Coverage at a glance
| Indication | Coverage |
|---|---|
| Obesity / chronic weight management (Wegovy and Zepbound) | Covered with PA |
| Obstructive sleep apnea (Zepbound, SURMOUNT-OSA indication) | Covered with PA |
| Cardiovascular risk reduction (Wegovy, SELECT indication) | Covered with PA |
Plan type: Commercial employer group and individual and family 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. Policy IP0206 states that a customer's benefit plan document "always supersedes the information in the Coverage Policies" and that weight-loss medications are specifically excluded under many benefit plans, employer groups and individual and family plans alike. Check the prescription drug section of your summary plan description first, then the criteria. Express Scripts, part of Cigna's Evernorth arm, is the pharmacy benefit manager for most Cigna commercial plans.
Coverage by indication
| BMI threshold | Baseline BMI 30 or higher, or baseline BMI 27 or higher with at least one weight-related comorbidity: hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cardiovascular disease, knee osteoarthritis, asthma, chronic obstructive pulmonary disease, metabolic dysfunction-associated steatotic liver disease or non-alcoholic fatty liver disease, polycystic ovarian syndrome, or coronary artery disease. Baseline means before any GLP-1 or GLP-1/GIP agonist. |
| Step therapy | No trial of another weight-loss drug is required. The policy requires a trial of behavioral modification and dietary restriction for at least 3 months, and that the medication be used alongside behavioral modification and a reduced-calorie diet. |
| Continuation | 5 percent or more loss of baseline body weight |
| Authorization length | 8 months initial, 1 year continuation, for both Wegovy and Zepbound |
What the prior authorization needs:
- Your plan must include the weight-loss drug benefit, because the policy states these medications are specifically excluded under many benefit plans
- Age 18 or older
- At least 3 months of behavioral modification and dietary restriction
- Documented baseline BMI within the threshold, measured before any GLP-1 or GLP-1/GIP agonist
- Comorbidity documentation when baseline BMI is 27 to 29.9
- No concurrent use with another GLP-1 or GLP-1/GIP agonist
Policy IP0206. Source: Cigna Drug Coverage Policy IP0206, Weight Loss: Glucagon-Like Peptide-1 Agonists BMI 30, effective June 1, 2026. Official payer coverage policy PDF (downloaded from static.cigna.com and read in full, 29 pages). Verified August 15, 2026.
| BMI threshold | Baseline BMI 30 or higher |
| Sleep study (AHI) | Apnea-hypopnea index of 15 or more events per hour on a sleep study, which the policy defines as moderate OSA, with 30 or more defined as severe |
| Step therapy | None. The policy does not require documented PAP failure or a sleep specialist. |
| Continuation | After at least 1 year of therapy: 10 percent or more loss of baseline body weight, plus prescriber-reported stability in obstructive sleep apnea signs or symptoms such as snoring, excessive daytime sleepiness or fatigue |
| Authorization length | 1 year initial, 1 year continuation |
What the prior authorization needs:
- Age 18 or older
- Baseline BMI 30 or higher
- Sleep study documenting moderate to severe OSA with an apnea-hypopnea index of 15 or more
- No central sleep apnea and no Cheyne-Stokes respiration
- Used alongside behavioral modification and a reduced-calorie diet
Policy IP0206. Source: Cigna Drug Coverage Policy IP0206, Weight Loss: Glucagon-Like Peptide-1 Agonists BMI 30, effective June 1, 2026. Official payer coverage policy PDF (downloaded from static.cigna.com and read in full, 29 pages). Verified August 15, 2026.
