Coverage at a glance
| Indication | Coverage |
|---|---|
| Obesity / chronic weight management (commercial, subject to the benefit exclusion flag) | Varies by plan |
| Commercial drug list changes (California lists narrowing, national lists adding Wegovy tablet) | Varies by plan |
| Weight loss (Anthem Blue Cross Medi-Cal, California Medicaid) | Not covered |
If your plan denies coverage, two cash programs to check.
No insurance needed.
- Strut Health$149 a month, with auto-refillcompounded semaglutideCheck price →You pick Weight Loss, then a five-minute online visit
- Shed$199 a monthcompounded semaglutideCheck price →Every medication is listed with a starting price
Cheapest GLP-1 without insurance compares the three cash routes. Cheapest GLP-1 ranks every cash price on the chart.
Prior authorization: the plan reviews the prescription before it pays. Non-formulary: not on the plan's covered-drug list, so it takes an exception.
Yes on some plans, and Anthem flags this on the drug list itself. Wegovy and Zepbound both sit at Tier 2 on Anthem's commercial drug lists. Both carry three codes: PA, QL and BE. BE is Anthem's code for a benefit exclusion, and its own code list adds "This drug may not be covered depending on your plans design." Anthem does not publish the rules it applies to a commercial request for these two drugs. So we cannot show you a sourced BMI number. This answer covers Commercial job-based and individual plans across the Anthem and Elevance states.
Source: Anthem Blue Cross National Drug List, Three Tier Drug Plan (DMHC filing, last updated January 1, 2025), anti-obesity GLP-1 and GIP/GLP-1 receptor agonist entries and the drug list code legend. Checked August 15, 2026.
Where your plan lists it. Anthem's National Drug List for three-tier plans, effective January 1, 2025, puts Wegovy and Zepbound on tier 2 and marks both BE, its benefit exclusion code, so a plan that excludes weight-loss drugs covers neither. Anthem's California list, effective September 1, 2026, drops Wegovy and puts the Zepbound auto-injector on tier 3. Source: Anthem Essential Drug List, Three Tier Drug Plan, California DMHC fully insured. Checked September 6, 2026.
What it costs once they say yes. With commercial insurance the manufacturer savings card takes Wegovy or Zepbound to as little as $25 a month. Your plan sets the copay before the card applies. What Wegovy costs with your plan. What Zepbound costs with your plan.
This varies by plan. Wegovy and Zepbound both carry the BE code. BE is Anthem's code for a benefit exclusion, and it means the drug may not be covered, depending on how your plan is built. The PA code beside it means the plan has to sign off, on plans where the benefit does exist. Anthem tells members to log in to the member portal, or use the Sydney app, to price the drug and read the plan documents. Do that before you read Tier 2 as covered.
One BCBS company, not all. Anthem Blue Cross and Blue Shield is the Elevance Health group of Blue plans. It runs in 14 states. They are California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. Other Blue Cross Blue Shield companies are separate licensees and write their own policies. So nothing on this page applies to Highmark, to Premera, to BCBS of South Carolina, or to the other independent Blues. Anthem's own drug lists also differ by state filing. The California-filed lists have moved away from these drugs faster than the national ones.
Coverage by indication
Anthem's published commercial drug lists put Zepbound and Wegovy at Tier 2, and Saxenda at Tier 3. Each is marked PA; BE; QL. The same document defines the codes. "PA = prior authorization. You may need to get benefits approved before certain prescriptions can be filled" and "BE = benefit exclusion. This drug may not be covered depending on your plans design." The same Tier 2 and the same three codes show up on the California-filed National Drug List Three Tier and on the non-California Anthem Blue Cross and Blue Shield Traditional Open Three Tier list. So the benefit-exclusion flag is a group-wide practice, and not a quirk of one state. What Anthem does not publish is the clinical criteria behind that sign-off. We could not find a BMI number, a list of qualifying conditions, a length of lifestyle trial, or a rule for renewing, in any public Anthem document.
| Step therapy | Not published. Anthem's commercial drug lists show a PA code on both drugs, and no ST code. That points to a sign-off with no formal step-therapy rule on these list versions. |
What the prior authorization needs:
- Prior authorization is required, per the PA code on Anthem's drug lists
- Your plan design must include the benefit, per the BE benefit-exclusion code on the same lists
- Quantity limit of one pen per week applies to both Wegovy and Zepbound
- Anthem directs members to the member portal or the Sydney app to price the medication and confirm coverage
Source: Anthem Blue Cross National Drug List, Three Tier Drug Plan (DMHC filing, last updated January 1, 2025), anti-obesity GLP-1 and GIP/GLP-1 receptor agonist entries and the drug list code legend. Anthem's own drug list PDF, reached from the Drug List Selection page at anthem.com and hosted by its formulary vendor. Lower confidence: the policy file would not open at the payer's own address, so the policy number and rules were checked against a second source.
