BCBS Louisiana

Does BCBS Louisiana cover Wegovy?

Quick answer · Weight Loss

BCBS Louisiana does not cover it for weight loss on Employer / Commercial Insurance and ACA Marketplace.

  • Employer / Commercial Insurance: Not covered. Wegovy for weight loss (to reduce excess body weight and maintain weight reduction long term in adults and pediatric patients aged 12 years and older with obesity and adults with overweight in the presence of at least one weight-related comorbid condition) is explicitly not covered for members whose contract EXCLUDES coverage of medications for obesity, weight loss, weight management, or weight maintenance. The document notes this exclusion applies to most member contracts.
  • ACA Marketplace: Not covered. Wegovy for weight loss (to reduce excess body weight and maintain weight reduction long term in adults and pediatric patients aged 12 years and older with obesity and adults with overweight in the presence of at least one weight-related comorbid condition) is explicitly not covered for members whose contract EXCLUDES coverage of medications for obesity, weight loss, weight management, or weight maintenance. The document notes this exclusion applies to most member contracts.

Last verified June 2, 2026. Policy effective May 1, 2026. Source: 00886%2020240812%20Wegovy%20semaglutideaccessible%20pdf.pdf. How we verify this data →

Check your card for your exact plan →

Wegovy for Weight Loss

What BCBS Louisiana requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Not covered

Wegovy for weight loss (to reduce excess body weight and maintain weight reduction long term in adults and pediatric patients aged 12 years and older with obesity and adults with overweight in the presence of at least one weight-related comorbid condition) is explicitly not covered for members whose contract EXCLUDES coverage of medications for obesity, weight loss, weight management, or weight maintenance. The document notes this exclusion applies to most member contracts.

Policy note: The policy explicitly states that coverage of medications for obesity, weight loss, weight management, or weight maintenance is considered an exclusion in most member contracts. The policy does not establish PA criteria for Wegovy for the weight_loss indication — it only establishes criteria for cv_risk_reduction and mash. The FDA-approved weight loss indication (adults/peds 12+ with obesity; adults overweight with comorbidity) is explicitly noted as not covered for contracts that exclude obesity medications.

Policy effective May 1, 2026 · verified June 2, 2026 · source: 00886%2020240812%20Wegovy%20semaglutideaccessible%20pdf.pdf

ACA Marketplace

Not covered

Wegovy for weight loss (to reduce excess body weight and maintain weight reduction long term in adults and pediatric patients aged 12 years and older with obesity and adults with overweight in the presence of at least one weight-related comorbid condition) is explicitly not covered for members whose contract EXCLUDES coverage of medications for obesity, weight loss, weight management, or weight maintenance. The document notes this exclusion applies to most member contracts.

Policy note: The policy explicitly states that coverage of medications for obesity, weight loss, weight management, or weight maintenance is considered an exclusion in most member contracts. The policy does not establish PA criteria for Wegovy for the weight_loss indication — it only establishes criteria for cv_risk_reduction and mash. The FDA-approved weight loss indication (adults/peds 12+ with obesity; adults overweight with comorbidity) is explicitly noted as not covered for contracts that exclude obesity medications.

Policy effective May 1, 2026 · verified June 2, 2026 · source: 00886%2020240812%20Wegovy%20semaglutideaccessible%20pdf.pdf

Wegovy for Heart Disease Risk Reduction

What BCBS Louisiana requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Age 45 and older
  • BMI of 27 or higher
  • A1C no higher than 6.4%
  • Established cardiovascular disease (prior_MI, prior_stroke_ischemic, prior_stroke_hemorrhagic, TIA, angina_pectoris_with_atherosclerosis_>=50%_stenosis, prior_PTCA, prior_CABG, symptomatic_carotid_stenosis_>=50%, prior_carotid_endarterectomy, carotid_artery_angioplasty_and_stenting, aortic_aneurysm_secondary_to_atherosclerosis, history_of_aortic_aneurysm_repair, symptomatic_PAD_with_intermittent_claudication_ABI<0.85, peripheral_arterial_revascularization, and amputation_due_to_atherosclerotic_disease)
  • On guideline-directed medical therapy (antiplatelet_agent (aspirin or P2Y12 inhibitor), lipid-lowering drug (statin, ezetimibe, fibrate, or PCSK9 inhibitor), and antihypertensive therapy (beta blocker, ACE-I, or ARB))
  • Lab results confirming eligibility
  • Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

Initial Authorization - CV Risk Reduction (Wegovy injection or tablet)

All of:

  • Patient is 45 years of age or older (ages 18-44 denied as not medically necessary; age <18 denied as investigational)
  • BMI >= 27 kg/m2 (BMI 25 to <27 denied as not medically necessary; BMI <25 denied as investigational)
  • Patient does NOT have Type I or Type II Diabetes Mellitus diagnosis AND does not have HbA1c >= 6.5%
  • Patient does NOT have NYHA Class IV heart failure, chronic pancreatitis, or acute pancreatitis within the last 180 days
  • Patient does NOT have personal history of, or first-degree relative with, medullary thyroid carcinoma or personal history of MEN 2
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient will NOT use medication in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • Patient will use medication in combination with guideline-directed pharmacotherapy for CVD (antiplatelet agent, lipid-lowering drug, and antihypertensive therapy)

