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Kaiser Foundation Health Plan of Colorado · Drug benefit: MedImpact takes the prior authorization requests; Kaiser Permanente staff review them · 2 documents cited · Read September 2026

Wegovy and Zepbound are non-formulary; weight-loss approval needs a plan with that benefit, four older drugs first, and 5% loss to renew.

American GLP, Publisher · Who writes this site

Kaiser Permanente Colorado publishes its HMO medication request guidelines in full, revised July 21, 2026, and they're unusually specific about weight-loss drugs.

The first test isn't medical. For weight loss, your benefit plan has to cover weight-loss medications. Wegovy and Zepbound are both non-formulary, specialty-tier drugs.

Then the step order: phentermine or diethylpropion, Qsymia, Contrave and generic liraglutide, each for at least three months, unless your doctor documents why you can't. Approval runs six months; to renew for a year, you need to have kept off at least 5% of your weight.

What has to be on file before a request?

A weight measured in the office within the past 4 weeks, a BMI of 30, or 27 with a condition such as high blood pressure, and your doctor's statement that you're on a reduced-calorie diet with more activity. You can't combine Wegovy or Zepbound with another GLP-1 or a DPP-4 drug.

Who reviews it, and how do you appeal?

Requests go to MedImpact by fax or phone and Kaiser staff review them against the committee's criteria. If a request doesn't meet them, it goes to a health plan physician. To appeal a denial, your physician contacts Kaiser Member Services at (303) 338-3800.

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.

Wegovy's entry reads "Non-Formulary; Specialty tier" and, for weight loss, "Patient must have benefit plan with coverage for weight loss medications."

Kaiser Permanente Colorado, HMO Medication Request Guidelines (revised 7/21/2026), effective August 2026 · source

"Patient must have an initial body mass index (BMI) of greater than or equal to 30 kg/m2, OR an initial BMI of greater than or equal to 27 kg/m2 AND at least one weight-related comorbid condition, such as hypertension, dyslipidemia, type 2 diabetes."

Kaiser Permanente Colorado, HMO Medication Request Guidelines (revised 7/21/2026), effective August 2026 · source

The step list, "in preferential order": "phentermine or diethylpropion: on a therapeutic dose of phentermine 37.5 mg per day or diethylpropion 75 mg per day for at least 3 months", then Qsymia, Contrave and "Generic liraglutide (Victoza)", each for at least 3 months.

Kaiser Permanente Colorado, HMO Medication Request Guidelines (revised 7/21/2026), effective August 2026 · source

Renewal for weight loss: "Patient must have achieved and maintained at least a 5% weight loss from baseline (objectively measured with in-office weight checks)." First approvals run "x 6 months" and renewals "x 1 year".

Kaiser Permanente Colorado, HMO Medication Request Guidelines (revised 7/21/2026), effective August 2026 · source

Zepbound's entry reads "Non-Formulary; Specialty tier" and asks the same first question: "Patient must have a benefit plan with coverage for weight loss medications."

Kaiser Permanente Colorado, HMO Medication Request Guidelines (revised 7/21/2026) · source

"If the physician wishes to appeal a denied request, he/she may do so by contacting Kaiser Permanente Member Services at (303) 338-3800 for more information."

Kaiser Permanente Colorado, HMO Medication Request Guidelines (revised 7/21/2026) · source

The Colorado commercial formulary covers "a Kaiser Permanente Colorado Commercial Mid and Large group plan" and is marked "CURRENT AS OF 9/15/2026". We found neither Wegovy nor Zepbound on it, while Ozempic is listed, which fits their non-formulary status. That's our reading of the list, not a statement Kaiser makes.

Kaiser Permanente Colorado, 2026 Commercial HMO Formulary, effective September 2026 · source

What these documents cannot tell you

Everything above is what Kaiser Permanente Colorado 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.

  • These are the HMO guidelines. Colorado's Marketplace, PPO, self-funded and federal employee plans use other formularies.
  • Whether your plan covers weight-loss medications is set by your Evidence of Coverage, not by these guidelines.
  • The guidelines have separate criteria for Wegovy after a heart attack and for liver disease (MASH), and for Zepbound for sleep apnea; this page covers the weight-loss route.
  • None of this is legal or medical advice. Your plan documents and your notice govern your case.

Where this comes from

  1. Kaiser Permanente Colorado, HMO Medication Request Guidelines (revised 7/21/2026), effective August 2026 — Open the document
  2. Kaiser Permanente Colorado, 2026 Commercial HMO Formulary, effective September 2026 — Open the document

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 Kaiser Permanente Colorado publishes. It is not affiliated with Kaiser Foundation Health Plan of Colorado, and your own plan documents and your own notice govern your case. Policies carry effective dates and change — read the sources before you act.