Anthem's commercial drug list change log records the following. On July 1, 2025 Wegovy went from Tier 2 to non-formulary on the four lists filed in California. They are the California CDI National Drug List, the California DMHC National Drug List, the California CDI Essential Drug List and the California DMHC Essential Drug List. Zepbound went from Tier 2 to Tier 3 on those same four lists, on the same day. On October 1, 2026 the Zepbound Standard Pen goes from Tier 3 to non-formulary on the two California DMHC lists. It does not change on the National Drug List, on the National Direct lists, on the Traditional Open Drug List or on the Essential Drug List. The Zepbound KwikPen was added at Tier 2 on those two California DMHC lists on August 1, 2026. On December 23, 2025 the Wegovy tablet went from non-formulary to Tier 2. That covers the National Drug List, the National Direct, National Direct Plus and National Direct Preferred lists, the Essential Drug List and the Essential Direct Drug List. On the Traditional Open Drug List it went from Tier 3 to Tier 2 the same day. The four California lists did not change. Saxenda and generic liraglutide have moved back and forth across 2025 and 2026.
| Effective date | October 1, 2026 |
Source: Anthem Formulary Update, rolling quarterly commercial drug list changes (Q4 2026 back through 2025), published at anthem.com. Anthem's own drug list change log PDF, downloaded from anthem.com.
Anthem Blue Cross put out a Medi-Cal notice to providers on November 14, 2025. It said Wegovy, Zepbound and Saxenda would come off the Medi-Cal Rx Contract Drugs List on January 1, 2026. From that date they are not eligible for coverage for weight loss. Claims for the three drugs deny with Reject Code 70, product or service not covered, whatever the diagnosis. Approvals already granted expired. Two routes survive. Anthem will still look at a Wegovy request for MASH, where the liver is not yet scarred to cirrhosis, or one for cardiovascular disease. It will still look at a Zepbound request for obstructive sleep apnea. Requests for members under 21 are reviewed for medical necessity under the federal EPSDT benefit. Seven diabetes drugs keep a rule of their own. Each one has to be for type 2 diabetes: Ozempic, Rybelsus, Mounjaro, Victoza, Byetta, Bydureon and Trulicity. Those deny with Reject Code 80 when the diagnosis is missing. This is California Medi-Cal only.
| Effective date | January 1, 2026 |
Source: Anthem Blue Cross, GLP-1 Coverage Considerations, November 14, 2025 (Medi-Cal Rx), document CA-BC-CD-001363-25-S604. Anthem's own provider notice PDF, downloaded from providers.anthem.com and read in full.
Obstructive sleep apnea: the Anthem weight-loss drug policy names no separate route for it. Zepbound's FDA label carries the indication, so ask the plan which policy applies to it.
Recent change: Anthem's own change log shows the four California-filed drug lists pulling back from Wegovy and Zepbound since July 2025. The national lists moved the other way, and added the Wegovy tablet at Tier 2 in December 2025.
Ozempic, Mounjaro and Rybelsus on Anthem plans
Ozempic, Mounjaro and Rybelsus are approved for type 2 diabetes, not weight loss.
Does Anthem cover Ozempic?
Yes, with prior approval. Anthem pays for Ozempic once your prescriber gets the plan to sign off.
Anthem commercial plans cover Ozempic for type 2 diabetes once the plan signs off. One published Anthem prescribing policy asks for a documented type 2 diabetes diagnosis. It then asks for a trial of metformin, or a reason metformin is not safe for you, or a history of heart or artery disease caused by plaque. The policy calls that last one atherosclerotic cardiovascular disease. The exact criteria and the drug list still vary by employer plan. Anthem will not cover Ozempic for weight loss. Its member benefits generally leave weight-loss drugs out, and the FDA approved Ozempic for type 2 diabetes only. Wegovy is the same medicine, semaglutide, at a higher dose approved for weight loss, and it sits under separate weight-loss coverage rules.
