Your BMI dropped and the plan wants to stop. What renewal requires
The drug worked, the weight came off, and now the renewal is the thing that decides whether you keep it. What 6 insurers put in writing about continuing a GLP-1, and what to send before the approval expires.
Every published renewal rule we have read measures the weight lost since therapy started, not the BMI the member has today. That is 6 insurers, and each one that publishes a weight-management rule states its bar as a percentage of starting weight. The table below carries the wording, the policy number and the date we read it.
What to send, in order
- Find your baseline weight in the record. Renewal is measured against the weight on the day therapy started, so that number has to be in the chart your prescriber submits. If it is missing, the plan has nothing to compare against and the request fails on paperwork rather than on merit.
- Read your own plan's renewal criterion. It is not the same test as the initial approval, and several policies say so explicitly. One in the table below renews on the initial criteria apart from the baseline BMI requirement.
- Send weight loss achieved and maintained, not current BMI. A percentage of baseline lost is the number nearly every published rule asks for. Few of them mention current BMI at all.
- If it is refused anyway, appeal on the criterion. The appeal library carries a letter per denial reason, and the strongest ones quote the plan's own renewal wording back at it.
What each insurer publishes for renewal
15 published renewal rules across 6 insurers, each read off that insurer's own policy document.
| Insurer | Drug and indication | What renewal requires | Source |
|---|---|---|---|
| Aetna | ZepboundObesity / weight management (FE-Compatible plans) | At least 5 percent loss of baseline body weight within the first 3 months of therapy | Policy 6947-C P04-2025Read June 18, 2026 |
| Ambetter | Wegovy and ZepboundCardiovascular risk reduction (Wegovy, SELECT indication) | First renewal requires at least 5 percent loss of baseline body weight. Second and later renewals require that the member has lost weight and/or maintained weight loss on therapy. | Policy CP.PMN.295Read August 15, 2026 |
| Ambetter | Wegovy and ZepboundMetabolic dysfunction-associated steatohepatitis (Wegovy injection) | After at least 12 months on the drug, one of three. Fibrosis improved by at least 1 stage with no worsening of MASH. Or MASH resolved with no worsening of fibrosis. Or no rise in fibrosis stage and no worsening of MASH from baseline. | Policy CP.PMN.295Read August 15, 2026 |
| Ambetter | Wegovy and ZepboundObesity / chronic weight management (California, Ambetter from Health Net) | First renewal requires at least 5 percent loss of baseline body weight. | Policy HNCA.CP.CPA.352 (Wegovy) and HNCA.CP.CPA.359 (Zepbound)Read August 15, 2026 |
| Ambetter | Wegovy and ZepboundObstructive sleep apnea (Zepbound, SURMOUNT-OSA indication) | First renewal needs at least 5 percent loss of baseline body weight, plus one measured sleep result. That can be a lower apnea-hypopnea index than at the start. Or a better score on the sleep apnea-specific hypoxic burden. Or a better score on a sleep-related patient reported outcome. Later renewals need weight lost or kept off, plus one of those three holding steady or improving. | Policy CP.PMN.298Read August 15, 2026 |
| Cigna | Wegovy and ZepboundObesity / chronic weight management (Wegovy and Zepbound) | 5 percent or more loss of baseline body weight | Policy IP0206Read August 15, 2026 |
| Cigna | Wegovy and ZepboundObstructive sleep apnea (Zepbound, SURMOUNT-OSA indication) | 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 | Policy IP0206Read August 15, 2026 |
| Kaiser Permanente | Wegovy and ZepboundObesity / chronic weight management (Kaiser Permanente Mid-Atlantic States) | Documented weight loss of at least 5 percent from baseline within the previous 3 months | Plan documentsRead August 15, 2026 |
| Kaiser Permanente | Wegovy and ZepboundObesity / chronic weight management (Kaiser Permanente Northwest) | Updated weight and BMI documented, and 5 percent or greater weight loss achieved and maintained since starting the drug | Plan documentsRead August 15, 2026 |
| Kaiser Permanente | Wegovy and ZepboundObstructive sleep apnea (Kaiser Permanente Northwest) | Updated weight and BMI documented, and 5 percent or greater weight loss achieved and maintained since starting the drug | Plan documentsRead August 15, 2026 |
| Kaiser Permanente | Wegovy and ZepboundObstructive sleep apnea (Zepbound, Kaiser Permanente Mid-Atlantic States) | Continues to meet the initial criteria apart from the baseline BMI requirement, and none of the listed reasons for non-coverage apply | Plan documentsRead August 15, 2026 |
| Molina | Wegovy and ZepboundMorbid obesity, Class III (California marketplace only) | At least 10 percent of baseline body weight lost, or kept off. The prescriber also has to confirm the member is sticking with a formalized weight management program. An authorization past 12 months of continuous Saxenda or Wegovy therapy needs documented weight maintenance and continued program participation. The policy sets a hard stop too. If the member has not lost at least 10 percent of baseline body weight by week 24, the drug must be stopped. | Policy C28425-ARead August 15, 2026 |
| Molina | Wegovy and ZepboundObesity and morbid obesity (New Mexico marketplace only) | Not published. Molina's Wegovy and Zepbound criteria documents send a New Mexico request off to a policy of its own. It is called Weight Management Therapy NM MMKP C29220-A. Molina does not publish it on the New Mexico provider drug criteria index. | Plan documentsRead August 15, 2026 |
| UnitedHealthcare | Wegovy and ZepboundObesity / chronic weight management (plans that elected weight-loss coverage) | You lose 5 percent or more of the body weight you started with, and you keep up the lifestyle change | Policy 2026 P 1114-21Read August 15, 2026 |
| UnitedHealthcare | Wegovy and ZepboundObstructive sleep apnea (Zepbound, plans without weight-loss coverage) | Under 52 weeks on the drug, any documented drop from baseline in the AHI, RDI or REI. At 52 weeks or more, a drop of 50 percent from baseline. Either way you also have to have lost 10 percent of your starting body weight. | Policy 2025 P 1475-2Read August 15, 2026 |
One policy in that table runs the other way, and stops the drug if too little weight has come off by a set week.
Where nothing is published
Not every plan publishes a renewal criterion, and one row above says so rather than guessing. If yours is one of them, ask the plan in writing for the continuation criteria before the current approval expires, and ask which document they come from.
Questions people ask at renewal
My BMI is now under 30. Does the plan have to stop?
Not on the published rules we have read. Renewal criteria are written around weight lost from baseline rather than the BMI reached, and one policy in the table above renews on the initial criteria apart from the baseline BMI requirement. Read your own plan's wording before you accept a refusal that cites your current BMI.
How much weight do plans want to see?
Five percent of starting body weight is the most common bar in the policies we have read, and some indications ask for more or add a clinical measure alongside it. The table above gives each rule in the insurer's own words with the document it comes from.
How long does an approval last?
Plans publish their own authorization period, and six or twelve months are both common. The renewal is a separate request against a separate criterion, so it is worth reading the continuation wording well before the current approval runs out.
What if the plan refuses the renewal?
You appeal on the criterion, and if that fails the cash routes are what is left. The cheapest verified all-in route on our chart is $76 a month, checked October 19, 2026.