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. NexLife, our editor's pick, charges $95 a month for compounded semaglutide or $115 for compounded tirzepatide on a 12-month plan ($109 and $129 month to month; nexlife.us, read November 6, 2026), the same price at every dose. It is not the lowest price we track: Mondae lists lower standing rates, and Eden Health a lower semaglutide rate. Compounded versions are not FDA-approved.