Checked August 27, 2026.
What Anthem requires for Ozempic
| Step therapy | Required |
What the prior authorization needs:
- Documented diagnosis of type 2 diabetes
- A trial of metformin that did not work well enough, or that you could not tolerate, or a contraindication to metformin, or a history of heart or artery disease caused by plaque (atherosclerotic cardiovascular disease, or ASCVD)
- Prior authorization approved before the pharmacy claim will pay
- Not approved for weight loss. Anthem member benefits generally exclude weight-loss drugs, and Ozempic is FDA-approved for type 2 diabetes only
Source: Anthem policy KYBCBS-CM-025647-23. The plan's own bulletin to providers. Lower confidence: the policy file would not open at the payer's own address, so the policy number and rules were checked against a second source.
Does Anthem cover Mounjaro?
Yes, with prior approval. Anthem pays for Mounjaro once your prescriber gets the plan to sign off.
Anthem covers Mounjaro for type 2 diabetes once the plan signs off. A quantity limit applies. On one 2025 Anthem drug list the medicine sits on Tier 2, which costs more than a generic, but the tier varies by employer plan. Anthem will not cover Mounjaro for weight loss, because the FDA approved it for type 2 diabetes only. The weight-loss version of the same drug, tirzepatide, is Zepbound. Anthem looks at Zepbound under a different policy, one written for weight loss.
Checked August 27, 2026.
What Anthem requires for Mounjaro
| Step therapy | Not required |
What the prior authorization needs:
- The plan has to sign off before it covers Mounjaro.
- Quantity limit applies.
- Placed on Tier 2 (higher cost share than Tier 1).
Source: Anthem 2025 Select Drug List (Four Tier), Maine, effective 12/01/2025. The plan's own covered-drug list. Lower confidence: the policy file would not open at the payer's own address, so the policy number and rules were checked against a second source.
Does Anthem cover Rybelsus?
Yes, with prior approval. Anthem pays for Rybelsus once your prescriber gets the plan to sign off.
Anthem commercial plans cover Rybelsus for type 2 diabetes once the plan signs off. Anthem's published commercial prescribing policy asks for a documented type 2 diabetes diagnosis. It then asks for a trial of metformin, or a reason metformin is not safe for you, or a history of heart or artery disease caused by plaque. The policy calls that last one atherosclerotic cardiovascular disease. The exact criteria and the covered drug list still vary by employer plan. Anthem will not cover Rybelsus for weight loss. Its member benefits generally leave weight-loss drugs out, and the FDA approved Rybelsus for type 2 diabetes only. Wegovy is the semaglutide approved for weight loss, and it sits under separate weight-loss coverage rules.
Checked August 28, 2026.
What Anthem requires for Rybelsus
| Step therapy | Required |
What the prior authorization needs:
- Documented diagnosis of type 2 diabetes
- A trial of metformin that did not work well enough, or that you could not tolerate, or a contraindication to metformin, or a history of heart or artery disease caused by plaque (atherosclerotic cardiovascular disease, or ASCVD)
- Prior authorization approved before the pharmacy claim will pay
- Not approved for weight loss. Anthem member benefits generally exclude weight-loss drugs, and Rybelsus is FDA-approved for type 2 diabetes only
Source: Anthem policy KYBCBS-CM-025647-23. The plan's own bulletin to providers. Lower confidence: the policy file would not open at the payer's own address, so the policy number and rules were checked against a second source.
What to do next
If you qualify under one of the covered indications above, prior authorization is the path. Match the documentation in the requirements list then have your prescriber submit it. Plans that approve reassess at renewal, so know your long-term maintenance dose before you start.
- Start with the Anthem prior-authorization letter template, which cites this plan's policy and the diagnosis codes a reviewer looks for. Pick the indication that matches your clinical picture.
- Read why plans say no and the four ways to appeal in the GLP-1 insurance guide.
- Your plan may treat another GLP-1 differently. The Anthem coverage check lists all 4, with the source for each.
- If the plan denies it, the appeal letter library has a template for each reason a plan gives. That covers the peer-to-peer call with a plan doctor, the Level 1 and Level 2 appeals inside the plan, and the outside review that follows them.
