Coverage at a glance
| Indication | Coverage |
|---|---|
| Type 2 diabetes | Covered with prior authorization |
Plan type: Commercial non-Medicare. Each indication below lists the BMI and clinical thresholds, the prior-authorization documentation, and the published policy it comes from.
This varies by plan. Weight-loss coverage of GLP-1 drugs is elected by the employer or plan, not standard. Under Kaiser Northwest's earlier criteria, Ozempic was covered for weight loss only for members whose plan included coverage for weight-loss medications; the current criteria, effective 07/01/26, include only type 2 diabetes pathways. Type 2 diabetes coverage does not depend on this election.
Coverage by indication
| Step therapy |
What the prior authorization needs:
- Prior authorization required through Kaiser's Criteria-Based Consultation Prescribing Program
- Documented type 2 diabetes diagnosis
- No personal or family history of medullary thyroid carcinoma or MEN 2
- On maximally tolerated metformin, or intolerance or contraindication to it
- Trial of at least two added diabetes drugs (sulfonylurea, pioglitazone, or an SGLT2 inhibitor) and, in most pathways, liraglutide
- A1C or glucose management indicator still above 6.9% after an adequate 3-month trial
- Quantity limits apply
Source: Injectable semaglutide (Ozempic): Criteria for Drug Coverage, Kaiser Permanente Northwest Region. payer_policy. Verified August 27, 2026.
Recent change: Kaiser Northwest's commercial criteria for Ozempic effective 07/01/26 list only type 2 diabetes pathways. An earlier version effective 11/06/25 also included a chronic weight management pathway, limited to members whose plan covered weight-loss drugs.
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.
What it costs without insurance
The programs below bill you directly. Prices checked every Monday.
Frequently asked questions
Does Kaiser cover Ozempic?
Kaiser Permanente covers Ozempic for type 2 diabetes, but only after prior authorization through its Criteria-Based Consultation Prescribing Program. Approval requires a documented type 2 diabetes diagnosis and step therapy, usually a trial of metformin plus other diabetes drugs, with A1C still above target. Kaiser does not cover Ozempic for weight loss under the standard pharmacy benefit. Wegovy is the same semaglutide at a higher dose and is the version FDA-approved for weight loss. The criteria here are Kaiser Permanente Northwest's. Criteria and formulary status are set by region, so details can differ across Kaiser's California, Colorado, Mid-Atlantic, Georgia, Hawaii, and Washington plans. This reflects the published policy verified August 2026.
What does Kaiser require to approve Ozempic?
For type 2 diabetes: true
Why might Kaiser deny Ozempic even if I meet the criteria?
Weight-loss coverage of GLP-1 drugs is elected by the employer or plan, not standard. Under Kaiser Northwest's earlier criteria, Ozempic was covered for weight loss only for members whose plan included coverage for weight-loss medications; the current criteria, effective 07/01/26, include only type 2 diabetes pathways. Type 2 diabetes coverage does not depend on this election.
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.