| BMI threshold | Baseline BMI 27 or higher |
| Cardiovascular criteria | One of the following: prior myocardial infarction, prior stroke (the policy expressly excludes transient ischemic attack), or a history of symptomatic peripheral arterial disease evidenced by intermittent claudication with an ankle-brachial index below 0.85, a peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease. |
| Step therapy | None. The medication must be used in combination with optimized pharmacotherapy for established cardiovascular disease, per the prescriber. |
| Authorization length | 1 year |
What the prior authorization needs:
- Age 18 or older
- Baseline BMI 27 or higher
- Documented prior heart attack, prior stroke, or symptomatic peripheral arterial disease
- Prescriber confirms use alongside optimized cardiovascular pharmacotherapy
- Used alongside behavioral modification and a reduced-calorie diet
Policy IP0206. Source: Cigna Drug Coverage Policy IP0206, Weight Loss: Glucagon-Like Peptide-1 Agonists BMI 30, effective June 1, 2026. Official payer coverage policy PDF (downloaded from static.cigna.com and read in full, 29 pages). Verified August 15, 2026.
Recent change: The current version of IP0206 took effect June 1, 2026 and now covers six agents: Foundayo (orforglipron), liraglutide (Saxenda and generic), Wegovy injection, Wegovy HD injection, Wegovy tablet and Zepbound. Prior authorization is required for all six.
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.
- Browse the prior-authorization letter library for a template that matches your plan and indication.
- Read the full coverage picture, denial reasons, and the four appeal pathways at GLP-1 insurance coverage.
- If the prior-authorization request is denied, the appeal letter library has templates by denial reason, covering peer-to-peer review, Level 1 and Level 2 internal appeal, and external review.
- 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. Some participants get a placebo, decided at random.
Frequently asked questions
Does Cigna cover Wegovy for weight loss?
Under Cigna's national coverage policy IP0206, effective June 1, 2026, Wegovy is approved for adults 18 and older who have engaged in a trial of behavioral modification and dietary restriction for at least three months and who had a baseline BMI of 30 or higher, or 27 or higher with a weight-related comorbidity. Initial approval is 8 months. Continuation is approved for one year and requires 5 percent loss of baseline body weight. The catch is on page one of the same policy: weight-loss medications are specifically excluded under many benefit plans, and the plan document supersedes the policy. Confirm the benefit exists before you count on the criteria.
Does Cigna cover Zepbound?
The criteria are identical to Wegovy's under IP0206: age 18 or older, at least three months of behavioral modification and dietary restriction, and a baseline BMI of 30 or higher, or 27 or higher with a listed comorbidity. Initial approval is 8 months, continuation is one year and requires 5 percent loss of baseline body weight. Zepbound also has a separate sleep-apnea pathway approved for one year, which requires BMI 30 or higher and a sleep study showing an apnea-hypopnea index of 15 or more, and excludes central sleep apnea and Cheyne-Stokes respiration. Continuation on the sleep-apnea pathway is stricter than on the weight pathway: 10 percent weight loss plus prescriber-reported stability in sleep apnea signs or symptoms.
What BMI does Cigna require for GLP-1 coverage?
Baseline BMI of 30 or higher, or baseline BMI of 27 or higher with at least one weight-related comorbidity. Cigna's comorbidity list in IP0206 is unusually broad and worth reading before you assume you do not qualify. It names hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cardiovascular disease, knee osteoarthritis, asthma, chronic obstructive pulmonary disease, metabolic dysfunction-associated steatotic liver disease or non-alcoholic fatty liver disease, polycystic ovarian syndrome, and coronary artery disease. Baseline means BMI before you started any GLP-1 or GLP-1/GIP agonist, so weight already lost on a prior drug does not disqualify you.
Does Cigna require step therapy before approving Wegovy or Zepbound?
Cigna's national policy IP0206 does not require a documented failure of phentermine, orlistat or any other older weight-loss drug before approving Wegovy or Zepbound. What it requires instead is a three-month trial of behavioral modification and dietary restriction, and that the medication be used alongside behavioral modification and a reduced-calorie diet. That is the national framework. Cigna publishes separate policies that alter prior authorization, quantity limits and benefit exclusions for particular plan designs, so an individual employer plan can be stricter. Confirm against your own plan documents rather than assuming the national policy applies unchanged.
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; those rows are marked lower confidence. Commercial coverage often depends on whether an employer elected the weight-management benefit. 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.