Plus any one of:

  • Prior myocardial infarction (MI)
  • Prior stroke (ischemic or hemorrhagic) or documented history of TIA
  • Angina pectoris with significant atherosclerosis (>= 50% stenosis)
  • Prior PTCA or CABG
  • Symptomatic carotid stenosis (>= 50% stenosis)
  • Prior carotid endarterectomy or carotid artery angioplasty and stenting
  • Aortic aneurysm secondary to atherosclerosis or history of aortic aneurysm repair
  • Symptomatic PAD evidenced by: intermittent claudication with ABI <0.85 (at rest), OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease

Continuation Authorization - CV Risk Reduction (Wegovy injection)

All of:

  • Patient has received an initial authorization for Wegovy injection or tablets
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient had a BMI >= 27 kg/m2 prior to initiation of therapy (BMI 25 to <27 at initiation denied as not medically necessary; BMI <25 at initiation denied as investigational)
  • Patient has NOT developed Type II DM since the previous authorization
  • Patient does NOT have NYHA Class IV heart failure, chronic pancreatitis, or acute pancreatitis within the last 180 days
  • Patient will continue guideline-directed pharmacotherapy for CVD (antiplatelet agent, lipid-lowering drug, and antihypertensive therapy)
  • Patient is tolerating a Wegovy injection maintenance dose of 2.4 mg once weekly
  • Patient will NOT use medication in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists

Plus any one of:

  • Prior MI
  • Prior stroke (ischemic or hemorrhagic) or documented history of TIA
  • Angina pectoris with significant atherosclerosis (>= 50% stenosis)
  • Prior PTCA or CABG
  • Symptomatic carotid stenosis (>= 50% stenosis)
  • Prior carotid endarterectomy or carotid artery angioplasty and stenting
  • Aortic aneurysm secondary to atherosclerosis or history of aortic aneurysm repair
  • Symptomatic PAD evidenced by: intermittent claudication with ABI <0.85 (at rest), OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease

Continuation Authorization - CV Risk Reduction (Wegovy tablet)

All of:

  • Patient has received an initial authorization for Wegovy injection or tablets
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient had a BMI >= 27 kg/m2 prior to initiation of therapy (BMI 25 to <27 at initiation denied as not medically necessary; BMI <25 at initiation denied as investigational)
  • Patient has NOT developed Type II DM since the previous authorization
  • Patient does NOT have NYHA Class IV heart failure, chronic pancreatitis, or acute pancreatitis within the last 180 days
  • Patient will continue guideline-directed pharmacotherapy for CVD (antiplatelet agent, lipid-lowering drug, and antihypertensive therapy)
  • Patient is tolerating a Wegovy tablet maintenance dose of 25 mg once daily
  • Patient will NOT use medication in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists

Plus any one of:

  • Prior MI
  • Prior stroke (ischemic or hemorrhagic) or documented history of TIA
  • Angina pectoris with significant atherosclerosis (>= 50% stenosis)
  • Prior PTCA or CABG
  • Symptomatic carotid stenosis (>= 50% stenosis)
  • Prior carotid endarterectomy or carotid artery angioplasty and stenting
  • Aortic aneurysm secondary to atherosclerosis or history of aortic aneurysm repair
  • Symptomatic PAD evidenced by: intermittent claudication with ABI <0.85 (at rest), OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease

Documentation to bring

  • Documentation of patient age >= 45 years
  • Baseline BMI documentation >= 27 kg/m2
  • Documentation of established CVD qualifying event (prior MI, prior stroke/TIA, angina with >= 50% stenosis, prior PTCA/CABG, symptomatic carotid stenosis >= 50%, prior carotid endarterectomy/stenting, aortic aneurysm, or symptomatic PAD with ABI <0.85/revascularization/amputation)
  • Documentation confirming no diagnosis of Type I or Type II Diabetes Mellitus
  • HbA1c lab result confirming HbA1c < 6.5%
  • Documentation of current guideline-directed pharmacotherapy for CVD (antiplatelet agent, lipid-lowering drug, and antihypertensive therapy) or clinical justification if any component is not used
  • Documentation confirming no NYHA Class IV heart failure diagnosis
  • Documentation confirming no chronic pancreatitis and no acute pancreatitis within the last 180 days
  • Documentation confirming no personal history or first-degree family history of medullary thyroid carcinoma or MEN 2
  • Prescriber attestation that medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Prescriber attestation that medication will NOT be used in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • For continuation (injection): Documentation that patient is tolerating Wegovy injection maintenance dose of 2.4 mg once weekly
  • For continuation (tablet): Documentation that patient is tolerating Wegovy tablet maintenance dose of 25 mg once daily
  • For continuation: Documentation confirming patient has not developed Type II DM since previous authorization

