Does Kaiser Permanente cover Zepbound, Wegovy, Ozempic or Mounjaro?

Eight Kaiser regions, side by side

Kaiser publishes a formulary and coverage documents for each region. The answers below come from those documents, or from brokers and news reports where marked. Where we could not read a region's current rule, the table says so.

Kaiser Permanente GLP-1 coverage by region, checked Oct 18, 2026

Region	Plans	Weight loss (Wegovy, Zepbound)	Type 2 diabetes (Ozempic, Mounjaro)	Latest dated change	Source
Northern and Southern California	Commercial; ACA members too, per Becker's	Removed from base coverage when prescribed only for weight loss with BMI under 40	Coverage continues for disease management such as diabetes	Renewals on or after Jan 1, 2025	[1] [2] [9]
California Medi-Cal	Medi-Cal (drugs through Medi-Cal Rx)	Not covered for weight loss only; members under 21 through prior authorization	Covered with a diagnosis code	Jan 1, 2026	[8]
Northwest (Oregon, SW Washington)	Commercial	Revised criteria effective Nov 5, 2026: only if your drug benefit covers weight-loss drugs. Wegovy is on the formulary with criteria; Zepbound is non-formulary and needs a failed 6-month semaglutide trial. Criteria in force before Nov 5 were not checked	Not confirmed	Criteria revised Sept 10, 2026, effective Nov 5, 2026	[10] [7]
Georgia	Five-tier formulary plans	Wegovy, Zepbound, Saxenda Tier 5 with prior authorization and quantity limits; Foundayo Tier 5 with prior authorization. The formulary does not say whether your plan covers weight loss	Ozempic and Mounjaro Tier 5 with prior authorization and quantity limits	Formulary current as of Sept 9, 2026	[3]
Hawaii	Individual and family (KPIF)	Excluded: "Drugs used for weight management"	Not confirmed	January 2026 plan guide	[11]
Washington	Individual, family and small group	Most plans exclude drugs for weight loss	Not confirmed	Formulary effective Oct 1, 2026	[12]
Colorado	Commercial	Not confirmed. Colorado state employees on Kaiser regained weight-loss coverage May 1, 2026	Ozempic Tier 3 with prior authorization; Mounjaro not confirmed	Formulary revised Sept 15, 2026	[13] [14]
Mid-Atlantic (Maryland, Virginia, DC)	Commercial and FEHB	Current rule not confirmed. A 2024 form covered Wegovy, Saxenda and Zepbound with prior authorization	Not confirmed	Form revised May 10, 2024	[15]

California: the BMI 40 line and Medi-Cal

Kaiser posted an October 2024 flyer on its employer site. It said that starting in January 2025, GLP-1 and other anti-obesity drugs would no longer be covered "for the sole purpose of weight loss." They would still be covered when prescribed as part of a "disease management program for conditions such as diabetes" ^[2]. The flyer names no region and no BMI line. Warner Pacific, an insurance general agency, reported that the change covered California commercial plans. It applied only when the drugs are "prescribed solely for the purpose of weight loss for patients with BMI less than 40," at contract renewal on or after Jan 1, 2025 ^[1]. Becker's also listed ACA members in California as affected ^[9]. We did not find a published Kaiser rule for members with a BMI of 40 or more, or an employer buy-back rider.

Kaiser members on Medi-Cal get their drugs through Medi-Cal Rx. On Jan 1, 2026, Medi-Cal Rx stopped covering Wegovy, Zepbound, Saxenda and other GLP-1s for weight loss. It still covers Wegovy for noncirrhotic MASH, and diabetes GLP-1s with a diagnosis code. Members under 21 can get weight-loss coverage through prior authorization ^[8]. Full detail: Medi-Cal and GLP-1s.

Kaiser's Northern California commercial HMO formulary was updated Oct 1, 2026 ^[6]. We could not read its weight-loss and diabetes pages. So as of Oct 18, 2026, tiers for Wegovy, Zepbound, Saxenda and Foundayo in California are not confirmed.

