Which insurance covers Zepbound and Wegovy? The 2026 insurer tracker

The coverage matrix, by insurer and use

Each row is one insurer or pharmacy benefit manager (PBM). Each column is one drug and one use, because plans decide them separately. A cell that says employer option means the drug can be covered for weight loss only if your employer or plan sponsor bought that benefit, usually with prior authorization (PA). Every cell carries its source and the date we checked it. For the Medicaid version of this table, see Medicaid GLP-1 coverage by state.

GLP-1 coverage by insurer, PBM and use, checked Oct 18, 2026

Insurer or PBM	Weight loss status	Wegovy for weight loss	Zepbound for weight loss	Foundayo for weight loss	Wegovy for heart risk	Zepbound for sleep apnea	Ozempic and Mounjaro for type 2 diabetes	Latest change	Plan types	Primary source
UnitedHealthcare / Optum Rx	Employer option [1]	Employer option, PA: BMI 30+ or 27+ with a condition; excluded on standard plans; Wegovy tablets typically excluded [1][5]	Employer option, same PA; excluded on standard plans; KwikPen and vials excluded on Optum Rx Premium list [1][5][12]	Employer option, PA (added May 2026) [1]	Covered on standard plans with PA: prior heart attack, stroke or PAD [5][1]	Covered on standard plans with PA [5]	Covered with PA: type 2 diabetes diagnosis, 12-month approval [13]	Oct 1, 2026: current weight-loss PA program took effect; Optum Rx 2027 Premium list drops brand Saxenda [1][14]	Commercial fully insured and self-funded, only if the employer adds weight-loss coverage; Medicare: CMS Bridge [1][15]	UnitedHealthcare, Oct 1, 2026 [1]
Aetna	Employer option [16]	Employer option, PA: BMI 30+ or 27+ with a condition and 6 months in a weight program; many plans exclude [16][17]	Employer option; back on Caremark template lists Oct 1, 2026 (pens only) [6][18]	Employer option; listed in Aetna specific-states policy [19]	PA in Aetna specific-states policy: established heart disease, BMI 27+ [19]	PA: AHI 15+ and BMI 30+ (Caremark criteria) [18]	Not confirmed	Oct 1, 2026: Zepbound returned to Caremark template formularies [6]	Commercial plans that include the benefit; left ACA exchanges for 2026; Medicare: CMS Bridge [16][20][15]	Aetna, Mar 10, 2026 [16]
CVS Caremark (PBM)	Employer option [6]	Preferred on template lists since Jul 1, 2025; plan sponsor decides [21][22]	Removed Jul 1, 2025; back as a preferred option Oct 1, 2026; plan sponsor decides [21][6]	New-to-market block lifted Jun 1, 2026; plan sponsor decides [6]	PA in default criteria: established heart disease, BMI 27+, no type 2 diabetes [17]	PA in default criteria: AHI 15+ and BMI 30+ [18]	Not confirmed	Oct 1, 2026: Zepbound back as an additional preferred option [6]	Commercial template formularies (about 25 to 30 million people, per CVS); sponsors can customize coverage [23][6]	CVS Health, May 28, 2026 [6]
Cigna	Employer option [2]	Employer option, PA: BMI 30+ or 27+ with a condition after 3 months of lifestyle changes [2]	Employer option, same PA; override plans need BMI 35+ or 27+ with two conditions (from Sep 1, 2026) [2][24]	Employer option, PA: BMI 30+ or 27+ with a condition (Sep 1, 2026) [25]	PA: BMI 27+ and prior heart attack, stroke or PAD [2]	PA: BMI 30+ and AHI 15+; renewal needs 10% loss [24]	Criteria not confirmed; not on Express Scripts 2026 or 2027 exclusion lists [28][26]	Sep 1, 2026: Zepbound override policy (BMI 35+) and Foundayo policy took effect [24][25]	Commercial fully insured and self-funded, by plan design; Cigna's own employee plan dropped coverage Jul 1, 2026; Medicare: CMS Bridge [2][27][15]	Cigna Healthcare, Apr 15, 2026 [2]
Express Scripts (PBM)	Employer option [26]	Listed as a preferred alternative on the 2026 and 2027 exclusion lists, as we read the tables; coverage depends on the plan [28][26]	As we read the lists: pens preferred; vials excluded in 2026; 2027 list also excludes KwikPens [28][26]	Preferred alternative on the 2027 list, as we read it; 2026 status not confirmed [26]	Not confirmed	Not confirmed	Not on the 2026 or 2027 exclusion lists [28][26]	Aug 1, 2026: date on the 2027 exclusion list, which, as we read it, excludes Zepbound KwikPens and vials [26]	National Preferred Formulary clients; the list says not all listed drugs are covered by all plans [26]	Express Scripts, Aug 1, 2026 [26]