Approval and renewal

  • Initial approval: 6 months
  • To renew, the plan looks for For continuation: patient must have established CVD (same qualifying events as initial), must have had a baseline BMI >= 27 kg/m2 prior to therapy initiation, must not have developed Type II DM since previous authorization, must not have NYHA Class IV heart failure/chronic pancreatitis/acute pancreatitis within last 180 days, must continue GDMT, and must be tolerating maintenance dose (2.4 mg/week for injection or 25 mg/day for tablet). Age >= 45 is NOT re-verified at continuation. A1C exclusion (>=6.5%) is NOT explicitly re-verified at continuation (only new T2DM diagnosis is checked) and staying on a maintenance dose of at least 2.4 mg.

Not covered when

  • Type II Diabetes Mellitus diagnosis
  • HbA1c >= 6.5%
  • NYHA Class IV heart failure
  • Chronic pancreatitis
  • Acute pancreatitis within the last 180 days
  • Personal history of medullary thyroid carcinoma
  • First-degree relative with medullary thyroid carcinoma
  • Personal history of Multiple Endocrine Neoplasia type 2 (MEN 2)
  • Concomitant use with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • Age < 18 (investigational)
  • Age 18-44 (denied as not medically necessary)
  • BMI < 25 (investigational)
  • BMI 25 to <27 (denied as not medically necessary)
  • Use without concomitant behavioral modification and reduced-calorie diet (investigational)
  • No established cardiovascular disease (not covered for contracts excluding obesity medications; not medically necessary for contracts including obesity medications)
  • Type 1 diabetes

Policy note: Policy covers both Wegovy injection and Wegovy tablet for CV risk reduction. Initial authorization is for 6 months. For contracts that INCLUDE obesity medication coverage, the established CVD requirement and GDMT requirement are additional company requirements (denial as not medically necessary if not met). For contracts that EXCLUDE obesity medication coverage, lack of established CVD results in a not covered determination. Wegovy tablet lacks a dedicated CV outcomes trial; support for this indication is based on pharmacokinetic modeling. The policy explicitly excludes patients with T1DM or T2DM AND HbA1c >= 6.5% (considered investigational). Ages 18-44 are denied as not medically necessary (not investigational). Minimum maintenance dose for continuation of injection is 2.4 mg/week; for tablet is 25 mg/day.

Policy effective May 1, 2026 · verified June 2, 2026 · source: 00886%2020240812%20Wegovy%20semaglutideaccessible%20pdf.pdf

ACA Marketplace

Covered with requirements

What you need to qualify

  • Age 45 and older
  • BMI of 27 or higher
  • A1C no higher than 6.4%
  • Established cardiovascular disease (prior_MI, prior_stroke_ischemic, prior_stroke_hemorrhagic, TIA, angina_pectoris_with_atherosclerosis_>=50%_stenosis, prior_PTCA, prior_CABG, symptomatic_carotid_stenosis_>=50%, prior_carotid_endarterectomy, carotid_artery_angioplasty_and_stenting, aortic_aneurysm_secondary_to_atherosclerosis, history_of_aortic_aneurysm_repair, symptomatic_PAD_with_intermittent_claudication_ABI<0.85, peripheral_arterial_revascularization, and amputation_due_to_atherosclerotic_disease)
  • On guideline-directed medical therapy (antiplatelet_agent (aspirin or P2Y12 inhibitor), lipid-lowering drug (statin, ezetimibe, fibrate, or PCSK9 inhibitor), and antihypertensive therapy (beta blocker, ACE-I, or ARB))
  • Lab results confirming eligibility
  • Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

Initial Authorization - CV Risk Reduction (Wegovy injection or tablet)

All of:

  • Patient is 45 years of age or older (ages 18-44 denied as not medically necessary; age <18 denied as investigational)
  • BMI >= 27 kg/m2 (BMI 25 to <27 denied as not medically necessary; BMI <25 denied as investigational)
  • Patient does NOT have Type I or Type II Diabetes Mellitus diagnosis AND does not have HbA1c >= 6.5%
  • Patient does NOT have NYHA Class IV heart failure, chronic pancreatitis, or acute pancreatitis within the last 180 days
  • Patient does NOT have personal history of, or first-degree relative with, medullary thyroid carcinoma or personal history of MEN 2
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient will NOT use medication in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • Patient will use medication in combination with guideline-directed pharmacotherapy for CVD (antiplatelet agent, lipid-lowering drug, and antihypertensive therapy)

Plus any one of:

  • Prior myocardial infarction (MI)
  • Prior stroke (ischemic or hemorrhagic) or documented history of TIA
  • Angina pectoris with significant atherosclerosis (>= 50% stenosis)
  • Prior PTCA or CABG
  • Symptomatic carotid stenosis (>= 50% stenosis)
  • Prior carotid endarterectomy or carotid artery angioplasty and stenting
  • Aortic aneurysm secondary to atherosclerosis or history of aortic aneurysm repair
  • Symptomatic PAD evidenced by: intermittent claudication with ABI <0.85 (at rest), OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease

Continuation Authorization - CV Risk Reduction (Wegovy injection)

All of:

  • Patient has received an initial authorization for Wegovy injection or tablets
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient had a BMI >= 27 kg/m2 prior to initiation of therapy (BMI 25 to <27 at initiation denied as not medically necessary; BMI <25 at initiation denied as investigational)
  • Patient has NOT developed Type II DM since the previous authorization
  • Patient does NOT have NYHA Class IV heart failure, chronic pancreatitis, or acute pancreatitis within the last 180 days
  • Patient will continue guideline-directed pharmacotherapy for CVD (antiplatelet agent, lipid-lowering drug, and antihypertensive therapy)
  • Patient is tolerating a Wegovy injection maintenance dose of 2.4 mg once weekly
  • Patient will NOT use medication in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists

Plus any one of:

  • Prior MI
  • Prior stroke (ischemic or hemorrhagic) or documented history of TIA
  • Angina pectoris with significant atherosclerosis (>= 50% stenosis)
  • Prior PTCA or CABG
  • Symptomatic carotid stenosis (>= 50% stenosis)
  • Prior carotid endarterectomy or carotid artery angioplasty and stenting
  • Aortic aneurysm secondary to atherosclerosis or history of aortic aneurysm repair
  • Symptomatic PAD evidenced by: intermittent claudication with ABI <0.85 (at rest), OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease

Continuation Authorization - CV Risk Reduction (Wegovy tablet)

All of:

  • Patient has received an initial authorization for Wegovy injection or tablets
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient had a BMI >= 27 kg/m2 prior to initiation of therapy (BMI 25 to <27 at initiation denied as not medically necessary; BMI <25 at initiation denied as investigational)
  • Patient has NOT developed Type II DM since the previous authorization
  • Patient does NOT have NYHA Class IV heart failure, chronic pancreatitis, or acute pancreatitis within the last 180 days
  • Patient will continue guideline-directed pharmacotherapy for CVD (antiplatelet agent, lipid-lowering drug, and antihypertensive therapy)
  • Patient is tolerating a Wegovy tablet maintenance dose of 25 mg once daily
  • Patient will NOT use medication in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists

Plus any one of:

  • Prior MI
  • Prior stroke (ischemic or hemorrhagic) or documented history of TIA
  • Angina pectoris with significant atherosclerosis (>= 50% stenosis)
  • Prior PTCA or CABG
  • Symptomatic carotid stenosis (>= 50% stenosis)
  • Prior carotid endarterectomy or carotid artery angioplasty and stenting
  • Aortic aneurysm secondary to atherosclerosis or history of aortic aneurysm repair
  • Symptomatic PAD evidenced by: intermittent claudication with ABI <0.85 (at rest), OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease

Documentation to bring

  • Documentation of patient age >= 45 years
  • Baseline BMI documentation >= 27 kg/m2
  • Documentation of established CVD qualifying event (prior MI, prior stroke/TIA, angina with >= 50% stenosis, prior PTCA/CABG, symptomatic carotid stenosis >= 50%, prior carotid endarterectomy/stenting, aortic aneurysm, or symptomatic PAD with ABI <0.85/revascularization/amputation)
  • Documentation confirming no diagnosis of Type I or Type II Diabetes Mellitus
  • HbA1c lab result confirming HbA1c < 6.5%
  • Documentation of current guideline-directed pharmacotherapy for CVD (antiplatelet agent, lipid-lowering drug, and antihypertensive therapy) or clinical justification if any component is not used
  • Documentation confirming no NYHA Class IV heart failure diagnosis
  • Documentation confirming no chronic pancreatitis and no acute pancreatitis within the last 180 days
  • Documentation confirming no personal history or first-degree family history of medullary thyroid carcinoma or MEN 2
  • Prescriber attestation that medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Prescriber attestation that medication will NOT be used in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • For continuation (injection): Documentation that patient is tolerating Wegovy injection maintenance dose of 2.4 mg once weekly
  • For continuation (tablet): Documentation that patient is tolerating Wegovy tablet maintenance dose of 25 mg once daily
  • For continuation: Documentation confirming patient has not developed Type II DM since previous authorization

Approval and renewal

  • Initial approval: 6 months
  • To renew, the plan looks for For continuation: patient must have established CVD (same qualifying events as initial), must have had a baseline BMI >= 27 kg/m2 prior to therapy initiation, must not have developed Type II DM since previous authorization, must not have NYHA Class IV heart failure/chronic pancreatitis/acute pancreatitis within last 180 days, must continue GDMT, and must be tolerating maintenance dose (2.4 mg/week for injection or 25 mg/day for tablet). Age >= 45 is NOT re-verified at continuation. A1C exclusion (>=6.5%) is NOT explicitly re-verified at continuation (only new T2DM diagnosis is checked) and staying on a maintenance dose of at least 2.4 mg.

