An independent guide to cash-pay care. Every price is dated and sourced.

How we check
Wellchosen Health

Does Anthem cover Zepbound, Wegovy, Ozempic or Mounjaro?

Anthem covers Zepbound and Wegovy for weight loss only when your employer or plan chose to include them: its national drug list, current as of Jan 1, 2025 and the newest we found, flags both with "BE," which Anthem defines as "This drug may not be covered depending on your plans design" [1]. Its California fully insured list, current as of Oct 1, 2026, flags the Zepbound KwikPen the same way [2]. Ozempic and Mounjaro are type 2 diabetes drugs [3] [4], and a 2023 Anthem notice in Kentucky tied coverage to a documented type 2 diabetes diagnosis [5]. Anthem's commercial prior authorization criteria for weight loss were not public in our search as of Oct 18, 2026.

Updated By the Wellchosen Health editorial team

Medical review: pending. A licensed clinician has not yet reviewed this page.

Anthem is the Blue Cross and Blue Shield licensee owned by Elevance Health, which says Anthem Blue Cross and Blue Shield and affiliated Blue plans are offered in 14 states [6] [7].

At a glance

Anthem footprint
14 statesAnthem Blue Cross and Blue Shield and affiliated Blue plans, per Elevance Health [6]
Not public
PA criteriaNot found in our search of public Anthem documents as of Oct 18, 2026
Checked
Oct 18, 2026The day we checked Anthem's drug lists [1] [2]

Anthem is a Blue plan, owned by Elevance Health

Elevance Health lists Anthem among its health plans and says "Anthem Blue Cross and Blue Shield and affiliated blue plans are offered in 14 states" [6]. Anthem holds its Blue license from the Blue Cross Blue Shield Association, which licenses its names to independent companies [7]. So Anthem's rules apply to Anthem members only. If your card names another Blue company, see our Blue Cross Blue Shield plan table.

What Anthem's drug lists show, drug by drug

Anthem drug list entries by use, checked Oct 18, 2026
UseDrugNational Drug List (current as of Jan 1, 2025)California Essential list, fully insured (Oct 1, 2026)Source
Weight lossWegovyTier 2, prior authorization, BENot found in the anti-obesity section[1] [2]
Weight lossZepboundTier 2, prior authorization, BEKwikPen only: Tier 2, prior authorization, BE, 4 pens per 28 days[1] [2]
Weight lossSaxenda or generic liraglutideSaxenda Tier 3, prior authorization, BEGeneric liraglutide Tier 1 or 1b, prior authorization, BE[1] [2]
Heart riskWegovyNot confirmedNot confirmed
Sleep apneaZepboundNot confirmedNot confirmed
Type 2 diabetesOzempic, MounjaroNot shown here. A 2023 Kentucky notice required a type 2 diabetes diagnosis; 2026 criteria not confirmedNot confirmed[5]
Anthem's national list file reads "CURRENT AS OF 1/1/2025" and may be out of date; we could not find a 2026 national list, so its column shows Anthem's rules as of Jan 1, 2025, not today. A drug on a list is not a promise of coverage when it carries the BE flag [1].

The uses stay separate. Wegovy is approved for weight management and, since Mar 8, 2024, to cut heart attack, stroke and cardiovascular death risk in adults with heart disease and obesity or overweight [8] [9]. Zepbound is approved for weight management and for moderate to severe sleep apnea with obesity [10]. Ozempic and Mounjaro are approved for type 2 diabetes [3] [4]. Anthem's own 2023 Kentucky notice says Wegovy and Saxenda "are FDA-approved for weight loss only and not for treatment of diabetes" [5].

What "BE" on an Anthem list means for you

Anthem's lists define BE as "benefit exclusion. This drug may not be covered depending on your plans design" [1]. In practice, your employer decides. If the plan includes weight-loss drugs, Wegovy or Zepbound goes through prior authorization. If it does not, a prior authorization request for weight loss cannot fix that, and the question becomes whether another use, such as heart risk or sleep apnea, is covered under a different benefit. Anthem did not publish an answer to that question in any document we found.

California: the fully insured Essential list

Anthem Blue Cross's California Essential 3-Tier list for fully insured plans regulated by the Department of Managed Health Care reads "CURRENT AS OF 10/1/2026." Its anti-obesity sections list the "ZEPBOUND KWIKPEN" at Tier 2 with prior authorization, the BE flag and a limit of 4 pens per 28 days, plus generic liraglutide for weight management [2]. We did not find Wegovy, Saxenda, Foundayo or the single-dose Zepbound pen in those sections. We could not open Anthem's formulary change log to date each step, so treat the order of changes as not confirmed. California Medi-Cal members follow state rules instead: see Medi-Cal and GLP-1s.

