Carriers
What the carriers publish
A carrier's own coverage policies are public, numbered and dated, and they answer a narrower question than they appear to. These pages quote them, and then say plainly what they cannot tell you about your own plan.
National insurers
- Cigna HealthcarePublishes three different BMI thresholds for the same drugs, and says in writing they are not clinically based.
- UnitedHealthcareSays in its own program document that weight-loss coverage is optional, and sells it to employers who choose to buy it.
- AetnaSays outright that on plans which exclude weight-loss drugs, its clinical criteria do not apply and the claim is denied on the exclusion.
- AnthemIts answer moves several times a year in both directions, and it publishes the news one state at a time.
- HumanaIts Medicare drug plans don't cover GLP-1s for weight loss alone; the $50 Bridge runs beside them through CMS, not Humana.
Blue Cross and Blue Shield plans
- BCBS Federal Employee ProgramThe one carrier here whose document actually describes you — and it says the anti-obesity benefit exists.
- Highmark Blue Cross Blue ShieldStandard and Enhanced policy versions are documented from 2025; a public Foundayo request form is now available, but current full criteria remain unverified.
- RegenceCovers Wegovy, Zepbound, Foundayo and Saxenda only where your contract covers weight loss, then asks for 5% loss to renew.
- Blue Cross Blue Shield of MassachusettsEnded GLP-1 coverage for obesity from January 2026 renewals, as an exclusion that can't be appealed, unless a large employer buys it back.
- Premera Blue CrossCovers weight-loss GLP-1s only when the employer elects the benefit, then approves Wegovy for 7 months and renews at 5% weight loss.
- Blue Cross and Blue Shield of TexasCovers Wegovy and the Zepbound auto-injector only for groups that elect GLP-1 coverage, and excludes the Zepbound KwikPen.
- Florida BlueExcludes FDA-approved weight-loss drugs unless a plan buys the coverage separately; its new Wegovy HD, KwikPen and Foundayo rules apply only to those groups.
- Horizon Blue Cross Blue Shield of New JerseyIts Classic drug list names anti-obesity drugs like Wegovy and Zepbound as an excluded class, while listing them on tier 3 for plans that include the benefit.
- Independence Blue CrossCovers weight-loss drugs only where the benefit doesn't exclude them, then requires 5% weight loss to renew Wegovy, Zepbound and Foundayo.
- CareFirst BlueCross BlueShieldLists Wegovy and Foundayo with prior authorization subject to your plan's benefits, and adds Zepbound to two formularies from October 1, 2026.
- Blue Cross Blue Shield of MichiganDoesn't cover GLP-1s for weight loss for fully insured large groups and some self-funded groups; where a group covers them, renewal needs 5% weight loss.
- Blue Cross and Blue Shield of North CarolinaRequires anti-obesity drug coverage on your plan, 6 months of lifestyle change first, and 5% weight loss to renew Wegovy, Zepbound or Foundayo.
- Blue Cross and Blue Shield of IllinoisCovers Wegovy and the Zepbound auto-injector only for groups that elect GLP-1 coverage, excludes the Zepbound KwikPen, and was still reviewing Foundayo.
Kaiser Permanente regions
- Kaiser Permanente NorthwestCovers Wegovy only for members whose plan includes weight-loss drugs, after two older drugs; Zepbound and Foundayo need a semaglutide trial first.
- Kaiser Permanente CaliforniaBoth California HMO formularies list Wegovy on tier 2, and neither lists Zepbound, Foundayo or the Saxenda brand.
- Kaiser Permanente WashingtonMost of its plans exclude weight-loss drugs; members with a weight-loss rider get separate criteria for Wegovy, Zepbound and Foundayo.
- Kaiser Permanente ColoradoWegovy and Zepbound are non-formulary; weight-loss approval needs a plan with that benefit, four older drugs first, and 5% loss to renew.
- Kaiser Permanente GeorgiaIts five-tier formulary puts Wegovy, Zepbound, Foundayo and Saxenda on the specialty tier, each needing prior authorization.
- Kaiser Permanente HawaiiIts Marketplace formulary lists none of Wegovy, Zepbound, Foundayo or Saxenda; the Added Choice plan lists Wegovy and Zepbound with prior authorization.
- Kaiser Permanente Mid-Atlantic StatesWegovy by prior authorization with BMI tiers; below BMI 35 an older drug comes first. Zepbound needs a semaglutide trial; Foundayo needs needle fear.
Marketplace and Medicaid plans
- Ambetter Health (Centene)Treats Wegovy and Zepbound for weight management as a benefit exclusion, but still reviews Wegovy for heart risk and Zepbound for sleep apnea.
- Molina HealthcareExcludes Wegovy and Zepbound for obesity; most Marketplace plans exclude them for every use, while Illinois Medicaid keeps heart and sleep apnea paths.
The pharmacy benefit managers behind them
Most plans don't write their own drug list. They adopt a template from a pharmacy benefit manager, and that list decides which form of a drug is preferred and which is excluded.
- Express ScriptsLists Wegovy, the Zepbound pen and Foundayo for 2026 and 2027, and excludes Saxenda and the Zepbound KwikPen and vials.
- CVS CaremarkOctober 2026 template formularies list Zepbound again; your employer still decides whether your plan covers weight-loss drugs.
- Optum RxIts 2027 lists add Foundayo, drop Saxenda to excluded, and still exclude the Zepbound KwikPen and vials.
Want the short version across all of them? Which insurance plans cover Zepbound and Wegovy puts each carrier's published position in one table.
Waiting on an approval? The prior authorization criteria for Zepbound and Wegovy sit side by side, insurer by insurer. Before you call, read what to say when you call your insurer.
The thing a carrier page gets wrong
A published clinical criterion looks like the rule that decides your case. Usually it is the second rule. The first is whether the plan you are in bought a weight-loss drug benefit at all, and that is a purchasing decision made by an employer or a plan sponsor rather than a clinical judgment made by the insurer. A carrier can publish a detailed body mass index threshold and still not pay, because the benefit the threshold sits inside was never bought.
That is why each page here leads with the benefit question and puts the clinical criteria under it, and why each one ends with a list of what its documents do not establish. If you want the rules that apply to everybody regardless of carrier, the employer plans page has the federal floor, and the commercial appeal procedure has the deadlines.
Nothing here is legal or medical advice, and no page predicts how an appeal will come out. Your plan document and the notice you received govern your case.