Applies to Employer and ACA Marketplace plans.
Not coveredThis PCG explicitly states it covers non-weight loss indications only. For use in weight loss, the member is directed to their benefit plan book. Weight loss coverage is outside the scope of this document.
Policy note: This PCG explicitly excludes weight loss as an indication. Members seeking Wegovy for weight loss are directed to their benefit plan book. No PA criteria are established in this document for weight loss.
Policy effective May 16, 2024 · verified June 2, 2026 · source: BCBS Arizona ACA Marketplace prior authorization policy