Does Cigna cover Wegovy, Zepbound, Ozempic or Mounjaro?

Cigna and Express Scripts coverage table

Cigna commercial coverage of GLP-1 drugs by use, checked Oct 18, 2026

Drug	Weight loss	Heart risk	Sleep apnea	Type 2 diabetes
Wegovy (pen, HD, pill)	If the plan covers weight loss: BMI 30, or 27 with a condition [1]. Override plans: BMI 32 [2]	BMI 27+ with prior heart attack, stroke or symptomatic PAD; 1 year [1]	Not an approved Wegovy use [22]	Not an approved Wegovy use [22]
Zepbound	If the plan covers weight loss: BMI 30, or 27 with a condition [1]. Zepbound override: BMI 35 [3]	Not an approved Zepbound use [23]	BMI 30+ and AHI 15+; renewal after 1 year needs 10% loss [3]	Not an approved Zepbound use [23]
Ozempic (injection and tablets)	Not medically necessary for weight loss without diabetes [5]	Through the diabetes policy only [5]	Not covered under the diabetes policy [5]	Prior authorization, documented diagnosis, 1 year [5]
Mounjaro	Not medically necessary for weight loss without diabetes [5]	Through the diabetes policy only [5]	Not covered under the diabetes policy [5]	Prior authorization, documented diagnosis, 1 year [5]

Cigna's policies also say a weight-loss GLP-1 should not be combined with Ozempic, Mounjaro or another GLP-1 ^[5]. For the drugs themselves, see Wegovy insurance, Zepbound insurance and Ozempic insurance.

Four Cigna policies, three BMI floors

Cigna writes separate policies for plans that cover weight loss as a standard benefit and for plans that would otherwise exclude it, called Benefit Exclusion Overrides. The documents do not say how a plan is assigned to one or the other, so ask your plan which policy number applies to you.

Cigna weight-loss GLP-1 policies in force on Oct 18, 2026

Policy	Effective	Drugs	BMI to start	Other rules
CNF684, standard	Revised Apr 15, 2026 [1]	Foundayo, Saxenda, Wegovy (pen, HD, pill), Zepbound	30+, or 27+ with one weight-related condition	Age 18+; 3 months of diet and behavior changes; first approval 8 months (Saxenda 4); renew yearly with 5% loss (Saxenda 4%) [1]
IP0621, override	Apr 30, 2026 [2]	Foundayo, Saxenda or liraglutide, Wegovy, Zepbound	32+, or 27+ with two conditions	Zepbound sleep apnea criteria match the standard policy [1] [2]; Cigna says these BMI thresholds "are not based on clinical data" [2]
BEO014, Zepbound override	Sept 1, 2026 [3]	Zepbound (KwikPen not targeted)	35+, or 27+ with two conditions	Renewal needs at least 5% loss; Cigna says the thresholds "are not based on clinical data" [3]
IP0206, Foundayo	Sept 1, 2026 [4]	Foundayo	30+, or 27+ with a condition	"Foundayo for any other use is considered not medically necessary." [4]

The BMI 35 line matters most for Zepbound users. A person with a BMI of 33 and one condition meets the standard policy and IP0621, but not the Zepbound override, which needs a BMI of 35 or two conditions ^[3]. Before you assume you qualify, ask which policy number your plan uses.

Heart risk and sleep apnea at Cigna

Cigna's standard policy has a heart-risk path for Wegovy, injection and pill: adults with a BMI of 27 or more and a prior heart attack, stroke or symptomatic peripheral artery disease, approved for 1 year; a transient ischemic attack does not count as a stroke ^[1]. For sleep apnea, Zepbound needs moderate to severe obstructive sleep apnea, a BMI of 30 or more and an AHI of 15 or more. After a year, renewal requires at least 10% weight loss and stable symptoms ^[3]. The same sleep apnea criteria appear in the standard and override policies ^{[1] [2] [3]}.

Ozempic and Mounjaro for diabetes

Policy IP0701, "Diabetes: Glucagon-Like Peptide-1 Agonists for Employer Plans", effective June 15, 2026, covers Ozempic (injection and tablets), Mounjaro, Trulicity, Rybelsus and others for type 2 diabetes ^[5]. The only criterion for Ozempic and Mounjaro is a documented type 2 diabetes diagnosis, through chart notes, labs or claims records. There is no metformin step. Approval lasts 1 year ^[5].

The same policy lists uses it treats as not medically necessary: weight loss without type 2 diabetes, type 1 diabetes, prediabetes, and metabolic syndrome without type 2 diabetes ^[5]. Ozempic and Mounjaro do not appear on Express Scripts' 2027 exclusion list or its list of 2026 exclusion changes, as we read them. That tells you they are not on those lists, not what tier they sit on ^{[6] [7]}. More: Ozempic vs Mounjaro.

Express Scripts formulary: 2026 and 2027 lists

Express Scripts publishes a yearly list of drugs excluded from its National Preferred Formulary, with preferred alternatives. The 2026 document lists only the changes coming Jan 1, 2026 and says it is not all-inclusive ^[6]. In both PDFs the text lost its column breaks, so which drugs are excluded and which are alternatives is our reading of the layout. The two years are consistent with each other ^{[6] [7]}.

Express Scripts National Preferred Formulary, weight-loss GLP-1 class

List	Excluded (as we read it)	Preferred alternatives (as we read it)	Source
2026 changes, effective Jan 1, 2026	Saxenda, Zepbound vials	Wegovy, Zepbound pens	[6]
2027, published with an Aug 1, 2026 footer	Zepbound KwikPens, Zepbound vials	Generic liraglutide, Foundayo, Wegovy HD, Wegovy pens, Wegovy tablets, Zepbound pens	[7]

So for 2027: Zepbound auto-injector pens stay preferred, but the KwikPen is excluded on the standard list, the same pen Medicare's Bridge covers ^{[7] [17]}. Foundayo and the Wegovy pill join the preferred alternatives ^[7].