Prior authorization at Anthem: what is public and what is not

  • Weight loss: in our search as of Oct 18, 2026, we found no public Anthem document giving its commercial BMI threshold, lifestyle program requirement or renewal rule for Wegovy or Zepbound. Ask your plan for the criteria document by name.
  • Type 2 diabetes: Anthem's May 15, 2023 notice in Kentucky required a type 2 diabetes diagnosis, plus a metformin trial, a reason metformin cannot be used, or atherosclerotic heart disease, for diabetes GLP-1s [5]. Current 2026 criteria were not confirmed.
  • CarelonRx: in our search, we could not confirm Anthem's pharmacy benefit manager list for 2026 from a primary document, so we do not report its tiers.
  • Foundayo and the Wegovy pill: neither appears on the Jan 1, 2025 national list, which predates both [1]. Their Anthem status is not confirmed.

Dated Anthem changes we could confirm

  1. Oct 1, 2026: California Essential list current as of this date shows the Zepbound KwikPen as the listed tirzepatide for weight management [2].
  2. Jan 1, 2025: National Drug List, current as of this date and the newest we found, shows Wegovy and Zepbound at Tier 2 and Saxenda at Tier 3, all flagged BE [1].
  3. May 15, 2023: Kentucky provider notice on prescribing GLP-1s for type 2 diabetes [5].

Checking an Anthem plan yourself

  1. Call the pharmacy number on your Anthem card. Ask: is Wegovy, Zepbound or Foundayo on my formulary, and does my plan exclude weight-loss drugs (the BE flag)?
  2. If it is covered, ask what the prior authorization requires and which drug is preferred.
  3. If you have Anthem through work, ask HR whether weight-loss drugs were included in this year's plan design.
  4. For diabetes, heart risk or sleep apnea, ask about that use by name.
  5. Anthem Medicare Advantage members: Medicare's GLP-1 Bridge, a program separate from regular Part D drug coverage, charges a $50 copayment for a one-month supply to eligible members [11]. See GLP-1s and Medicare. Anthem Medicaid members follow their state's rules: Medicaid coverage by state.

If Anthem will not pay

  • Appeal with your prescriber if the denial is about criteria rather than a plan exclusion, and send the missing records.
  • Zepbound with Lilly's card: commercially insured people whose plan does not cover Zepbound can pay as low as $299 to $449 a month for the KwikPen depending on dose, with the $449 doses (7.5 mg and up) needing a refill within 45 days [12].
  • Zepbound cash price: $299 for 2.5 mg, $399 for 5 mg and $449 for 7.5 mg and up per 28-day month on LillyDirect, the $449 price when each refill comes within 45 days, checked Oct 17, 2026 [13]. More on Zepbound cost.
  • Wegovy cash price: $349 a month for the pen at NovoCare, $199 for a new self-pay patient's first two low-dose fills through Dec 31, 2026; Wegovy pill $149 to $299 [14]. More on Wegovy cost.
  • Foundayo cash price: $149 to $299 a month on LillyDirect, with some doses at temporary prices through Dec 31, 2026 and the top two doses needing a refill within 45 days, checked Oct 17, 2026 [15]. Compare all on the GLP-1 price tracker.

Before you start any of these drugs

All four drugs carry a boxed warning for thyroid C-cell tumors seen in rodents and should not be used with a personal or family history of medullary thyroid carcinoma or MEN 2 [10] [8]. Severe stomach pain that does not ease, or swelling, hives or trouble breathing, needs prompt care. Low blood sugar is more likely alongside insulin or a sulfonylurea. For an emergency, call 911.

Compare Anthem with Kaiser Permanente, UnitedHealthcare and Cigna, or see every carrier on the GLP-1 insurance coverage tracker. Drug pages: Zepbound insurance, Wegovy insurance, Ozempic insurance.

Questions people ask

Does Anthem cover Zepbound?

Only if your plan design includes weight-loss drugs. Anthem's national list, current as of Jan 1, 2025, shows Zepbound at Tier 2 with prior authorization and the BE (benefit exclusion) flag [1]. On Anthem Blue Cross's California fully insured Essential list, only the Zepbound KwikPen is listed, at Tier 2 with a limit of 4 pens per 28 days, as of Oct 1, 2026 [2].

Does Anthem cover Wegovy for weight loss?