- Call the number on your insurance card and ask whether your specific plan includes the weight-management drug benefit before you submit.
- If your plan does not cover the indication you need, compare cash prices in the cost guide or check whether a clinical trial near you fits. Neither one goes through your insurer. Clinical trials cost nothing and many pay you for your time.
What it costs without insurance
The programs below bill you directly. Prices checked every Monday.
Frequently asked questions
Does Anthem cover Wegovy for weight loss?
Wegovy appears on Anthem's commercial drug lists at Tier 2, under the heading anti-obesity GLP-1 receptor agonists, with three codes attached: PA for prior authorization, QL for a quantity limit of one pen per week, and BE for benefit exclusion. Anthem defines BE as meaning the drug may not be covered depending on your plan's design. Wegovy is on the list and prior authorization is required. Whether your employer plan covers the category at all is a separate question, and only your plan documents answer it. Anthem does not publish the clinical criteria it applies to commercial prior-authorization requests for Wegovy, so we cannot cite a BMI threshold from an Anthem source.
Does Anthem cover Zepbound?
Zepbound appears at Tier 2 on Anthem's commercial drug lists under the heading anti-obesity GIP and GLP-1 receptor agonists, with the same three codes as Wegovy: PA, QL at one pen per week, and BE for benefit exclusion. The picture is moving in California. Anthem's change log shows Zepbound going from Tier 2 to Tier 3 on the four California-filed drug lists effective July 1, 2025, then Zepbound Standard Pen moving from Tier 3 to non-formulary on the two California DMHC lists effective October 1, 2026, with Zepbound KwikPen added to those lists at Tier 2 effective August 1, 2026. If you are a California Anthem member on the Standard Pen, that is a change worth calling about before October.
What BMI does Anthem require for GLP-1 coverage?
We cannot answer this from an Anthem source, and we would rather say so than repeat a number we cannot check. Anthem's public Clinical Criteria library covers drugs billed under the medical benefit, meaning injected, infused or implanted products administered in a clinical setting. Wegovy and Zepbound are self-administered pharmacy-benefit drugs, and their commercial prior-authorization criteria are not published on Anthem's public site. Several third-party sites state that Anthem uses BMI 30, or 27 with a comorbidity. That matches what most commercial plans do, but no Anthem-published document confirms it, so we have not put it on this page. Ask your prescriber to pull the current criteria through the Anthem provider portal, or call the pharmacy member services number on your card.
Does Anthem cover GLP-1s for weight loss on Medicaid?
In California, no, as of January 1, 2026. Anthem Blue Cross published a Medi-Cal notice stating that Wegovy, Zepbound and Saxenda were removed from the Medi-Cal Rx Contract Drugs List effective that date and are no longer eligible for coverage for weight loss. Claims deny with Reject Code 70, product or service not covered, regardless of indication, and previously approved prior authorizations expired. Two exceptions survive: prior authorization is still considered for Wegovy when used for noncirrhotic MASH or cardiovascular disease, and for Zepbound when used for obstructive sleep apnea. Members under 21 are reviewed for medical necessity under the federal EPSDT benefit. This is California Medi-Cal only and does not describe Anthem Medicaid plans in other states.
Does Anthem cover Zepbound for sleep apnea?
The Anthem weight-loss drug policy names no separate obstructive sleep apnea route. Zepbound's FDA label carries the sleep apnea indication, so ask the plan which policy applies to it. Source: Anthem Blue Cross National Drug List, Three Tier Drug Plan (DMHC filing, last updated January 1, 2025), anti-obesity GLP-1 and GIP/GLP-1 receptor agonist entries and the drug list code legend, read August 2026.
Coverage for other payers
See the full payer coverage index for every plan we have sourced.
How we built this page
Every page here comes from the payer's own policy, a federal law, or KFF's plan research. Each row links its source and gives the date we read it. Some plan files load at the address the payer gives but will not open. We check those against a second source and mark the row lower confidence. Job-based plans also choose whether to add the weight-drug benefit at all, so those rows say varies by plan rather than a flat yes.
This is reference information, not medical or legal advice, and not a guarantee of coverage. GLP-1 coverage policies change often. Always confirm the current policy with your insurer using the number on your card before you rely on this page. If your experience differs from what is shown here, email hello@glpchart.com with the details and we will re-verify.
