Which insurance plans cover Zepbound and Wegovy?

Among firms that offer health benefits AND have 200 or more workers: 16% of those with 200 to 999 workers, 30% of those with 1,000 to 4,999, and 43% of those with 5,000 or more covered GLP-1 agonists used primarily for weight loss in 2025. Firms under 200 workers were not asked this question at all.

KFF Employer Health Benefits Survey, effective October 2025 · source

Cigna states that the benefit itself is frequently absent, and points the reader at their plan document rather than at a clinical rule: "Weight loss medications are specifically excluded under many benefit plans [both Employer Groups and Individual and Family Plans]. Please refer to the applicable benefit plan document to determine benefit availability and the terms and conditions of coverage."

Cigna Healthcare, Drug Coverage Policy IP0739, "Weight Loss – Glucagon-Like Peptide-1 Agonists BMI ≥ 35", effective April 2026 · source

Cigna says its own BMI thresholds are not a clinical finding. The Zepbound override policy states that it "has been developed to authorize coverage of Zepbound for the treatment of weight loss in adults with a body mass index (BMI) of ≥ 27 kg/m2 with at least two weight-related comorbidities, or with a body mass index of ≥ 35 kg/m2," and then adds: "The BMI thresholds for the weight loss indications in adults are not based on clinical data but are provided in this product offering to allow a subset of patients to obtain these medications."

Cigna Healthcare, Benefit Exclusion Overrides Policy BEO014, "Zepbound Benefit Exclusion Overrides Policy BMI ≥ 35", effective September 2026 · source

UnitedHealthcare describes its weight-loss coverage as something an employer buys rather than something its members have. The program's own background section opens: "This is an optional program that is put in place for clients or businesses that have elected to cover weight loss products with Prior Authorization/Notification."

UnitedHealthcare, Clinical Pharmacy Programs, "Prior Authorization/Notification – Plans with Weight Loss/Appetite Suppression Medication Coverage" (2026 P 1114-22), effective September 2026 · source

A separate program exists for plans that did not buy it, and it says why: "Medications for the purpose of weight loss are typically a benefit exclusion. The program allows for coverage of Wegovy injection or tablet for the cardiovascular risk reduction indication and Wegovy injection for MASH." It will not approve Wegovy for weight loss, because that is the thing those plans exclude.

UnitedHealthcare, Clinical Pharmacy Programs, "Prior Authorization/Non-Formulary – Wegovy (semaglutide) injection, Wegovy (semaglutide) tablets – Cardiovascular Risk Reduction and MASH Only" (2026 P 1445-4), effective May 2026 · source

Zepbound has the same arrangement through a different door. Its non-formulary program repeats that "Medications for the purpose of weight loss are typically a benefit exclusion," and then states: "The program allows for coverage of Zepbound for obesity with obstructive sleep apnea." It requires a sleep study, a BMI of at least 30, and either continued symptoms despite adherent positive airway pressure therapy or a reason you cannot use it.

UnitedHealthcare, Clinical Pharmacy Programs, "Prior Authorization/Non-Formulary – Zepbound (tirzepatide) – Obstructive Sleep Apnea Only" (2026 P 1475-3), effective September 2026 · source

Aetna states when its own criteria stop applying. Its weight reduction policy notes that "Many Aetna benefit plans specifically exclude coverage of weight reduction medications under the pharmacy benefit and/or under the health benefits plan," and continues: "The medical necessity criteria set forth below do not apply to health plans that specifically exclude services and supplies for or related to treatment of obesity or for diet or weight control. Under these plans, claims for weight loss drugs will be denied based on this exclusion." The policy's history records a last review of 03/10/2026.

Aetna, Medical Clinical Policy Bulletin 0039, "Weight Reduction Programs and Devices", effective February 2000 · source

Aetna's current weight-loss GLP-1 policy sets an adult floor of 35 and requires half a year of program participation before the drug. Authorization may be granted where "The patient has a baseline body mass index (BMI) greater than or equal to 35 kg/m2" and "The patient has participated in a comprehensive weight management program that encourages behavioral modification, reduced-calorie diet, AND increased physical activity with continuing follow-up for at least 6 months prior to using drug therapy."