Blue Cross Blue Shield	Varies; see plan table [29]	Varies; see plan table [29]	Varies; see plan table [29]	Varies; see plan table [29]	Varies; see plan table [29]	Varies; see plan table [29]	Varies; see plan table [29]	Jan 1, 2026: BCBS Massachusetts (as plans renew, unless the employer buys a rider) and BCBS Vermont stopped covering weight-loss GLP-1s [30][31]	33 to 35 independent companies (BCBSA gives both counts), each with its own drug policy [29]	Blue Cross Blue Shield Association, Oct 18, 2026 [29]
Anthem (Elevance Health)	Employer option [32]	Employer option (benefit exclusion flag); not on California fully insured Essential list as of Oct 1, 2026 [32]	Employer option; California Essential list: KwikPen only, Tier 2, PA [32]	Not confirmed	Not confirmed	Not confirmed	PA with type 2 diabetes diagnosis (2023 notice); current criteria not confirmed [33]	Oct 1, 2026: California Essential list shows Zepbound KwikPen only and no Wegovy [32]	Commercial, only if the plan design includes weight-loss drugs [32]	Anthem Blue Cross, Oct 1, 2026 [32]
Kaiser Permanente	Varies by region [34][35][36]	Varies by region: removed from California commercial base coverage for BMI under 40 (2025); Georgia Tier 5, PA [34][35]	Georgia Tier 5, PA; Northwest non-formulary, after 6 months of semaglutide [35][37]	Georgia Tier 5, PA; other regions not confirmed [35]	Northwest criteria include heart risk (effective Nov 5, 2026); other regions not confirmed [36]	Northwest: non-formulary review, BMI 30+ and AHI 30+; other regions not confirmed [37]	Colorado: Ozempic Tier 3, PA; Georgia: Ozempic and Mounjaro Tier 5, PA [38][35]	Sep 10, 2026: Northwest revised Wegovy and Zepbound criteria, effective Nov 5, 2026 [36][37]	Regional HMO plans; weight-loss use depends on the plan's drug benefit [36]	Kaiser Permanente of Georgia, Sep 9, 2026 [35]
TRICARE	Covered with PA [3]	Covered with PA on Prime and Select: BMI 30+ or 27+ with a condition, generic oral drug tried first [3][39][40]	Covered with PA on Prime and Select, same criteria; Uniform Formulary [3][39][40]	Not confirmed	Not confirmed as its own route; heart disease counts as a condition for the BMI 27 path [41]	Covered with PA: AHI 15+ and BMI 30+ [39][41]	Covered for diabetes, including TRICARE For Life; both on the Uniform Formulary [42][40]	Jun 30, 2026: obesity coverage confirmed for overseas Prime and Select [43]	Prime and Select; TRICARE For Life and direct-care-only excluded since Aug 31, 2025 [3][42]	TRICARE (Defense Health Agency), Oct 1, 2026 [3]
Humana (Medicare)	Excluded under Part D (CMS Bridge instead) [8]	Not under Part D; Medicare GLP-1 Bridge: $50 a month from Jul 1, 2026 [8][11]	Not under Part D; Bridge covers the KwikPen only, $50 a month [8][11]	Not under Part D; Bridge covers it, $50 a month [8][11]	Part D may cover, per Humana; tier not confirmed [8]	Not confirmed	Part D may cover for diabetes, per Humana; tiers not confirmed [8]	Jul 1, 2026: Medicare GLP-1 Bridge began; CMS uses Humana to process it [11]	Medicare Advantage and Part D; exit from employer commercial plans announced Feb 23, 2023 [44]	Humana, Jun 8, 2026 [8]
Ambetter (Centene)	Excluded [7][45]	Excluded: weight management is a benefit exclusion [7]	Excluded: weight management is a benefit exclusion [45]	Not on Illinois 2026 list; other states not confirmed [46]	PA: established heart disease, BMI 27+, 6 months in a weight program [7]	PA: AHI 15+ and BMI 30+ [45]	Illinois: both Tier 2 with PA; other states not confirmed [46]	Sep 2026: Centene marketplace Wegovy and Zepbound policies reviewed; weight management still excluded [7][45]	ACA marketplace plans; one formulary per state [7][46]	Centene (Ambetter), Sep 2026 [7]
FEP Blue (federal employees)	Covered with PA [4]	Covered with PA: BMI 30+ or 27+ with a condition, weight program; preferred on Standard and Basic [4][47][48]	Covered with PA after Wegovy, Saxenda and two oral drugs (Standard, Basic); non-formulary on Focus [49][48]	Not confirmed	Listed as a use on the Wegovy PA form; criteria not confirmed [47]	Listed as a use on the Zepbound PA form [48]	Not confirmed	Sep 18, 2026: Wegovy PA form revised; OPM's 2027 call letter requires carriers to cover a GLP-1 for weight loss with behavioral therapy [47][50]	FEHB: FEP Blue Standard, Basic and Focus [4][48]	FEP Blue (Blue Cross and Blue Shield Service Benefit Plan), Oct 18, 2026 [4]

