The facts
Weight loss
Generally no
Type 2 diabetes
Yes, with PA
Prior auth
Typical
Typical cost
Plan-specific (T2D only)
The criteria, as published
3 of 9 criteria are stated in the Cigna documents we read. Tap a row for the exact wording. Where a cell says not published, the documents we read do not say, and the line under it is how to find out.
- Formulary status
- Not published in what we readLook Ozempic up in your plan's drug list or price tool, or call the number on your card.
- BMI threshold
- Not published in what we readAsk member services for the written prior authorization criteria for Ozempic.
- Qualifying conditions
Type 2 diabetes, age 18 and over
“Type 2 Diabetes Mellitus. Approve for 1 year if … the request is for Byetta, exenatide (generic to Byetta), Ozempic injection, Ozempic tablets, Rybelsus: Approve if the patient is ≥ 18 years of age”
static.cigna.com · reviewed 2026-06-03- Lifestyle program
- Not published in what we readAsk whether a diet, exercise or behavioral program has to be documented, and for how long.
- Step therapy
- Not published in what we readAsk whether another drug has to be tried before Ozempic.
- Quantity limit
- Not published in what we readAsk what quantity limit applies to each fill.
- Renewal
Approval lasts 1 year
“Type 2 Diabetes Mellitus. Approve for 1 year if … the request is for Byetta, exenatide (generic to Byetta), Ozempic injection, Ozempic tablets, Rybelsus: Approve if the patient is ≥ 18 years of age”
static.cigna.com · reviewed 2026-06-03- Plan can exclude it?
Yes: Cigna treats weight-loss use as not medically necessary
“is(are) considered not medically necessary for ANY other use(s) including the following … Weight Loss Treatment. The products in this policy are not FDA-approved for weight loss.”
static.cigna.com · reviewed 2026-06-03- 2026 change
- Not published in what we readAsk whether Ozempic's status changed this year or changes at your next renewal.
Who actually decides this
Not the logo on your card, most of the time. Three parties sit between you and the answer, and knowing which one is saying no tells you who to ask.
- 1
The pharmacy benefit manager
No single PBM to name here, which is itself the finding. Different plans under this name use different benefit managers, so one national statement about the formulary would be wrong.
- 2
Your employer, if the plan comes through work
Weight-loss drugs are usually a category an employer buys or declines, not something the insurer includes by default. That is why two people holding identical cards get opposite answers, and why the useful question for member services is whether your plan includes the weight-loss medication benefit at all, before anything about criteria.
How prior authorization works here
Six steps. Specifics come from the criteria above; where Cigna does not publish one, the step says what to ask for.
- 1
Confirm the benefit exists
Before any paperwork, ask whether your plan includes the weight-loss drug benefit. On whether a plan can leave it out, the documents say: Yes: Cigna treats weight-loss use as not medically necessary.
- 2
Get the criteria in writing
Ask for the written prior authorization criteria for Ozempic, so your prescriber answers the plan's questions rather than guessing at them.
- 3
Your prescriber documents the clinical picture
Current and baseline BMI, with dates. Conditions: Type 2 diabetes, age 18 and over. Records of any diet, exercise or behavioral program.
- 4
Answer step therapy, if there is any
Ask whether another drug must come first. If you have already tried one, the request should list it with dates and the reason it stopped.
- 5
Submit, then track it
Your prescriber sends the plan’s form with the notes. Write down the date and the reference number, and ask how you will hear back.
- 6
Plan for the renewal
What the documents say: Approval lasts 1 year.
Get your real answer
Check your plan's price via myCigna or express-scripts.com "Price a Medication" for Ozempic, and make sure the prescriber submits the prior auth with a documented type 2 diabetes diagnosis (not obesity alone).
Coverage is plan-specific: this page reports what Cigna publishes, not a promise about your plan. Not medical or insurance advice.
