rate.