Two rows cannot be reduced to one answer. Blue Cross Blue Shield is not one insurer: the Association describes 33 independent companies on one part of its site and 35 on another, and each writes its own drug policy ^[29]. Our Blue Cross Blue Shield page has the plan-by-plan table. Kaiser Permanente sets coverage by region: it removed weight-loss GLP-1s from base California commercial coverage for patients with a BMI under 40 at renewals from Jan 1, 2025 ^[34], while its Georgia 2026 formulary lists Wegovy, Zepbound and Foundayo at Tier 5 with prior authorization ^[35]. See Kaiser Permanente coverage.

How many employers cover GLP-1s for weight loss

1. 5,000 or more workers43% ^[9]
2. 1,000 to 4,999 workers30% ^[9]
3. 200 to 999 workers16% ^[9]

Among firms that offer health benefits. KFF did not report a figure for firms under 200 workers in its GLP-1 section ^[9].

In KFF's 2025 Employer Health Benefits Survey, 43% of firms with 5,000 or more workers covered GLP-1s used mainly for weight loss, up from 28% in 2024. The share was 30% for firms with 1,000 to 4,999 workers and 16% for firms with 200 to 999 ^[9]. Among covering firms with 5,000+ workers, 59% said use was higher than expected, and 34% of covering firms required enrollees to meet with a dietitian ^[9].

A newer survey points the other way. STAT, citing Reuters, reported that a Business Group on Health survey found the share of employers covering GLP-1s for weight loss fell from 72% in 2025 to 60% in 2026, and that about 14% of employers have dropped or plan to drop coverage in 2027 ^[54]. Those figures are as reported by STAT; we did not open the Business Group on Health report itself. We did not find a KFF 2026 survey release as of Oct 18, 2026.

What changed in 2025 and 2026

Newest first. Dates are effective dates unless marked otherwise.

• 2027 plan year: Express Scripts' 2027 National Preferred Formulary exclusion list, dated Aug 1, 2026 with no effective date printed, excludes Zepbound KwikPens and vials as we read its columns. Wegovy pens, Wegovy HD, Wegovy tablets, Zepbound pens, Foundayo and generic liraglutide are listed as the preferred alternatives ^[26].
• Jan 1, 2027 (scheduled): Optum Rx's 2027 Premium formulary excludes brand Saxenda and lists generic liraglutide at Tier 1. Wegovy, Wegovy HD, Zepbound auto-injector and Foundayo sit at Tier 2 with prior authorization; Zepbound KwikPens and vials stay excluded ^[14].
• Plan year 2027: OPM told every Federal Employees Health Benefits carrier to cover at least one GLP-1 for weight loss, only alongside intensive behavioral therapy, in a letter dated Mar 31, 2026 ^[50].
• Oct 1, 2026: CVS Caremark added Zepbound back to its commercial template formularies as an additional preferred option ^[6]. Wegovy kept preferred status ^[22].
• Sep 1, 2026: Cigna's Zepbound override policy for plans that otherwise exclude weight loss took effect, requiring BMI 35+ or 27+ with two conditions ^[24].
• Jul 1, 2026: Cigna ended GLP-1 weight-loss coverage for its own employees; it said plans outside its employee health plan were not affected ^[27][56]. The same day, the Medicare GLP-1 Bridge began ^[10].
• Jun 30, 2026: TRICARE said obesity management now qualifies for GLP-1 coverage for beneficiaries in overseas Prime and Select plans ^[43].
• Jun 1, 2026: CVS Caremark lifted its new-to-market block on Foundayo ^[6].
• May 2026: UnitedHealthcare added Foundayo and Wegovy HD to its weight-loss prior authorization criteria ^[1].
• Jan 1, 2026: Blue Cross Blue Shield of Massachusetts began covering GLP-1s only for type 2 diabetes, as plans renew ^[30], and Blue Cross and Blue Shield of Vermont made weight-loss GLP-1s a benefit exclusion ^[31]. Express Scripts' 2026 exclusion list appears to exclude Saxenda and Zepbound vials; the PDF's columns run together, so that is our reading ^[28]. Aetna stopped selling ACA exchange plans ^[20].
• Aug 31, 2025: TRICARE For Life and direct-care-only beneficiaries lost weight-loss drug coverage; diabetes GLP-1s stayed covered ^[42].
• Jul 1, 2025: CVS Caremark preferred Wegovy and removed Zepbound from its commercial template formularies ^[21].

