What BMI do you need for Wegovy under BCBS Wyoming?

For weight loss on Employer / Commercial Insurance plans, BCBS Wyoming requires a BMI of 30 or higher, or 27 or higher with a qualifying weight-related condition. Other plan types may differ — see each plan type below.

How long does a Wegovy approval last with BCBS Wyoming?

Initial approvals last 12 months, and renewals are granted in 12-month periods.

What does BCBS Wyoming require to renew Wegovy?

At least 5% weight loss from the starting weight, at least 5% reduction in BMI, For renewal (after 52 weeks), adult patients must have achieved and maintained >= 5% weight loss from baseline, OR pediatric patients must have achieved and maintained >= 5% BMI reduction from baseline. Patients with = 85th percentile for age and sex, not combining with another weight loss agent, maintaining low-calorie diet/increased physical activity/behavioral modifications, not combining with another GLP-1 agonist, and no FDA labeled contraindications, and at least 52 weeks on therapy before the first renewal.

How current is this information?

This page reflects BCBS Wyoming's written policy as of June 1, 2026, last verified against the source document on June 4, 2026.

Does BCBS Wyoming cover Wegovy?

Wegovy for Weight Loss

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

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

Age 12 and older
BMI of 30 or higher
BMI of 27 or higher with a weight-related condition (hypertension, T2DM, OSA, CVD, and dyslipidemia)
BMI of 25 or higher for patients of Asian descent
BMI at or above the 95th percentile for age and sex
6 months of a documented diet and exercise program

Qualification pathways

You can qualify through any one of these.

Adult weight management (BMI >= 30)

All of:

Patient is an adult (18 years of age or over)
BMI >= 30 kg/m^2
Obesity is NOT restricted from coverage under the patient's benefit
Patient is new to therapy, new to Prime, or attempting a repeat weight loss course of therapy
Patient has been on a weight loss regimen of low-calorie diet, increased physical activity, and behavioral modifications for a minimum of 6 months
Patient will NOT use the requested agent in combination with another weight loss agent (e.g., Contrave, phentermine, Qsymia, Xenical)
Patient will NOT use the requested agent in combination with another GLP-1 receptor agonist
Patient does NOT have any FDA labeled contraindications to the requested agent
Patient is currently on a weight loss regimen of a low-calorie diet, increased physical activity, and behavioral modifications AND will continue it
Age is within FDA labeling for the requested indication OR there is support for use at patient's age

Plus any one of:

Patient has NOT tried a targeted weight loss agent (e.g., Saxenda, Wegovy, Zepbound) in the past 12 months
Patient tried a targeted weight loss agent for a previous course of therapy in the past 12 months AND prescriber anticipates success with repeating therapy

Adult weight management (BMI >= 25 - Asian descent)

All of:

Patient is an adult (18 years of age or over)
Patient is of South Asian, Southeast Asian, or East Asian descent
BMI >= 25 kg/m^2
Obesity is NOT restricted from coverage under the patient's benefit
Patient is new to therapy, new to Prime, or attempting a repeat weight loss course of therapy
Patient has been on a weight loss regimen of low-calorie diet, increased physical activity, and behavioral modifications for a minimum of 6 months
Patient will NOT use the requested agent in combination with another weight loss agent (e.g., Contrave, phentermine, Qsymia, Xenical)
Patient will NOT use the requested agent in combination with another GLP-1 receptor agonist
Patient does NOT have any FDA labeled contraindications to the requested agent
Patient is currently on a weight loss regimen of a low-calorie diet, increased physical activity, and behavioral modifications AND will continue it
Age is within FDA labeling for the requested indication OR there is support for use at patient's age

Plus any one of:

Patient has NOT tried a targeted weight loss agent (e.g., Saxenda, Wegovy, Zepbound) in the past 12 months
Patient tried a targeted weight loss agent for a previous course of therapy in the past 12 months AND prescriber anticipates success with repeating therapy

Adult weight management (BMI >= 27 with comorbidity)

All of:

Patient is an adult (18 years of age or over)
BMI >= 27 kg/m^2
At least one weight-related comorbidity/risk factor/complication (e.g., hypertension, type 2 diabetes mellitus, obstructive sleep apnea, cardiovascular disease, dyslipidemia)
Obesity is NOT restricted from coverage under the patient's benefit
Patient is new to therapy, new to Prime, or attempting a repeat weight loss course of therapy
Patient has been on a weight loss regimen of low-calorie diet, increased physical activity, and behavioral modifications for a minimum of 6 months
Patient will NOT use the requested agent in combination with another weight loss agent (e.g., Contrave, phentermine, Qsymia, Xenical)
Patient will NOT use the requested agent in combination with another GLP-1 receptor agonist
Patient does NOT have any FDA labeled contraindications to the requested agent
Patient is currently on a weight loss regimen of a low-calorie diet, increased physical activity, and behavioral modifications AND will continue it
Age is within FDA labeling for the requested indication OR there is support for use at patient's age

Plus any one of:

Patient has NOT tried a targeted weight loss agent (e.g., Saxenda, Wegovy, Zepbound) in the past 12 months
Patient tried a targeted weight loss agent for a previous course of therapy in the past 12 months AND prescriber anticipates success with repeating therapy

Pediatric weight management (age 12-17, BMI >= 95th percentile or >= 30)

All of:

Patient is pediatric (12 to 17 years of age)
Obesity is NOT restricted from coverage under the patient's benefit
Patient is new to therapy, new to Prime, or attempting a repeat weight loss course of therapy
Patient has been on a weight loss regimen of low-calorie diet, increased physical activity, and behavioral modifications for a minimum of 6 months
Patient will NOT use the requested agent in combination with another weight loss agent
Patient will NOT use the requested agent in combination with another GLP-1 receptor agonist
Patient does NOT have any FDA labeled contraindications to the requested agent
Patient is currently on a weight loss regimen of a low-calorie diet, increased physical activity, and behavioral modifications AND will continue it
Age is within FDA labeling for the requested indication OR there is support for use at patient's age

Plus any one of:

BMI >= 95th percentile for age and sex
BMI >= 30 kg/m^2
BMI >= 85th percentile for age and sex AND at least one weight-related comorbidity/risk factor/complication (e.g., hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea)

Documentation to bring

Documentation of BMI >= 30 kg/m^2 (or >= 27 with comorbidity, or >= 25 if Asian descent, or BMI percentile for pediatric patients)
Documentation of 6-month weight loss regimen (low-calorie diet, increased physical activity, behavioral modifications)
Documentation of weight-related comorbidity if using the 27 kg/m^2 threshold
Documentation of ancestry if using the 25 kg/m^2 Asian threshold
Documentation that obesity is not restricted from coverage under the patient's benefit

Quantity limits

1.5 MG tab, 4 MG tab, 9 MG tab — 60 Tablets per 180 days (84-day)
25 MG tab — 30 Tablets per 30 days
0.25 MG/0.5 ML injection, 0.5 MG/0.5 ML injection, 1 MG/0.5 ML injection — 8 Pens per 180 days (84-day)
1.7 MG/0.75 ML injection, 2.4 MG/0.75 ML injection — 4 Pens per 28 days
7.2 MG/0.75 ML injection (Wegovy hd) — 4 Pens per 28 days

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for at least 5% weight loss from the starting weight, at least 5% reduction in BMI, For renewal (after 52 weeks), adult patients must have achieved and maintained >= 5% weight loss from baseline, OR pediatric patients must have achieved and maintained >= 5% BMI reduction from baseline. Patients with < 52 weeks on therapy on maximum-tolerated dose may also qualify. Renewal also requires: obesity not restricted from benefit, continuing current weight loss course of therapy, pediatric patients (12-17) must have current BMI >= 85th percentile for age and sex, not combining with another weight loss agent, maintaining low-calorie diet/increased physical activity/behavioral modifications, not combining with another GLP-1 agonist, and no FDA labeled contraindications, and at least 52 weeks on therapy before the first renewal. Make sure your starting weight and date are in the chart now — renewal is measured against it.

Not covered when

Combination with another weight loss agent (e.g., Contrave, phentermine, Qsymia, Xenical) not allowed
Combination with another GLP-1 receptor agonist (e.g., Saxenda, Wegovy, Zepbound, Bydureon, Byetta, Mounjaro, Ozempic, Rybelsus, Trulicity, Victoza) not allowed
Any FDA labeled contraindications to the requested agent
Obesity restricted from coverage under the patient's benefit

Policy note: Policy applies to Wegovy injection (subcutaneous) and Wegovy tablets. Quantity limit criteria allow exceptions for maintenance on lower doses if patient is unable to use FDA-labeled maintenance strength and has achieved weight loss on the lower strength. For continuation after 52 weeks on maximum-tolerated dose, patient must demonstrate >= 5% weight loss (adult) or >= 5% BMI reduction (pediatric). Patients with < 52 weeks on maximum-tolerated dose may qualify for renewal without demonstrating weight loss. Policy also allows approval if patient has another FDA labeled indication for the requested agent.