Only when your plan includes weight-loss drugs: Anthem's national list, current as of Jan 1, 2025, flags Wegovy BE, meaning it "may not be covered depending on your plans design" [1]. We did not find Wegovy in the anti-obesity section of Anthem Blue Cross's California Essential list current as of Oct 1, 2026 [2]. Anthem's BMI and lifestyle criteria were not public as of Oct 18, 2026.

Does Anthem cover Ozempic?

Ozempic is approved for type 2 diabetes, not weight loss [3]. Anthem's 2023 Kentucky notice required a documented type 2 diabetes diagnosis, plus a metformin trial, a reason metformin cannot be used, or atherosclerotic heart disease [5]. Current 2026 criteria were not confirmed.

Does Anthem cover Ozempic for weight loss?

Anthem told Kentucky prescribers in 2023 that GLP-1s for diabetes require a type 2 diabetes diagnosis [5], so Ozempic without diabetes is unlikely to qualify under those criteria. The weight-loss version of semaglutide is Wegovy [8], which Anthem covers only where the plan includes weight-loss drugs [1].

Does Anthem cover Mounjaro?

Mounjaro is approved for type 2 diabetes [4], and Anthem's 2023 notice tied diabetes GLP-1 coverage to a type 2 diabetes diagnosis [5]. For weight loss, the matching drug is Zepbound, which Anthem lists with the BE flag [1]. With commercial coverage of Mounjaro, Lilly's card can cut the cost to as little as $25 for a 1-, 2- or 3-month fill [16].

Does Anthem cover tirzepatide?

Tirzepatide is sold as Mounjaro for type 2 diabetes and Zepbound for weight management and sleep apnea [4] [10]. Anthem flags Zepbound BE, so weight-loss coverage depends on your plan [1]. In California's fully insured Essential list, only the Zepbound KwikPen is listed [2].

Does Anthem cover the Wegovy pill?

Not confirmed as of Oct 18, 2026: the Anthem national list we found is dated Jan 1, 2025, before the Wegovy pill's FDA approval was announced on Dec 22, 2025 [1] [17]. Without coverage, the pill costs $149 to $299 a month through NovoCare [14].

Does Anthem Medicare Advantage cover Wegovy?

Since July 1, 2026, Medicare's GLP-1 Bridge, which is separate from regular Part D drug coverage, covers Wegovy, Foundayo and the Zepbound KwikPen (not single-dose Zepbound pens or vials) for eligible members at a $50 copayment for a one-month supply [11] [18]. People with type 2 diabetes, sleep apnea or fatty liver disease are not eligible for the Bridge, and Medicare says their Part D plan might cover their GLP-1s [11].

Sources

18 cited
  1. National Drug List, 3-tier. Anthem, Jan 1, 2025.
  2. California Essential 3-Tier Drug List (DMHC). Anthem Blue Cross, Oct 1, 2026.
  3. Ozempic (semaglutide) injection label. DailyMed, National Library of Medicine, May 2026.
  4. Mounjaro (tirzepatide) label. DailyMed, National Library of Medicine, Aug 2026.
  5. Network alert: prescribing GLP-1 receptor agonists. Anthem Blue Cross and Blue Shield (Kentucky provider news), May 15, 2023.
  6. Our companies. Elevance Health, Oct 18, 2026.
  7. The Blue Cross Blue Shield System. Blue Cross Blue Shield Association, Oct 18, 2026.
  8. Wegovy (semaglutide) injection and tablets label. DailyMed, National Library of Medicine, Jun 2026.
  9. FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweight. US Food and Drug Administration, Mar 8, 2024.
  10. Zepbound (tirzepatide) label. DailyMed, National Library of Medicine, Aug 2026.
  11. Weight loss drugs coverage. Medicare.gov (CMS), Oct 17, 2026.
  12. Zepbound coverage and savings. Eli Lilly and Company, Oct 17, 2026.
  13. Zepbound on LillyDirect: self-pay prices. Eli Lilly and Company (LillyDirect), Oct 17, 2026.
  14. Wegovy self-pay offer. Novo Nordisk (NovoCare Pharmacy), Oct 17, 2026.
  15. Foundayo on LillyDirect: self-pay prices. Eli Lilly and Company (LillyDirect), Oct 17, 2026.
  16. Mounjaro savings card terms. Eli Lilly and Company, Oct 17, 2026.
  17. Wegovy pill FDA approval. Novo Nordisk, Dec 22, 2025.
  18. Medicare GLP-1 Bridge: information for pharmacies. Centers for Medicare & Medicaid Services, Oct 17, 2026.

This page is general information, not medical advice. Talk with a licensed clinician about your own care.