Why the same plan can say yes and no to one drug

Coverage follows the reason the drug is prescribed. UnitedHealthcare's standard commercial drug list marks Wegovy and Zepbound for weight loss as a benefit exclusion, yet still covers Wegovy injection for heart risk and fatty liver disease (MASH), and Zepbound for sleep apnea ^[5]. Ambetter's marketplace policies do the same: weight management is excluded, while Wegovy for heart risk and Zepbound for sleep apnea can be approved with prior authorization ^[7][45].

• Weight loss (obesity): Wegovy, Zepbound and Foundayo. Usually an employer option in commercial plans, and excluded from regular Medicare Part D ^[8]. See Wegovy insurance and Zepbound insurance.
• Heart risk: Wegovy for adults with established heart disease and overweight or obesity. Cigna's policy, for example, asks for BMI 27+ and a prior heart attack, stroke or peripheral artery disease ^[2].
• Sleep apnea: Zepbound for moderate to severe obstructive sleep apnea with obesity. Caremark's default criteria ask for an apnea-hypopnea index (AHI) of 15+ and BMI 30+ ^[18].
• Type 2 diabetes: Ozempic and Mounjaro. UnitedHealthcare covers them with records confirming the diagnosis and a 12-month approval ^[13]. See Ozempic insurance.

Check your own plan in five steps

1. Find the drug list (formulary) for your plan on the insurer's site or app, or call the pharmacy number on your member card.
2. Search each drug by name and by form. Lists can treat pens, KwikPens, vials and tablets differently: Optum Rx's 2026 Premium list covers the Zepbound auto-injector but excludes the KwikPen and vials ^[12].
3. Ask whether weight-loss drugs are part of your benefit, or a benefit exclusion. If excluded, ask whether heart risk, sleep apnea or diabetes is covered.
4. Ask for the prior authorization criteria in writing: BMI, required lifestyle program, earlier drugs you must try, and the renewal rule, which is often 5% weight loss ^[1][2].
5. If you are denied, ask for the reason and the appeal deadline in writing, and have your prescriber send any missing records.

If your plan says no: self-pay prices

Brand self-pay prices now sit far below list price. Self-pay payments through NovoCare do not count toward insurance deductibles ^[52]. Full price breakdowns are on Zepbound cost, Wegovy cost, Foundayo and GLP-1 cost. If you are on Medicare, see the Medicare GLP-1 Bridge.

Self-pay prices if your plan says no, checked Oct 17, 2026

Drug and channel	Price a month	Conditions	Source
Zepbound, LillyDirect (vial or KwikPen)	$299 to $449	$449 for 7.5 to 15 mg needs a refill within 45 days; otherwise $499 to $699	LillyDirect [51]
Wegovy pen, NovoCare	$349	New patients: $199 for the first two fills of 0.25 mg or 0.5 mg, through Dec 31, 2026; Wegovy HD $399	NovoCare [52]
Wegovy pill, NovoCare	$149 to $299	$149 for 1.5 mg; $199 for 4 mg; $299 for 9 mg and 25 mg	NovoCare [52]
Foundayo, LillyDirect	$149 to $299	Some prices temporarily reduced through Dec 31, 2026; top doses need a refill within 45 days	LillyDirect [53]
Medicare GLP-1 Bridge (Part D enrollees who qualify)	$50	Wegovy, Zepbound KwikPen or Foundayo, Jul 1, 2026 to Dec 31, 2027	CMS [10][11]

Insurer and PBM pages

• UnitedHealthcare and Optum Rx
• Aetna
• CVS Caremark
• Cigna and Express Scripts
• Blue Cross Blue Shield and FEP Blue
• Anthem
• Kaiser Permanente
• TRICARE
• Humana
• Medicaid GLP-1 coverage by state

How we check

• Primary documents first. Each cell comes from the insurer's or PBM's own prior authorization policy, formulary, member notice or SEC filing where we could open one, or from a news report where we could not. The primary source and its date are in the last column; every source is listed below.
• Date checked. Our own check of every row was on Oct 18, 2026. That date is ours, not the insurer's, and it sits beside each source in the last column. Policies change at plan renewal, so the date matters.
• What the labels mean. Covered with PA means the published policy covers the drug for that use when prior authorization criteria are met. Employer option means coverage exists only on plans that bought the benefit. Excluded means the published policy says the use is not covered. None of these means a given member is covered.
• Not confirmed. We write Not confirmed when we could not open the policy or found only an unreliable source. By our count of the table above, Foundayo for weight loss is not confirmed at 3 of 12 rows.
• Report a change. Email [email protected] with a link to the new policy or notice, and we will check it and update the date.