Coverage at a glance
| Indication | Coverage |
|---|---|
| Obesity / chronic weight management | Covered with PA |
Plan type: Commercial employer-sponsored plans. Each indication below lists the BMI and clinical thresholds, the prior-authorization documentation, and the published policy it comes from.
This varies by plan. Cigna's national policy is the framework, but the employer plan document governs whether the weight-management benefit is included. Check your summary of benefits or call the number on your card. Express Scripts is the pharmacy benefit manager for most Cigna commercial plans.
Coverage by indication
| BMI threshold | BMI 30 or higher, or BMI 27 or higher with at least one weight-related comorbidity |
| Step therapy | Step therapy may apply on some plan designs. CVS Caremark now requires Wegovy first on some plans. |
What the prior authorization needs:
- BMI within the threshold
- Prior weight-loss attempts documented
- Ongoing clinical follow-up
- Prior authorization is required for all GLP-1s regardless of indication
- Plan-specific PA criteria apply, because the national policy is a framework and the employer plan document governs
Policy IP0206. Source: Cigna National Formulary, Drug Coverage Policy IP0206: Weight Loss GLP-1 Agonists BMI 30 or higher. Official payer coverage policy PDF (public URL confirmed, binary; policy number and framework confirmed via the search-result title and Cigna policy PDF URLs on static.cigna.com). Verified June 12, 2026. This row is marked lower confidence: the policy document was confirmed at its public URL but served as an unreadable file, so the policy number and framework were cross-checked against secondary sources.
Recent change: Cigna announced in 2025 a $200 per month cap on out-of-pocket cost for qualifying employer plans, and loosened PA requirements for participating employers.
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.
- Start with the Cigna 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 the full coverage picture, denial reasons, and the four appeal pathways at GLP-1 insurance coverage.
- 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-pay options in the cost guide and the cheapest legitimate programs.
Frequently asked questions
Does Cigna cover Wegovy and Zepbound?
It depends on your plan. Cigna covers Wegovy and Zepbound for obesity with prior authorization under policy IP0206, but coverage and the exact PA rules depend on what your employer's plan document includes. This reflects the published policy verified June 2026.
What does Cigna require to approve Wegovy and Zepbound?
For obesity / chronic weight management: The BMI requirement is BMI 30 or higher, or BMI 27 or higher with at least one weight-related comorbidity. Step therapy may apply on some plan designs. CVS Caremark now requires Wegovy first on some plans.
Why might Cigna deny Wegovy and Zepbound even if I meet the criteria?
Cigna's national policy is the framework, but the employer plan document governs whether the weight-management benefit is included. Check your summary of benefits or call the number on your card. Express Scripts is the pharmacy benefit manager for most Cigna commercial plans.
Coverage for other payers
See the full payer coverage index for every plan we have sourced.
How we built this page
Each page is built from a published payer policy document, government statute, or independent formulary analysis (KFF). Every indication row carries the source URL and the date we verified it. Where a payer's policy PDF was confirmed at its public URL but served as an unreadable binary, the policy number and coverage framework were cross-checked against secondary sources and the row is marked lower confidence. Commercial coverage often depends on whether an employer elected the weight-management benefit, 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.
