The facts
Weight loss
Plan-dependent
Type 2 diabetes
Not indicated
Prior auth
Required
Typical cost
$200/mo cap on opt-in plans
The criteria, as published
4 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
Listed on Cigna's 2026 drug list (pens, HD, tablets); not covered by all plans
“WEGOVY HD [INJ] / WEGOVY PENS [INJ] / WEGOVY TABLETS … Not all the medications listed are covered by all prescription plans; check your benefit materials”
express-scripts.com · 2026 plan year- BMI threshold
BMI 30+, or 27+ with a weight-related condition
“Weight loss medications are specifically excluded under many benefit plans … At baseline, patient had a BMI ≥ 30 kg/m2; OR … BMI ≥ 27 kg/m2 … at least ONE of the following weight-related comorbidities”
static.cigna.com · effective 2026-06-01- Qualifying conditions
At least one weight-related comorbidity when BMI is 27 to 29.9
“Weight loss medications are specifically excluded under many benefit plans … At baseline, patient had a BMI ≥ 30 kg/m2; OR … BMI ≥ 27 kg/m2 … at least ONE of the following weight-related comorbidities”
static.cigna.com · effective 2026-06-01- 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 Wegovy.
- Quantity limit
- Not published in what we readAsk what quantity limit applies to each fill.
- Renewal
- Not published in what we readAsk how long an approval lasts and what the renewal needs.
- Plan can exclude it?
Yes: weight-loss drugs are excluded under many benefit plans
“Weight loss medications are specifically excluded under many benefit plans … At baseline, patient had a BMI ≥ 30 kg/m2; OR … BMI ≥ 27 kg/m2 … at least ONE of the following weight-related comorbidities”
static.cigna.com · effective 2026-06-01- 2026 change
- Not published in what we readAsk whether Wegovy'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: weight-loss drugs are excluded under many benefit plans.
- 2
Get the criteria in writing
Ask for the written prior authorization criteria for Wegovy, so your prescriber answers the plan's questions rather than guessing at them.
- 3
Your prescriber documents the clinical picture
BMI: BMI 30+, or 27+ with a weight-related condition. Conditions: At least one weight-related comorbidity when BMI is 27 to 29.9. 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. Our Wegovy prior authorization letter template covers the cover letter. Write down the date and the reference number, and ask how you will hear back.
- 6
Plan for the renewal
Ask how long the approval lasts and what the renewal needs, so the gap does not catch you out.
Get your real answer
Log in to express-scripts.com or myCigna and run "Price a Medication" for Wegovy. If it shows not covered, ask HR/benefits whether the plan includes the weight-loss GLP-1 benefit or the Evernorth $200/month cap option.
Coverage is plan-specific: this page reports what Cigna publishes, not a promise about your plan. Not medical or insurance advice.
