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Cigna Healthcare

The Cigna Group · Drug benefit: Express Scripts, part of Evernorth · 6 documents cited · Read September 2026

Publishes three different BMI thresholds for the same drugs, and says in writing they are not clinically based.

Denise Ramirez, Coverage Editor · Who writes this

Cigna publishes more about its GLP-1 rules than most carriers do, and reading the documents together produces an answer most coverage pages never give you: the clinical criteria are not the thing that decides it.

The policies themselves say so. One of them states that weight loss medications are specifically excluded under many benefit plans, both employer groups and individual and family plans, and points the reader at their own plan document. Underneath that sits a separate family of policies whose entire job is to authorize coverage where a plan has bought an override of that exclusion. So the first question is not what your body mass index is. It is whether the plan your employer purchased includes the benefit at all.

The second thing the documents show is that there is no single Cigna threshold. Policies in force on the day we read them carry different BMI floors for the same drugs, and Cigna states in two of them that the thresholds are not based on clinical data. That is an unusually candid sentence for a coverage policy, and it is the sentence a reader most needs, because it means the number is a product design choice rather than a medical finding.

What none of these documents does is tell you which one applies to you. We could not find anything published that maps a member to a policy or a tier, and we say so below rather than leaving you to assume the page describes your plan.

What decides it first: the benefit, not the BMI

Cigna's weight-loss GLP-1 policy carries a standing note that weight loss medications are excluded under many benefit plans and directs the reader to their own plan document to find out whether the benefit exists. That note is doing more work than its placement suggests.

The proof is the existence of the Benefit Exclusion Overrides policies. They are numbered separately, they carry their own effective dates, and their stated purpose is to authorize coverage of a drug for weight loss where the plan would otherwise exclude it. A carrier does not build and maintain a family of override policies unless the underlying exclusion is common.

The practical consequence for a reader: a denial that cites a benefit exclusion is a different problem from a denial that cites a clinical criterion. The first is about what the plan bought and is usually not fixable by sending more clinical evidence. The second is.

Why there is more than one BMI number

On the day we read them, Cigna had policies in force carrying different BMI floors for overlapping sets of the same drugs. One is titled for a threshold of 35. One override policy is titled for a threshold of 32 and another for 35, and both also allow entry at 27 with at least two weight-related comorbidities. The revision history of a fourth records that it was once retitled around a threshold of 30.

Cigna does not present these as competing clinical judgments. Two of the policies say the opposite in the same sentence: the thresholds are not based on clinical data, and are offered so that a subset of patients can obtain the medications. Read plainly, that is a statement that the number is a benefit-design lever.

That matters for an appeal. Arguing that a threshold is clinically wrong argues against a claim the carrier has not made. The question a reader can actually ask is which policy was applied to them and why.

Why a drug being on the list is not the same as being covered

Cigna's pharmacy benefit runs through Express Scripts, and a natural next move is to look up whether your drug is on the formulary. It is worth knowing in advance what that will and will not settle.

A formulary answers a question about the drug list. The benefit exclusion quoted above answers a question about the plan, and it is decided separately and sits above the list. A drug can appear on the formulary and still not be available to you, because your employer did not buy the weight-loss benefit that the override policies exist to switch on.

So if you are checking a formulary to find out whether you are covered, you are reading the wrong document for that question. The document that answers it is your own plan's benefit description, which is what Cigna's policy tells you to consult.

What changed on September 1, 2026

Cigna split its combined weight-loss GLP-1 policy into per-product policies. Its own revision record is the document that shows this, rather than any announcement: the Foundayo policy's revision table logs that Saxenda, liraglutide, Wegovy tablet, Wegovy injection and Zepbound were removed and moved to new individual policies, with a review date in July 2026 and an effective date of September 1, 2026.

The practical effect is that a reader searching for one combined policy will find a stub, and the criteria they want are now in a policy named for their specific drug. It also means a criterion quoted from before that date may have been superseded without the number itself changing.

Every claim above, with the document behind it

These are the policies we opened and the month we opened them. Each one carries its own policy number and effective date on its face, and those are printed here as the document shows them.

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, conditions and limitations 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

The same sentence appears under a different threshold in the companion policy for liraglutide, which is titled for a BMI of 32 rather than 35. It authorizes coverage "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 ≥ 32 kg/m2, and for pediatric patients with a BMI ≥ 95th percentile for age and sex," and repeats that "The BMI thresholds for the weight loss indications in adults are not based on clinical data." Two policies, two different adult thresholds, the same disclaimer.