Not covered when

  • Type II Diabetes Mellitus diagnosis
  • HbA1c >= 6.5%
  • NYHA Class IV heart failure
  • Chronic pancreatitis
  • Acute pancreatitis within the last 180 days
  • Personal history of medullary thyroid carcinoma
  • First-degree relative with medullary thyroid carcinoma
  • Personal history of Multiple Endocrine Neoplasia type 2 (MEN 2)
  • Concomitant use with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • Age < 18 (investigational)
  • Age 18-44 (denied as not medically necessary)
  • BMI < 25 (investigational)
  • BMI 25 to <27 (denied as not medically necessary)
  • Use without concomitant behavioral modification and reduced-calorie diet (investigational)
  • No established cardiovascular disease (not covered for contracts excluding obesity medications; not medically necessary for contracts including obesity medications)
  • Type 1 diabetes

Policy note: Policy covers both Wegovy injection and Wegovy tablet for CV risk reduction. Initial authorization is for 6 months. For contracts that INCLUDE obesity medication coverage, the established CVD requirement and GDMT requirement are additional company requirements (denial as not medically necessary if not met). For contracts that EXCLUDE obesity medication coverage, lack of established CVD results in a not covered determination. Wegovy tablet lacks a dedicated CV outcomes trial; support for this indication is based on pharmacokinetic modeling. The policy explicitly excludes patients with T1DM or T2DM AND HbA1c >= 6.5% (considered investigational). Ages 18-44 are denied as not medically necessary (not investigational). Minimum maintenance dose for continuation of injection is 2.4 mg/week; for tablet is 25 mg/day.

Policy effective May 1, 2026 · verified June 2, 2026 · source: 00886%2020240812%20Wegovy%20semaglutideaccessible%20pdf.pdf

Wegovy for Liver Disease (MASH)

What BCBS Louisiana requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Confirmed MASH diagnosis by liver_biopsy, FibroScan_VCTE, transient_elastography, shear_wave_elastography, and MRE, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

Initial Authorization - MASH (Wegovy injection only)

All of:

  • Patient is 18 years of age or older
  • Confirmed and documented diagnosis of MASH with moderate to advanced liver fibrosis (stages F2 to F3) - NOT cirrhosis (F4) and NOT hepatic decompensation
  • Patient does NOT have cirrhosis (F4) or hepatic decompensation
  • Patient does NOT have Type I Diabetes Mellitus diagnosis
  • Patient does NOT have acute pancreatitis within the last 180 days
  • Patient has no history or current evidence of chronic pancreatitis
  • Patient does NOT have documented causes of chronic liver disease other than MASLD
  • Patient has no history or current evidence of hepatocellular carcinoma
  • Patient does NOT have personal history of, or first-degree relative with, medullary thyroid carcinoma or personal history of MEN 2
  • Patient does NOT have excessive alcohol use within past 3 months (defined as >20 g/day for women and >30 g/day for men)
  • Patient's concomitant related conditions (dyslipidemia, Type II diabetes, hypertension) are managed according to standard of care
  • Medication will be used in conjunction with lifestyle interventions (diet and exercise)
  • Patient will NOT use medication in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • Patient will NOT use medication in combination with Rezdiffra (resmetirom tablets)

Plus any one of:

  • Liver biopsy within the last 12 months confirming MASH with F2-F3 fibrosis AND (if biopsy used) NAFLD Activity Score (NAS) >= 4 with score > 1 in ALL of: steatosis, hepatocyte ballooning, and lobular inflammation
  • Imaging-based elastography within the last 6 months confirming F2-F3 fibrosis (vibration-controlled elastography/FibroScan, transient elastography, shear wave elastography, or magnetic resonance elastography)

Continuation Authorization - MASH (Wegovy injection only)

All of:

  • Patient has an initial authorization for the requested medication
  • Patient has documentation of a diagnosis of MASH with moderate to advanced liver fibrosis (stages F2 to F3)
  • Patient has NOT progressed to stage F4 (cirrhosis)
  • Patient has been adherent to treatment with Wegovy
  • Patient is experiencing a positive clinical response (stabilization and/or improvement in fibrosis and/or MASH)
  • Patient's concomitant related conditions (dyslipidemia, Type II diabetes, hypertension) are managed according to standard of care
  • Patient does NOT have excessive alcohol use within past 3 months (>20 g/day for women and >30 g/day for men)
  • Patient is tolerating a maintenance dose of 2.4 mg once weekly
  • Patient will NOT use medication in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • Patient will NOT use medication in combination with Rezdiffra (resmetirom tablets)