Policy effective June 1, 2026 · verified June 4, 2026 · source: WY_Weight_Management_PAQL_ProgSum.pdf

ACA Marketplace

Covered with requirements

What you need to qualify

Age 12 and older
BMI of 30 or higher
BMI of 27 or higher with a weight-related condition (hypertension, T2DM, OSA, CVD, and dyslipidemia)
BMI of 25 or higher for patients of Asian descent
BMI at or above the 95th percentile for age and sex
6 months of a documented diet and exercise program

Qualification pathways

You can qualify through any one of these.

Adult weight management (BMI >= 30)

All of:

Patient is an adult (18 years of age or over)
BMI >= 30 kg/m^2
Obesity is NOT restricted from coverage under the patient's benefit
Patient is new to therapy, new to Prime, or attempting a repeat weight loss course of therapy
Patient has been on a weight loss regimen of low-calorie diet, increased physical activity, and behavioral modifications for a minimum of 6 months
Patient will NOT use the requested agent in combination with another weight loss agent (e.g., Contrave, phentermine, Qsymia, Xenical)
Patient will NOT use the requested agent in combination with another GLP-1 receptor agonist
Patient does NOT have any FDA labeled contraindications to the requested agent
Patient is currently on a weight loss regimen of a low-calorie diet, increased physical activity, and behavioral modifications AND will continue it
Age is within FDA labeling for the requested indication OR there is support for use at patient's age

Plus any one of:

Patient has NOT tried a targeted weight loss agent (e.g., Saxenda, Wegovy, Zepbound) in the past 12 months
Patient tried a targeted weight loss agent for a previous course of therapy in the past 12 months AND prescriber anticipates success with repeating therapy

Adult weight management (BMI >= 25 - Asian descent)

All of:

Patient is an adult (18 years of age or over)
Patient is of South Asian, Southeast Asian, or East Asian descent
BMI >= 25 kg/m^2
Obesity is NOT restricted from coverage under the patient's benefit
Patient is new to therapy, new to Prime, or attempting a repeat weight loss course of therapy
Patient has been on a weight loss regimen of low-calorie diet, increased physical activity, and behavioral modifications for a minimum of 6 months
Patient will NOT use the requested agent in combination with another weight loss agent (e.g., Contrave, phentermine, Qsymia, Xenical)
Patient will NOT use the requested agent in combination with another GLP-1 receptor agonist
Patient does NOT have any FDA labeled contraindications to the requested agent
Patient is currently on a weight loss regimen of a low-calorie diet, increased physical activity, and behavioral modifications AND will continue it
Age is within FDA labeling for the requested indication OR there is support for use at patient's age

Plus any one of:

Patient has NOT tried a targeted weight loss agent (e.g., Saxenda, Wegovy, Zepbound) in the past 12 months
Patient tried a targeted weight loss agent for a previous course of therapy in the past 12 months AND prescriber anticipates success with repeating therapy

Adult weight management (BMI >= 27 with comorbidity)

All of:

Patient is an adult (18 years of age or over)
BMI >= 27 kg/m^2
At least one weight-related comorbidity/risk factor/complication (e.g., hypertension, type 2 diabetes mellitus, obstructive sleep apnea, cardiovascular disease, dyslipidemia)
Obesity is NOT restricted from coverage under the patient's benefit
Patient is new to therapy, new to Prime, or attempting a repeat weight loss course of therapy
Patient has been on a weight loss regimen of low-calorie diet, increased physical activity, and behavioral modifications for a minimum of 6 months
Patient will NOT use the requested agent in combination with another weight loss agent (e.g., Contrave, phentermine, Qsymia, Xenical)
Patient will NOT use the requested agent in combination with another GLP-1 receptor agonist
Patient does NOT have any FDA labeled contraindications to the requested agent
Patient is currently on a weight loss regimen of a low-calorie diet, increased physical activity, and behavioral modifications AND will continue it
Age is within FDA labeling for the requested indication OR there is support for use at patient's age

Plus any one of:

Patient has NOT tried a targeted weight loss agent (e.g., Saxenda, Wegovy, Zepbound) in the past 12 months
Patient tried a targeted weight loss agent for a previous course of therapy in the past 12 months AND prescriber anticipates success with repeating therapy

Pediatric weight management (age 12-17, BMI >= 95th percentile or >= 30)

All of:

Patient is pediatric (12 to 17 years of age)
Obesity is NOT restricted from coverage under the patient's benefit
Patient is new to therapy, new to Prime, or attempting a repeat weight loss course of therapy
Patient has been on a weight loss regimen of low-calorie diet, increased physical activity, and behavioral modifications for a minimum of 6 months
Patient will NOT use the requested agent in combination with another weight loss agent
Patient will NOT use the requested agent in combination with another GLP-1 receptor agonist
Patient does NOT have any FDA labeled contraindications to the requested agent
Patient is currently on a weight loss regimen of a low-calorie diet, increased physical activity, and behavioral modifications AND will continue it
Age is within FDA labeling for the requested indication OR there is support for use at patient's age

Plus any one of:

BMI >= 95th percentile for age and sex
BMI >= 30 kg/m^2
BMI >= 85th percentile for age and sex AND at least one weight-related comorbidity/risk factor/complication (e.g., hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea)

Documentation to bring

Documentation of BMI >= 30 kg/m^2 (or >= 27 with comorbidity, or >= 25 if Asian descent, or BMI percentile for pediatric patients)
Documentation of 6-month weight loss regimen (low-calorie diet, increased physical activity, behavioral modifications)
Documentation of weight-related comorbidity if using the 27 kg/m^2 threshold
Documentation of ancestry if using the 25 kg/m^2 Asian threshold
Documentation that obesity is not restricted from coverage under the patient's benefit

Quantity limits

1.5 MG tab, 4 MG tab, 9 MG tab — 60 Tablets per 180 days (84-day)
25 MG tab — 30 Tablets per 30 days
0.25 MG/0.5 ML injection, 0.5 MG/0.5 ML injection, 1 MG/0.5 ML injection — 8 Pens per 180 days (84-day)
1.7 MG/0.75 ML injection, 2.4 MG/0.75 ML injection — 4 Pens per 28 days
7.2 MG/0.75 ML injection (Wegovy hd) — 4 Pens per 28 days

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for at least 5% weight loss from the starting weight, at least 5% reduction in BMI, For renewal (after 52 weeks), adult patients must have achieved and maintained >= 5% weight loss from baseline, OR pediatric patients must have achieved and maintained >= 5% BMI reduction from baseline. Patients with < 52 weeks on therapy on maximum-tolerated dose may also qualify. Renewal also requires: obesity not restricted from benefit, continuing current weight loss course of therapy, pediatric patients (12-17) must have current BMI >= 85th percentile for age and sex, not combining with another weight loss agent, maintaining low-calorie diet/increased physical activity/behavioral modifications, not combining with another GLP-1 agonist, and no FDA labeled contraindications, and at least 52 weeks on therapy before the first renewal. Make sure your starting weight and date are in the chart now — renewal is measured against it.

Not covered when

Combination with another weight loss agent (e.g., Contrave, phentermine, Qsymia, Xenical) not allowed
Combination with another GLP-1 receptor agonist (e.g., Saxenda, Wegovy, Zepbound, Bydureon, Byetta, Mounjaro, Ozempic, Rybelsus, Trulicity, Victoza) not allowed
Any FDA labeled contraindications to the requested agent
Obesity restricted from coverage under the patient's benefit

Policy note: Policy applies to Wegovy injection (subcutaneous) and Wegovy tablets. Quantity limit criteria allow exceptions for maintenance on lower doses if patient is unable to use FDA-labeled maintenance strength and has achieved weight loss on the lower strength. For continuation after 52 weeks on maximum-tolerated dose, patient must demonstrate >= 5% weight loss (adult) or >= 5% BMI reduction (pediatric). Patients with < 52 weeks on maximum-tolerated dose may qualify for renewal without demonstrating weight loss. Policy also allows approval if patient has another FDA labeled indication for the requested agent.