Cigna Healthcare, Benefit Exclusion Overrides Policy BEO007, "Liraglutide Benefit Exclusion Overrides Policy BMI ≥ 32", effective September 2026 · source

A third threshold is in the policy titles themselves. One policy in force is titled "Weight Loss – Glucagon-Like Peptide-1 Agonists BMI ≥ 35" with an effective date of April 30, 2026. A separate policy's revision history records an earlier retitling "from 'Weight Loss – Glucagon-Like Peptide-1 Agonists' to 'Weight Loss – Glucagon-Like Peptide-1 Agonists BMI ≥ 30'" — so thresholds of 30, 32 and 35 all appear across Cigna's published weight-loss GLP-1 policies.

Cigna Healthcare, Drug Coverage Policies IP0739 and IP0206, effective April 2026 · source

Cigna's own revision record is what documents the September 2026 restructuring. The Foundayo policy's Revision Details table logs: "Removed Saxenda, liraglutide, Wegovy Tablet, Wegovy Injection and Zepbound. The products were moved to new individual policies," against a review date of 07/09/2026 and an effective date of 09/01/2026. The per-product policies that resulted — for liraglutide, Wegovy injection, Wegovy tablet and Zepbound — each carry an effective date of 09/01/2026 on their face.

Cigna Healthcare, Drug Coverage Policy IP0206, "Foundayo" (Revision Details), effective September 2026 · source

Zepbound now has a policy of its own, effective September 1, 2026, separate from the combined policy it was removed from and separate again from the benefit exclusion override policy that governs whether the drug is available to a plan at all.

Cigna Healthcare, Drug Coverage Policy IP0816, "Zepbound", effective September 2026 · source

Cigna's member-facing appeal window is 180 calendar days. Its appeals and grievances page describes the internal single-level appeal process for coverage decisions and says to begin it "within 180 calendar days of the date of the initial payment or denial notice," explaining why you believe the initial decision should be reconsidered.

Cigna Healthcare, Appeals and grievances (member guide) · source

What these documents cannot tell you

Everything above is what Cigna Healthcare publishes. None of it establishes what your own plan does, and the gap between those two things is wider than a carrier policy makes it look.

  • Nothing Cigna publishes maps a member to a policy. We could not find any public document that says which BMI threshold or which override policy applies to a given plan, so this page cannot tell you your own threshold and does not try to.
  • These are national policy documents. Cigna administers many plan designs, and where it only provides utilization review services to a client it does not make the coverage determination at all — the policies say so themselves in their instructions for use.
  • A self-funded employer plan may adopt different rules. The name on the card does not settle whether state insurance law reaches the plan or whose criteria govern it.
  • None of this is legal or medical advice, and this page does not predict how an appeal will come out. Your plan document and the notice you received govern your case.

Where this comes from

  1. Cigna Healthcare, Drug Coverage Policy IP0739, "Weight Loss – Glucagon-Like Peptide-1 Agonists BMI ≥ 35", effective April 2026 — static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/ip_0739_cover
  2. Cigna Healthcare, Benefit Exclusion Overrides Policy BEO014, "Zepbound Benefit Exclusion Overrides Policy BMI ≥ 35", effective September 2026 — static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/beo_014_cover
  3. Cigna Healthcare, Benefit Exclusion Overrides Policy BEO007, "Liraglutide Benefit Exclusion Overrides Policy BMI ≥ 32", effective September 2026 — static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/beo_007_cover
  4. Cigna Healthcare, Drug Coverage Policy IP0206, "Foundayo" (Revision Details), effective September 2026 — static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/ip_0206_cover
  5. Cigna Healthcare, Drug Coverage Policy IP0816, "Zepbound", effective September 2026 — static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/ip_0816_cover
  6. Cigna Healthcare, Appeals and grievances (member guide) — www.cigna.com/individuals-families/member-guide/appeals-grievances

Where to go next

American GLP is not a law firm, an insurer, a government office or a clinician, and nothing here is legal or medical advice. This page describes what Cigna Healthcare publishes. It is not affiliated with The Cigna Group, and your own plan documents and your own notice govern your case. Policies carry effective dates and change — read the sources before you act.