Documentation to bring

  • Documentation of patient age >= 18 years
  • Confirmed and documented diagnosis of MASH with moderate to advanced liver fibrosis (F2 to F3 fibrosis)
  • Liver biopsy report within the last 12 months confirming MASH with F2-F3 fibrosis (if biopsy used as confirmation method), OR imaging-based elastography report within the last 6 months (FibroScan/VCTE, transient elastography, shear wave elastography, or MRE) confirming F2-F3 fibrosis
  • If liver biopsy used: NAFLD Activity Score (NAS) >= 4 documented, with score > 1 in ALL of steatosis, hepatocyte ballooning, and lobular inflammation
  • Documentation confirming no cirrhosis (F4) or hepatic decompensation
  • Documentation confirming no Type I Diabetes Mellitus diagnosis
  • Documentation confirming no acute pancreatitis within the last 180 days
  • Documentation confirming no history or current evidence of chronic pancreatitis
  • Documentation confirming no other documented causes of chronic liver disease other than MASLD
  • Documentation confirming no history or current evidence of hepatocellular carcinoma
  • Documentation confirming no personal history or first-degree family history of medullary thyroid carcinoma or MEN 2
  • Documentation confirming patient does not have excessive alcohol use within past 3 months (>20 g/day women, >30 g/day men)
  • Documentation that comorbid conditions (dyslipidemia, T2DM if present, hypertension) are managed per standard of care
  • Prescriber attestation that medication will be used in conjunction with lifestyle interventions (diet and exercise)
  • Prescriber attestation that medication will NOT be used in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • Prescriber attestation that medication will NOT be used in combination with Rezdiffra (resmetirom tablets)
  • For continuation: Documentation of positive clinical response (stabilization and/or improvement in fibrosis and/or MASH)
  • For continuation: Documentation confirming adherence to treatment
  • For continuation: Documentation that patient is tolerating maintenance dose of 2.4 mg once weekly
  • For continuation: Documentation confirming patient has not progressed to F4 cirrhosis

Approval and renewal

  • To renew, the plan looks for For continuation: patient must be experiencing a positive clinical response as evidenced by documentation of stabilization and/or improvement in fibrosis and/or MASH (e.g., improved steatosis, improved fibrosis, improvement in fibrosis score, lack of disease progression). Patient must not have progressed to stage F4 (cirrhosis). Patient must have been adherent to treatment. Patient must be tolerating maintenance dose of 2.4 mg once weekly. Comorbid conditions (dyslipidemia, T2DM, hypertension) must be managed per standard of care. Alcohol limits continue to apply (within past 3 months). Initial diagnosis confirmation testing (biopsy/imaging) is NOT re-required at continuation — only documentation of MASH F2-F3 diagnosis is needed and staying on a maintenance dose of at least 2.4 mg.

Not covered when

  • Cirrhosis (F4) or hepatic decompensation (investigational for contracts including obesity medications; not covered for contracts excluding obesity medications)
  • Acute pancreatitis within the last 180 days
  • History or current evidence of chronic pancreatitis
  • Documented causes of chronic liver disease other than MASLD
  • History or current evidence of hepatocellular carcinoma
  • Personal history of medullary thyroid carcinoma
  • First-degree relative with medullary thyroid carcinoma
  • Personal history of MEN 2
  • Excessive alcohol use within past 3 months (>20 g/day for women or >30 g/day for men)
  • Concomitant use with Rezdiffra (resmetirom tablets) - investigational
  • Concomitant use with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists - investigational
  • Wegovy TABLET formulation for MASH - explicitly not covered
  • Pediatric patients (age < 18) - investigational
  • Use without lifestyle interventions (diet and exercise) - investigational
  • Absence of confirmed MASH F2-F3 diagnosis (investigational for contracts including obesity medications; not covered for contracts excluding obesity medications)
  • Type 1 diabetes

Policy note: IMPORTANT: Only Wegovy injection is covered for MASH. Wegovy tablet for MASH is explicitly stated as not covered. The policy requires fibrosis staging F2 to F3 only — F1 and below are not covered, and F4 (cirrhosis) is explicitly excluded. Confirmation requires either liver biopsy within 12 months OR imaging-based elastography (specifically: FibroScan/VCTE, transient elastography, shear wave elastography, or MRE) within 6 months. Note that FIB-4 and ELF (serum/blood-based tests) are NOT accepted as confirmation methods per this policy — only biopsy or imaging elastography. If biopsy is used, NAS >= 4 with score > 1 in all three components (steatosis, hepatocyte ballooning, lobular inflammation) is required. Type I DM is excluded (investigational); Type II DM is NOT excluded but must be managed per standard of care. Alcohol limits: >20 g/day for women and >30 g/day for men within past 3 months is an exclusion. Concomitant Rezdiffra use is investigational. For contracts including obesity medication coverage, the MASH F2-F3 diagnosis requirement is an additional company requirement; for contracts excluding obesity medication coverage, absence of confirmed diagnosis results in not covered determination.