Aetna, Pharmacy Clinical Policy Bulletin, "Weight Loss (BMI 35) GIP-GLP-1, GLP-1 Agonists PA with Limit 6450-C P08-2025 v8" · source

On one Aetna commercial plan, Zepbound is excluded and Wegovy is a preferred alternative to it. The 2026 Formulary Exclusions Drug List for the Advanced Control Plan, headed "Drugs not covered — and their covered alternatives", carries three weight-management entries in its excluded column — ZEPBOUND, CONTRAVE and XENICAL — each printed against the same preferred options: "liraglutide, orlistat, QSYMIA, WEGOVY". Saxenda and Foundayo do not appear on the list at all.

Aetna, "2026 Formulary Exclusions Drug List — Advanced Control Plan", effective July 2026 · source

The member-facing warning is much softer than the policy language, and it names who runs the drug benefit. Aetna's commercial clinical program summary tells members: "Your plan may not cover certain drugs to treat conditions such as infertility, erectile dysfunction and weight loss." The same document states that "Pharmacy benefits are administered by an affiliated pharmacy benefit manager, CVS Caremark" and that "Aetna® is part of the CVS Health® family of companies."

Aetna, "2026 Aetna Commercial Clinical Program Summary", effective 2026 · source

Anthem states the benefit position in its own words, while explaining why it gates the diabetes GLP-1s: "For the most part, our member benefits specifically exclude weight loss drugs, yet GLP-1 Receptor Agonists approved only for diabetes are being used off-label for weight loss and contributing to clinically inappropriate use." The same notice adds a lever no other carrier here uses: "Compliance with prescribing guidelines is a requirement of Anthem network participation."

Anthem Blue Cross and Blue Shield, Provider News (Missouri), "Glucagon-Like Peptide-1 prior authorization changes", effective December 2023 · source

Anthem's own formulary update records these drugs changing tier at least nine times, in both directions, each with its own effective date: Zepbound from Tier 2 to Tier 3 (7/1/2025); Wegovy from Tier 2 to non-formulary (7/1/2025); Saxenda from Tier 3 to non-formulary (7/1/2025, and again 4/1/2026); Qsymia from Tier 3 to non-formulary (7/10/2025); the Wegovy tablet from non-formulary to Tier 2 (12/23/2025); liraglutide, listed as generic Saxenda, from non-formulary to Tier 1 (1/1/2026); Foundayo from non-formulary to Tier 2 (5/15/2026); the Zepbound KwikPen from not-covered to Tier 2 (8/1/2026); and the Zepbound standard pen from Tier 3 to non-formulary (10/1/2026).

Anthem, Formulary Update (unbranded, quarterly rolling) · source

The benefit is stated to exist, which is the opposite of what the commercial carriers publish. In the preventive care section the brochure notes: "Benefits are available for anti-obesity medications. See Section 5(f)." The same note appears in the FEP Blue Focus brochure.

Blue Cross and Blue Shield Service Benefit Plan, 2026 Standard and Basic Option brochure (RI 71-005), effective 2026 · source

CVS Health's announcement, dated May 28, 2026: "CVS Caremark will add Zepbound back to our commercial formularies as an additional preferred option October 1, 2026, increasing access to GLP-1s at a more affordable price for plan sponsors who elect to provide coverage of those medications for their members." The same release says: "Plan sponsors that adopt CVS Caremark template formularies retain discretion to customize coverage for their members."

CVS Health, company news release, effective May 2026 · source

Lilly's release of May 28, 2026, subheaded "CVS Caremark begins covering Foundayo June 1 and resumes Zepbound coverage by October 1", says "all three of the nation's largest pharmacy benefit managers (PBMs) will cover Lilly's full obesity medicine portfolio" and that "For eligible patients with commercial coverage, both medicines are available for as little as $25 a month." A footnote reads "Terms and conditions apply."

Eli Lilly and Company, news release, effective May 2026 · source

Lilly, April 9, 2026: "approximately half of Americans with employer-sponsored insurance lack coverage for obesity management medications."

Eli Lilly and Company, news release, effective April 2026 · source · PR Newswire