Coverage at a glance
| Indication | Coverage |
|---|---|
| Wegovy for cardiovascular risk reduction (SELECT) and MASH | Covered with PA |
| Zepbound for obstructive sleep apnea (SURMOUNT-OSA indication) | Covered with PA |
Plan type: Commercial and ACA marketplace. Each indication below lists the BMI and clinical thresholds, the prior-authorization documentation, and the published policy it comes from.
Coverage by indication
Oscar's published clinical guidelines list Wegovy under the cardiovascular risk reduction and MASH indications (PG194, Version 6), not under general obesity. Oscar excludes weight loss as a standalone covered indication on its listed pharmacy clinical guidelines.
What the prior authorization needs:
- Established cardiovascular disease for the cardiovascular indication, per SELECT criteria
- MASH diagnosis documented by imaging or biopsy for the MASH indication
- Prior authorization, with clinical guideline PG194 Version 6 applying
Source: Oscar Health, Clinical Guidelines: Pharmacy. Official payer clinical guidelines index page (HTML, fetched directly). Verified June 12, 2026.
Oscar lists a separate New York specific policy (PG276) for Zepbound OSA, reflecting New York's rule that insurers not impose step therapy for FDA-approved indications. The general PG255 applies in other states.
| BMI threshold | BMI 30 or higher |
What the prior authorization needs:
- OSA diagnosis, moderate to severe
- Obesity, BMI 30 or higher
- Prior authorization, with clinical guideline PG255 Version 4, and the New York specific PG276 Version 2, applying
Source: Oscar Health, Clinical Guidelines: Pharmacy. Official payer clinical guidelines index page (HTML, fetched directly). Verified June 12, 2026.
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 Oscar Health 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.
- 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 Oscar Health cover Wegovy and Zepbound?
It depends on the indication. Oscar Health covers Wegovy for cardiovascular risk and MASH, and Zepbound for sleep apnea, all with prior authorization. Oscar's listed clinical guidelines do not cover weight loss as a standalone indication. This reflects the published policy verified June 2026.
What does Oscar Health require to approve Wegovy and Zepbound?
For wegovy for cardiovascular risk reduction (SELECT) and MASH: Prior authorization is required, with the documentation listed in the requirements above.
Is Wegovy and Zepbound covered for weight loss under Oscar Health?
Coverage depends on the indication. Weight loss alone may be excluded while a related medical indication is covered. Each indication and its rule are listed above with the source.
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.