Policy effective May 1, 2026 · verified June 2, 2026 · source: 00886%2020240812%20Wegovy%20semaglutideaccessible%20pdf.pdf

ACA Marketplace

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Confirmed MASH diagnosis by liver_biopsy, FibroScan_VCTE, transient_elastography, shear_wave_elastography, and MRE, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

Initial Authorization - MASH (Wegovy injection only)

All of:

  • Patient is 18 years of age or older
  • Confirmed and documented diagnosis of MASH with moderate to advanced liver fibrosis (stages F2 to F3) - NOT cirrhosis (F4) and NOT hepatic decompensation
  • Patient does NOT have cirrhosis (F4) or hepatic decompensation
  • Patient does NOT have Type I Diabetes Mellitus diagnosis
  • Patient does NOT have acute pancreatitis within the last 180 days
  • Patient has no history or current evidence of chronic pancreatitis
  • Patient does NOT have documented causes of chronic liver disease other than MASLD
  • Patient has no history or current evidence of hepatocellular carcinoma
  • Patient does NOT have personal history of, or first-degree relative with, medullary thyroid carcinoma or personal history of MEN 2
  • Patient does NOT have excessive alcohol use within past 3 months (defined as >20 g/day for women and >30 g/day for men)
  • Patient's concomitant related conditions (dyslipidemia, Type II diabetes, hypertension) are managed according to standard of care
  • Medication will be used in conjunction with lifestyle interventions (diet and exercise)
  • Patient will NOT use medication in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • Patient will NOT use medication in combination with Rezdiffra (resmetirom tablets)

Plus any one of:

  • Liver biopsy within the last 12 months confirming MASH with F2-F3 fibrosis AND (if biopsy used) NAFLD Activity Score (NAS) >= 4 with score > 1 in ALL of: steatosis, hepatocyte ballooning, and lobular inflammation
  • Imaging-based elastography within the last 6 months confirming F2-F3 fibrosis (vibration-controlled elastography/FibroScan, transient elastography, shear wave elastography, or magnetic resonance elastography)

Continuation Authorization - MASH (Wegovy injection only)

All of:

  • Patient has an initial authorization for the requested medication
  • Patient has documentation of a diagnosis of MASH with moderate to advanced liver fibrosis (stages F2 to F3)
  • Patient has NOT progressed to stage F4 (cirrhosis)
  • Patient has been adherent to treatment with Wegovy
  • Patient is experiencing a positive clinical response (stabilization and/or improvement in fibrosis and/or MASH)
  • Patient's concomitant related conditions (dyslipidemia, Type II diabetes, hypertension) are managed according to standard of care
  • Patient does NOT have excessive alcohol use within past 3 months (>20 g/day for women and >30 g/day for men)
  • Patient is tolerating a maintenance dose of 2.4 mg once weekly
  • Patient will NOT use medication in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • Patient will NOT use medication in combination with Rezdiffra (resmetirom tablets)

Documentation to bring

  • Documentation of patient age >= 18 years
  • Confirmed and documented diagnosis of MASH with moderate to advanced liver fibrosis (F2 to F3 fibrosis)
  • Liver biopsy report within the last 12 months confirming MASH with F2-F3 fibrosis (if biopsy used as confirmation method), OR imaging-based elastography report within the last 6 months (FibroScan/VCTE, transient elastography, shear wave elastography, or MRE) confirming F2-F3 fibrosis
  • If liver biopsy used: NAFLD Activity Score (NAS) >= 4 documented, with score > 1 in ALL of steatosis, hepatocyte ballooning, and lobular inflammation
  • Documentation confirming no cirrhosis (F4) or hepatic decompensation
  • Documentation confirming no Type I Diabetes Mellitus diagnosis
  • Documentation confirming no acute pancreatitis within the last 180 days
  • Documentation confirming no history or current evidence of chronic pancreatitis
  • Documentation confirming no other documented causes of chronic liver disease other than MASLD
  • Documentation confirming no history or current evidence of hepatocellular carcinoma
  • Documentation confirming no personal history or first-degree family history of medullary thyroid carcinoma or MEN 2
  • Documentation confirming patient does not have excessive alcohol use within past 3 months (>20 g/day women, >30 g/day men)
  • Documentation that comorbid conditions (dyslipidemia, T2DM if present, hypertension) are managed per standard of care
  • Prescriber attestation that medication will be used in conjunction with lifestyle interventions (diet and exercise)
  • Prescriber attestation that medication will NOT be used in combination with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists
  • Prescriber attestation that medication will NOT be used in combination with Rezdiffra (resmetirom tablets)
  • For continuation: Documentation of positive clinical response (stabilization and/or improvement in fibrosis and/or MASH)
  • For continuation: Documentation confirming adherence to treatment
  • For continuation: Documentation that patient is tolerating maintenance dose of 2.4 mg once weekly
  • For continuation: Documentation confirming patient has not progressed to F4 cirrhosis

Approval and renewal

  • To renew, the plan looks for For continuation: patient must be experiencing a positive clinical response as evidenced by documentation of stabilization and/or improvement in fibrosis and/or MASH (e.g., improved steatosis, improved fibrosis, improvement in fibrosis score, lack of disease progression). Patient must not have progressed to stage F4 (cirrhosis). Patient must have been adherent to treatment. Patient must be tolerating maintenance dose of 2.4 mg once weekly. Comorbid conditions (dyslipidemia, T2DM, hypertension) must be managed per standard of care. Alcohol limits continue to apply (within past 3 months). Initial diagnosis confirmation testing (biopsy/imaging) is NOT re-required at continuation — only documentation of MASH F2-F3 diagnosis is needed and staying on a maintenance dose of at least 2.4 mg.

