Commercial
Employer coverage is mostly a function of how big your employer is. Large employers cover these drugs far more often than small ones.
If your plan does cover them, expect prior authorization with a BMI floor, a documented lifestyle attempt, and a weight-loss target you have to hit to keep the coverage.
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 · read August 2026
Among firms with 200 or more workers that cover these drugs for weight loss, 34% require enrollees to meet with a dietitian, case manager or therapist, or to join a lifestyle program for the drug to be covered.
KFF Employer Health Benefits Survey, effective October 2025 · source · read August 2026
Cigna's published criteria require a trial of behavioral modification and dietary restriction for at least three months, plus a baseline BMI of 30 or more, or 27 or more with a weight-related condition. Continuing coverage requires documented weight loss: at least 5% of baseline for Wegovy, Zepbound and Foundayo, and at least 4% for Saxenda.
Cigna, effective revised through April 2026 · source · read August 2026
UnitedHealthcare publishes the same BMI structure, with reauthorization requiring 5% weight loss for Wegovy and an initial six-month authorization for Zepbound. Its own document calls this an optional program that applies only where the employer elected to cover weight-loss products, which is why your colleague at another company can get a different answer.
UnitedHealthcare, effective September 2026 · source · read August 2026
Do not assume one BMI number applies to you. The same insurer publishes different floors for different employer benefit options: Cigna publishes both a 30 and a 32 threshold, and UnitedHealthcare's document contains a stricter tier at 40.
Cigna, effective April 2026 · source · read August 2026
Ask member services for the prior authorization policy for GLP-1 weight-management drugs by name. The document exists and they can send it.
Most denials at this stage are for missing documentation of a three-month lifestyle trial, not for your BMI.
You have 180 days from the denial to file an internal appeal, and four months from the final internal denial to request external review.
If the appeal fails, or you cannot wait
Cash-pay telehealth is the fallback, not the bargain: you pay the whole cost yourself, and a covered prescription is almost always cheaper than any of these. Use this route when coverage has actually been exhausted, or when you need to start while an appeal runs.
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Prices in those notes were read from each company's own site in August 2026 and change often. Check the current number before you buy.
Your state's Medicaid posture is in the coverage matrix, and the appeal routes are on the procedures page.