The $200 cap and other Evernorth programs

In May 2025, Evernorth reached deals with Lilly and Novo Nordisk to cap monthly out-of-pocket costs for Zepbound and Wegovy at $200 for members of participating plans ^[8], with payments counting toward the deductible ^[9]. At the time, about half of Cigna's clients covered GLP-1s for weight loss, and Evernorth's Harold Carter said the option was "really focused towards clients that aren't covering it today" ^[11].

In July 2025, Express Scripts said "Later this year, Express Scripts will add GLP-1s for weight loss to the Patient Assurance Program", and that under its EncircleRx program the monthly copay for GLP-1 weight-loss drugs "will be limited to no more than $200". The same release says the Patient Assurance Program caps diabetes drugs at $25 for up to a 34-day supply on participating plans ^[10]. Whether your employer joined any of these is a plan choice. Ask the pharmacy line by program name.

Cigna dropped coverage for its own employees

Cigna ended GLP-1 weight-loss coverage in its own employee health plan on July 1, 2026, after circulating a document to employees on June 1, STAT reported, citing Reuters ^[12]. Employees paying cash were told the purchases will not apply toward a deductible ^[12]. A Cigna spokesperson told Reuters the change does not affect plans outside Cigna's employee health plan or coverage for type 2 diabetes ^[13].

It fits a wider pullback. A Business Group on Health survey, as reported by STAT, found the share of employers covering GLP-1s for weight loss fell from 72% in 2025 to 60% in 2026, and about 14% have dropped or plan to drop coverage in 2027 ^[14]. Some employers went the other way: Colorado's state employee plans began covering GLP-1s for weight loss on May 1, 2026, and members on its Cigna plan get Zepbound, with other options only for a medical reason ^[15].

What changed and when

• Aug 1, 2026 (footer date): Express Scripts 2027 exclusion list posted: Zepbound KwikPens and vials excluded; Foundayo and Wegovy tablets among preferred alternatives ^[7].
• Sept 1, 2026: Zepbound override BEO014 (BMI 35) and Foundayo policy IP0206 take effect ^{[3] [4]}.
• July 9, 2026: Cigna splits its GLP-1 weight-loss policies by drug ^{[3] [4]}.
• July 1, 2026: Cigna's own employee plan drops weight-loss GLP-1 coverage ^[12]; the Medicare GLP-1 Bridge opens ^[16].
• June 15, 2026: diabetes policy IP0701 adds Ozempic tablets ^[5].
• April 30, 2026: override policy IP0621 (BMI 32) takes effect ^[2].
• April 15, 2026: standard policy CNF684 last revised ^[1].
• Jan 1, 2026: Express Scripts 2026 list excludes Saxenda and Zepbound vials ^[6].
• July 10, 2025: Express Scripts announces weight-loss GLP-1s will join the Patient Assurance Program ^[10].
• May 21, 2025: Evernorth announces the $200 monthly cap ^{[8] [11]}.

The Aug 1, 2026 entry is placed by publication rather than effective date, since the 2027 list's effective date is not printed ^[7].

Finding your own Cigna rules

1. Call the number on your Cigna ID card, or Express Scripts if your card names it, and ask whether weight-loss drugs are a covered benefit or excluded ^[2].
2. Ask which policy number applies to your request: CNF684, IP0621, BEO014 or IP0206. That tells you the BMI floor ^{[1] [2] [3] [4]}.
3. Ask whether your plan participates in the $200 cap, EncircleRx or the Patient Assurance Program ^{[8] [10]}.
4. Ask whether your plan uses the National Preferred Formulary or a custom list, and confirm which Zepbound form (pen, KwikPen, vial) is preferred ^{[6] [7]}.
5. Keep 3 months of diet and behavior records; the standard policy requires them ^[1].

Other insurers work differently: UnitedHealthcare, Aetna, Blue Cross Blue Shield, and the insurer coverage tracker.

Options after a Cigna denial

• Check which floor you missed. If the denial cites BMI 32 or 35, the plan is on an override policy ^{[2] [3]}; resubmitting under the standard criteria will not help, but documenting a second weight-related condition may, since the overrides accept BMI 27 with two conditions.
• Name the right use. Heart disease (Wegovy) and sleep apnea (Zepbound) have their own criteria ^{[1] [3]}.
• Appeal with your prescriber by the deadline on the letter.
• Self-pay prices, checked Oct 17, 2026: Wegovy pens $349 a month on NovoCare, Wegovy HD $399, the Wegovy pill $149 to $299, and $199 for each of a new self-pay patient's first two starting-dose pen fills through Dec 31, 2026 ^[18]. Zepbound on LillyDirect is $299 to $449 per 28 days; the $449 price for 7.5 mg and up needs a refill within 45 days, or it rises to as much as $699 ^[19]. If your commercial Cigna plan covers Zepbound, Lilly's savings card can bring it to as little as $25 ^[20]; Mounjaro's list price is $1,112.16 for 28 days ^[21]. See Wegovy cost, Zepbound cost and the GLP-1 price tracker.
• 65 or older? The Medicare GLP-1 Bridge covers Wegovy, Foundayo and the Zepbound KwikPen at $50 a month through Dec 31, 2027 for Part D members who meet its BMI rules ^{[16] [17]}. We did not check Cigna-branded Medicare plans. See Medicare and GLP-1s.

Compare Cigna with other insurers