Policy effective June 1, 2026 · verified June 4, 2026 · source: WY_Weight_Management_PAQL_ProgSum.pdf

Wegovy for Heart Disease Risk Reduction

What BCBS Wyoming 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
Prescribed by or in consultation with a specialist
Established cardiovascular disease (MI, stroke, and PAD)
On guideline-directed medical therapy (ACE_inhibitor, ARB, beta_blocker, statin, and ezetimibe)
Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction - Initial Approval

All of:

Requested use is to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal MI, or non-fatal stroke) in adults with established CVD
Patient is either obese or overweight
Requested agent is FDA labeled for the requested indication and route of administration
Patient does NOT have type 2 diabetes
Patient BMI >= 27 kg/m^2
Patient age >= 45 years
Currently being treated in the past 90 days with antihypertensive therapy (e.g., ACE inhibitor, ARB, beta blocker)
Currently being treated in the past 90 days with lipid lowering therapy (e.g., any statin, ezetimibe)
Patient will continue antihypertensive therapy AND lipid lowering therapy in combination with the requested agent
Prescriber is a specialist (e.g., cardiologist) or has consulted with a specialist

Plus any one of:

History of myocardial infarction
History of stroke
Peripheral artery disease as defined by intermittent claudication with ankle-brachial index < 0.85 at rest, peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease

CV Risk Reduction - Tobacco Use

Plus any one of:

Patient does NOT currently use any tobacco products (e.g., cigarettes, chewing tobacco)
Patient is being managed for tobacco cessation

Documentation to bring

Medical records confirming history of qualifying CV event (MI, stroke, or PAD as defined)
Documentation of BMI >= 27 kg/m^2
Documentation that patient does NOT have type 2 diabetes
Documentation of patient age >= 45 years
Documentation of current antihypertensive therapy within past 90 days (ACE inhibitor, ARB, or beta blocker)
Documentation of current lipid-lowering therapy within past 90 days (any statin or ezetimibe)
Documentation of tobacco non-use or enrollment in tobacco cessation management
Documentation of specialist prescriber or specialist consultation (e.g., cardiologist)

Quantity limits

0.25 MG/0.5 ML injection, 0.5 MG/0.5 ML injection, 1 MG/0.5 ML injection — 8 Pens per 180 days (84-day)
1.7 MG/0.75 ML injection, 2.4 MG/0.75 ML injection — 4 Pens per 28 days
7.2 MG/0.75 ML injection (Wegovy hd) — 4 Pens per 28 days

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for Patient must demonstrate clinical benefit with the requested agent. At renewal, GDMT requirement is softened: antihypertensive and/or lipid-lowering therapy (vs. both required at initial). BMI, T2DM exclusion, and age >= 45 requirements are not re-verified at renewal. Tobacco use/cessation requirement remains. Specialist/specialist consultation remains required.

Not covered when

Type 2 diabetes explicitly excluded from CV risk reduction pathway
Current tobacco use (unless managed for cessation)
Any FDA labeled contraindications to the requested agent

Policy note: PAD qualification requires intermittent claudication with ankle-brachial index < 0.85 at rest, OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease. At renewal, the GDMT requirement changes from requiring BOTH antihypertensive AND lipid-lowering therapy to antihypertensive therapy AND/OR lipid-lowering therapy. Initial approval requires both; renewal requires at least one. Specialist (e.g., cardiologist) or specialist consultation required at both initial and renewal.

Policy effective June 1, 2026 · verified June 4, 2026 · source: WY_Weight_Management_PAQL_ProgSum.pdf

ACA Marketplace

Covered with requirements

What you need to qualify

Age 45 and older
BMI of 27 or higher
Prescribed by or in consultation with a specialist
Established cardiovascular disease (MI, stroke, and PAD)
On guideline-directed medical therapy (ACE_inhibitor, ARB, beta_blocker, statin, and ezetimibe)
Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction - Initial Approval

All of:

Requested use is to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal MI, or non-fatal stroke) in adults with established CVD
Patient is either obese or overweight
Requested agent is FDA labeled for the requested indication and route of administration
Patient does NOT have type 2 diabetes
Patient BMI >= 27 kg/m^2
Patient age >= 45 years
Currently being treated in the past 90 days with antihypertensive therapy (e.g., ACE inhibitor, ARB, beta blocker)
Currently being treated in the past 90 days with lipid lowering therapy (e.g., any statin, ezetimibe)
Patient will continue antihypertensive therapy AND lipid lowering therapy in combination with the requested agent
Prescriber is a specialist (e.g., cardiologist) or has consulted with a specialist

Plus any one of:

History of myocardial infarction
History of stroke
Peripheral artery disease as defined by intermittent claudication with ankle-brachial index < 0.85 at rest, peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease

CV Risk Reduction - Tobacco Use

Plus any one of:

Patient does NOT currently use any tobacco products (e.g., cigarettes, chewing tobacco)
Patient is being managed for tobacco cessation

Documentation to bring

Medical records confirming history of qualifying CV event (MI, stroke, or PAD as defined)
Documentation of BMI >= 27 kg/m^2
Documentation that patient does NOT have type 2 diabetes
Documentation of patient age >= 45 years
Documentation of current antihypertensive therapy within past 90 days (ACE inhibitor, ARB, or beta blocker)
Documentation of current lipid-lowering therapy within past 90 days (any statin or ezetimibe)
Documentation of tobacco non-use or enrollment in tobacco cessation management
Documentation of specialist prescriber or specialist consultation (e.g., cardiologist)

Quantity limits

0.25 MG/0.5 ML injection, 0.5 MG/0.5 ML injection, 1 MG/0.5 ML injection — 8 Pens per 180 days (84-day)
1.7 MG/0.75 ML injection, 2.4 MG/0.75 ML injection — 4 Pens per 28 days
7.2 MG/0.75 ML injection (Wegovy hd) — 4 Pens per 28 days

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for Patient must demonstrate clinical benefit with the requested agent. At renewal, GDMT requirement is softened: antihypertensive and/or lipid-lowering therapy (vs. both required at initial). BMI, T2DM exclusion, and age >= 45 requirements are not re-verified at renewal. Tobacco use/cessation requirement remains. Specialist/specialist consultation remains required.

Not covered when

Type 2 diabetes explicitly excluded from CV risk reduction pathway
Current tobacco use (unless managed for cessation)
Any FDA labeled contraindications to the requested agent

Policy note: PAD qualification requires intermittent claudication with ankle-brachial index < 0.85 at rest, OR peripheral arterial revascularization procedure, OR amputation due to atherosclerotic disease. At renewal, the GDMT requirement changes from requiring BOTH antihypertensive AND lipid-lowering therapy to antihypertensive therapy AND/OR lipid-lowering therapy. Initial approval requires both; renewal requires at least one. Specialist (e.g., cardiologist) or specialist consultation required at both initial and renewal.

Policy effective June 1, 2026 · verified June 4, 2026 · source: WY_Weight_Management_PAQL_ProgSum.pdf

Wegovy for Liver Disease (MASH)

What BCBS Wyoming 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
Prescribed by or in consultation with a specialist
Confirmed MASH diagnosis by liver_biopsy, FibroScan_VCTE, ELF_test, and MRE, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

MASH with Moderate to Advanced Fibrosis (F2-F3) - Wegovy Injection

All of:

Diagnosis of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), formerly known as NASH, with moderate to advanced liver fibrosis (consistent with stages F2 to F3)
Stage F2 or F3 fibrosis confirmed prior to therapy by one of: liver biopsy, VCTE, ELF score, or MRE
Requested agent is Wegovy injection
Patient is an adult (18 years of age or over)
Patient is being monitored and/or treated for any comorbid conditions (e.g., cardiovascular disease, diabetes, dyslipidemia, hypertension)
Patient does NOT have decompensated cirrhosis
Patient does NOT have moderate to severe hepatic impairment (Child-Pugh Class B or C)
Patient does NOT have any other liver disease (e.g., Wilson's disease, hepatocellular carcinoma, hepatitis)
Prescriber is a specialist (e.g., hepatologist, gastroenterologist) or has consulted with a specialist

Plus any one of:

Female patient: alcohol consumption < 20 grams/day
Male patient: alcohol consumption < 30 grams/day

Documentation to bring

Medical records confirming diagnosis of noncirrhotic MASH
Documentation of F2 or F3 fibrosis staging by: liver biopsy, VCTE, ELF score, or MRE (prior to therapy initiation)
Documentation that patient does NOT have decompensated cirrhosis
Documentation that patient does NOT have Child-Pugh Class B or C hepatic impairment
Documentation that patient does NOT have other liver disease (e.g., Wilson's disease, hepatocellular carcinoma, hepatitis)
Documentation of alcohol consumption level (< 20 g/day for females, < 30 g/day for males)
Documentation of monitoring/treatment for comorbid conditions (e.g., CVD, diabetes, dyslipidemia, hypertension)
Documentation of specialist prescriber or specialist consultation (e.g., hepatologist, gastroenterologist)

