Carrier
Kaiser Permanente Northwest
Covers Wegovy only for members whose plan includes weight-loss drugs, after two older drugs; Zepbound and Foundayo need a semaglutide trial first.
Kaiser Permanente publishes its drug criteria region by region, and the Northwest region — Oregon and southwest Washington — posts a sheet for each weight-loss drug. This page is about that region only.
Every sheet opens the same way: the drug is covered for weight loss only for members whose plan includes weight-loss medications. Everyone else pays the member cash price.
Then the steps. Wegovy needs a trial of two older weight-loss drugs first. Zepbound and Foundayo sit off the formulary and need a semaglutide trial before they're considered. To keep any of them past a year, you need to have lost and kept off at least 5% of your weight.
Which dates do these criteria carry?
The Wegovy and Zepbound sheets we opened were revised in September 2026 and take effect November 5, 2026. The version in force before that wasn't on Kaiser's index page, so we can't quote it. The Foundayo and Saxenda sheets took effect July 1, 2026.
What do you need to try first?
For Wegovy, a three-month trial of at least two older drugs or combinations — phentermine, diethylpropion, topiramate, Qsymia or Contrave — unless you can't take them. For Zepbound, at least six months of semaglutide and then a bariatric medicine chart review. For Foundayo, a trial of semaglutide.
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.
"Zepbound is covered under the prescription drug benefit for weight loss ONLY for Kaiser Northwest members with coverage for medications used to treat weight loss. Others pay member cash price."
Kaiser Permanente Northwest Region, Criteria for tirzepatide (Zepbound) Coverage, effective November 2026 · source
Wegovy's weight-loss rule: "BMI greater than or equal to 30 kg/m2 or BMI greater than or equal to 27 kg/m2 AND has at least one of the following comorbid conditions documented," a list that includes high blood pressure, diabetes, prediabetes and sleep apnea.
Kaiser Permanente Northwest Region, Criteria for semaglutide injectable (Wegovy, Wegovy HD) Coverage, effective November 2026 · source
"Patient has failed an adequate trial^ to at least two of the following medications or medication combination therapies, or patient has an allergy, intolerance, or contraindication to all the following therapies," where "Adequate trial is defined as a 3-month treatment duration".
Kaiser Permanente Northwest Region, Criteria for semaglutide injectable (Wegovy, Wegovy HD) Coverage, effective November 2026 · source
"Non-Formulary tirzepatide (Zepbound) requires a clinical review." It asks that the patient "has then failed a minimum 6-month trial of semaglutide (Ozempic/Wegovy) followed by a bariatric medicine chart review."
Kaiser Permanente Northwest Region, Criteria for tirzepatide (Zepbound) Coverage, effective November 2026 · source
Continued use, every 12 months: "Achieved and maintained 5% or greater weight loss after starting tirzepatide (Zepbound)."
Kaiser Permanente Northwest Region, Criteria for tirzepatide (Zepbound) Coverage, effective November 2026 · source
Foundayo: "Patient has failed an adequate trial^ of semaglutide (Ozempic/Wegovy) or has an allergy, intolerance, or contraindication to semaglutide (Ozempic/Wegovy)."
Kaiser Permanente Northwest Region, Criteria for orforglipron (Foundayo) Coverage, effective July 2026 · source
What these documents cannot tell you
Everything above is what Kaiser Permanente Northwest 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 Northwest region's rules. Kaiser's other regions publish their own, and six of them have their own page here.
- Whether your plan includes weight-loss drugs at all isn't in these sheets. Kaiser tells members to call Pharmacy Services in their home region to confirm it.
- The Wegovy and Zepbound sheets take effect November 5, 2026. Until then an earlier version applies, and it wasn't posted where we could read it.
- None of this is legal or medical advice. Your plan documents and your notice govern your case.
Where this comes from
- Kaiser Permanente Northwest Region, Criteria for tirzepatide (Zepbound) Coverage, effective November 2026 — Open the document
- Kaiser Permanente Northwest Region, Criteria for semaglutide injectable (Wegovy, Wegovy HD) Coverage, effective November 2026 — Open the document
- Kaiser Permanente Northwest Region, Criteria for orforglipron (Foundayo) Coverage, effective July 2026 — Open the document
Where to go next
- How employer and commercial plans treat GLP-1s
- When a weight-loss exclusion doesn't block every use
- What Foundayo costs, and who will pay for it
- How to appeal a commercial or employer plan denial
- Kaiser Permanente Mid-Atlantic's criteria
- Every carrier we have read
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 Northwest publishes. It is not affiliated with Kaiser Foundation Health Plan of the Northwest, and your own plan documents and your own notice govern your case. Policies carry effective dates and change — read the sources before you act.