Heart risk, sleep apnea and MASH at Kaiser

Non-weight uses in Kaiser documents, checked Oct 18, 2026

Use	Drug	What Kaiser documents show	Source
Heart risk	Wegovy	Northwest criteria effective Nov 5, 2026 include a cardiovascular route: age 55 to 74, no diabetes, BMI 27+, a prior STEMI or type 1 NSTEMI heart attack, and active diet or exercise changes. Other regions not confirmed	[10]
Sleep apnea	Zepbound	Northwest criteria effective Nov 5, 2026 cover severe sleep apnea (AHI 30+) with BMI 30+ and a sleep study within 5 years. Other regions not confirmed	[7]
MASH (liver)	Wegovy	Northwest criteria list MASH; Medi-Cal Rx keeps Wegovy for noncirrhotic MASH	[10] [8]
Type 2 diabetes	Ozempic, Mounjaro	Kaiser's 2025 flyer: continues under disease management. Georgia: both Tier 5 with prior authorization. Colorado: Ozempic Tier 3 with prior authorization	[2] [3] [13]

What a Kaiser prior authorization asks for

• Northwest, Wegovy (criteria effective Nov 5, 2026): BMI 30 or more, or 27 or more with a weight-related condition. Adults first fail 3-month trials of two of these: phentermine, diethylpropion, topiramate, phentermine/topiramate or naltrexone/bupropion. Renewal comes every 12 months and needs 5% weight loss achieved and kept ^[10].
• Northwest, Zepbound (criteria effective Nov 5, 2026): "Non-formulary tirzepatide (Zepbound) requires a clinical review." You need a failed trial of at least 6 months of semaglutide first, unless it cannot be used. Your drug benefit must cover weight-loss drugs. Renewal comes every 12 months with 5% loss ^[7].
• Mid-Atlantic, 2024 form: enrollment in Kaiser's Clinical Pharmacy Weight Management Service, or a specialist prescriber. BMI 30 or more (or 27 or more with a condition) and a lifestyle program. Failure of, intolerance to or a contraindication to 3-month trials of all of Qsymia, Contrave and Xenical. Saxenda and Zepbound also needed a Wegovy trial. Approvals lasted 6 months and were renewed with 5% loss ^[15]. This form may have been replaced.
• Colorado state employees: Kaiser members can get medically appropriate GLP-1s through Kaiser's pre-authorization process from May 1, 2026 ^[14].

Changes at Kaiser, newest first

1. Nov 5, 2026 (scheduled): revised Northwest Wegovy and Zepbound criteria take effect ^{[10] [7]}.
2. Oct 1, 2026: Washington individual, family and small group formulary takes effect, saying most plans exclude weight-loss drugs ^[12]; Northern California commercial formulary updated ^[6].
3. Sept 15, 2026: Colorado commercial formulary revised ^[13].
4. Sept 9, 2026: Georgia formulary current as of this date, including Foundayo ^[3].
5. May 1, 2026: Colorado state employee plans, including Kaiser, cover GLP-1s for weight loss again ^[14].
6. January 2026: Medi-Cal Rx ends weight-loss-only GLP-1 coverage on Jan 1, except for members under 21 with prior authorization; Hawaii's January 2026 individual plan guide lists weight-management drugs as not covered ^{[8] [11]}.
7. Jan 1, 2025: California commercial base coverage of weight-loss-only GLP-1s ends below BMI 40, at contract renewals on or after this date ^[1].

Checking your own Kaiser plan

1. Find your region on your Kaiser card or plan documents. Rules differ by region.
2. Open your evidence of coverage and search for "weight management" or "weight loss". Hawaii's individual plan guide, for example, lists "Drugs used for weight management" as not covered ^[11].
3. Call member services and ask whether your drug benefit covers weight-loss medications, and whether Wegovy, Zepbound or Foundayo is on your region's formulary.
4. Ask for the criteria document for the drug and use your clinician is prescribing: weight loss, heart risk, sleep apnea or diabetes.
5. If you have Kaiser through an employer, ask HR whether weight-loss drugs were bought back. Colorado's state employee plan is one example of an employer adding coverage ^[14].

When Kaiser will not cover it

• Appeal if you meet the published criteria and the denial cites missing records.
• Ask about the member cash price. Kaiser Northwest's Wegovy criteria refer members whose benefit excludes weight-loss drugs to a member cash price ^[10].
• Zepbound outside Kaiser: $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 applies when each refill comes within 45 days. Checked Oct 17, 2026 ^[19]. See Zepbound cost.
• Wegovy outside Kaiser: $349 a month for the pen at NovoCare. A new self-pay patient pays $199 for each of the first two low-dose fills through Dec 31, 2026. The Wegovy pill is $149 to $299 ^[20]. See Wegovy cost.
• Ozempic for diabetes, without coverage: $349 a month through NovoCare for 0.25, 0.5 or 1 mg, and $499 for 2 mg, checked Oct 17, 2026 ^[21]. Price comparisons: GLP-1 price tracker.
• Kaiser Medicare members: the GLP-1 Bridge has a $50 copayment for a one-month supply if you qualify ^[16]. See GLP-1s and Medicare.

Other insurers: Blue Cross Blue Shield, Anthem, Aetna, and the full GLP-1 insurance coverage tracker. Drug pages: Wegovy insurance, Zepbound insurance, Ozempic insurance.