Not covered when

  • Cirrhosis (F4) or hepatic decompensation (investigational for contracts including obesity medications; not covered for contracts excluding obesity medications)
  • Acute pancreatitis within the last 180 days
  • History or current evidence of chronic pancreatitis
  • Documented causes of chronic liver disease other than MASLD
  • History or current evidence of hepatocellular carcinoma
  • Personal history of medullary thyroid carcinoma
  • First-degree relative with medullary thyroid carcinoma
  • Personal history of MEN 2
  • Excessive alcohol use within past 3 months (>20 g/day for women or >30 g/day for men)
  • Concomitant use with Rezdiffra (resmetirom tablets) - investigational
  • Concomitant use with other GLP-1 Agonists or GLP-1/GIP Receptor Agonists - investigational
  • Wegovy TABLET formulation for MASH - explicitly not covered
  • Pediatric patients (age < 18) - investigational
  • Use without lifestyle interventions (diet and exercise) - investigational
  • Absence of confirmed MASH F2-F3 diagnosis (investigational for contracts including obesity medications; not covered for contracts excluding obesity medications)
  • Type 1 diabetes

Policy note: IMPORTANT: Only Wegovy injection is covered for MASH. Wegovy tablet for MASH is explicitly stated as not covered. The policy requires fibrosis staging F2 to F3 only — F1 and below are not covered, and F4 (cirrhosis) is explicitly excluded. Confirmation requires either liver biopsy within 12 months OR imaging-based elastography (specifically: FibroScan/VCTE, transient elastography, shear wave elastography, or MRE) within 6 months. Note that FIB-4 and ELF (serum/blood-based tests) are NOT accepted as confirmation methods per this policy — only biopsy or imaging elastography. If biopsy is used, NAS >= 4 with score > 1 in all three components (steatosis, hepatocyte ballooning, lobular inflammation) is required. Type I DM is excluded (investigational); Type II DM is NOT excluded but must be managed per standard of care. Alcohol limits: >20 g/day for women and >30 g/day for men within past 3 months is an exclusion. Concomitant Rezdiffra use is investigational. For contracts including obesity medication coverage, the MASH F2-F3 diagnosis requirement is an additional company requirement; for contracts excluding obesity medication coverage, absence of confirmed diagnosis results in not covered determination.

Policy effective May 1, 2026 · verified June 2, 2026 · source: 00886%2020240812%20Wegovy%20semaglutideaccessible%20pdf.pdf

Why Wegovy requests get denied by BCBS Louisiana

Based on what this policy asks for. Fix these before the first submission.

  1. Your plan's benefit excludes weight loss medications. A prior authorization cannot override a benefit exclusion — ask about a formulary exception or a different covered pathway.
  2. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.
  3. BMI not documented in the chart notes (or documented without a baseline weight and date).

If weight loss isn't covered on your plan

BCBS Louisiana has separate Wegovy policies that don't depend on the weight loss benefit:

Wegovy is also sold directly by Novo Nordisk without insurance through NovoCare.

Frequently asked questions

Does BCBS Louisiana cover Wegovy?
BCBS Louisiana does not cover it for weight loss on Employer / Commercial Insurance and ACA Marketplace.
How long does a Wegovy approval last with BCBS Louisiana?
Initial approvals last 6 months.
What does BCBS Louisiana require to renew Wegovy?
For continuation: patient must have established CVD (same qualifying events as initial), must have had a baseline BMI >= 27 kg/m2 prior to therapy initiation, must not have developed Type II DM since previous authorization, must not have NYHA Class IV heart failure/chronic pancreatitis/acute pancreatitis within last 180 days, must continue GDMT, and must be tolerating maintenance dose (2.4 mg/week for injection or 25 mg/day for tablet). Age >= 45 is NOT re-verified at continuation. A1C exclusion (>=6.5%) is NOT explicitly re-verified at continuation (only new T2DM diagnosis is checked) and staying on a maintenance dose of at least 2.4 mg.
What if my plan excludes weight loss medications?
BCBS Louisiana has separate Wegovy policies for heart disease risk reduction and liver disease (mash), which are covered on some plan types and don't depend on the weight-loss benefit. Wegovy is also available for cash through NovoCare.
How current is this information?
This page reflects BCBS Louisiana's written policy as of May 1, 2026, last verified against the source document on June 2, 2026.

Other medications under BCBS Louisiana

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes BCBS Louisiana's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.