Quantity limits

0.25 MG/0.5 ML injection, 0.5 MG/0.5 ML injection, 1 MG/0.5 ML injection — 8 Pens per 180 days (84-day)
1.7 MG/0.75 ML injection, 2.4 MG/0.75 ML injection — 4 Pens per 28 days
7.2 MG/0.75 ML injection (Wegovy hd) — 4 Pens per 28 days

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for Patient must demonstrate clinical benefit with the requested agent. Fibrosis staging confirmation (liver biopsy, VCTE, ELF, or MRE) is NOT required at renewal. Alcohol consumption limits, hepatic exclusions, and specialist/consultation requirement remain at renewal.

Not covered when

Decompensated cirrhosis
Moderate to severe hepatic impairment (Child-Pugh Class B or C)
Any other liver disease (e.g., Wilson's disease, hepatocellular carcinoma, hepatitis)
Alcohol consumption >= 20 g/day (female) or >= 30 g/day (male)
Cirrhotic MASH (must be noncirrhotic)

Policy note: Policy specifies Wegovy INJECTION only for MASH indication — Wegovy tablets are NOT included in the MASH pathway. MASH was formerly known as nonalcoholic steatohepatitis (NASH). Alcohol limit: one standard drink contains roughly 14 grams of pure alcohol (12 oz regular beer, 5 oz wine, or 1.5 oz distilled spirits). At renewal, fibrosis staging confirmation is not re-required, but alcohol limits and hepatic exclusions remain.

Policy effective June 1, 2026 · verified June 4, 2026 · source: WY_Weight_Management_PAQL_ProgSum.pdf

ACA Marketplace

Covered with requirements

What you need to qualify

Age 18 and older
Prescribed by or in consultation with a specialist
Confirmed MASH diagnosis by liver_biopsy, FibroScan_VCTE, ELF_test, and MRE, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

MASH with Moderate to Advanced Fibrosis (F2-F3) - Wegovy Injection

All of:

Diagnosis of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), formerly known as NASH, with moderate to advanced liver fibrosis (consistent with stages F2 to F3)
Stage F2 or F3 fibrosis confirmed prior to therapy by one of: liver biopsy, VCTE, ELF score, or MRE
Requested agent is Wegovy injection
Patient is an adult (18 years of age or over)
Patient is being monitored and/or treated for any comorbid conditions (e.g., cardiovascular disease, diabetes, dyslipidemia, hypertension)
Patient does NOT have decompensated cirrhosis
Patient does NOT have moderate to severe hepatic impairment (Child-Pugh Class B or C)
Patient does NOT have any other liver disease (e.g., Wilson's disease, hepatocellular carcinoma, hepatitis)
Prescriber is a specialist (e.g., hepatologist, gastroenterologist) or has consulted with a specialist

Plus any one of:

Female patient: alcohol consumption < 20 grams/day
Male patient: alcohol consumption < 30 grams/day

Documentation to bring

Medical records confirming diagnosis of noncirrhotic MASH
Documentation of F2 or F3 fibrosis staging by: liver biopsy, VCTE, ELF score, or MRE (prior to therapy initiation)
Documentation that patient does NOT have decompensated cirrhosis
Documentation that patient does NOT have Child-Pugh Class B or C hepatic impairment
Documentation that patient does NOT have other liver disease (e.g., Wilson's disease, hepatocellular carcinoma, hepatitis)
Documentation of alcohol consumption level (< 20 g/day for females, < 30 g/day for males)
Documentation of monitoring/treatment for comorbid conditions (e.g., CVD, diabetes, dyslipidemia, hypertension)
Documentation of specialist prescriber or specialist consultation (e.g., hepatologist, gastroenterologist)

Quantity limits

0.25 MG/0.5 ML injection, 0.5 MG/0.5 ML injection, 1 MG/0.5 ML injection — 8 Pens per 180 days (84-day)
1.7 MG/0.75 ML injection, 2.4 MG/0.75 ML injection — 4 Pens per 28 days
7.2 MG/0.75 ML injection (Wegovy hd) — 4 Pens per 28 days

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for Patient must demonstrate clinical benefit with the requested agent. Fibrosis staging confirmation (liver biopsy, VCTE, ELF, or MRE) is NOT required at renewal. Alcohol consumption limits, hepatic exclusions, and specialist/consultation requirement remain at renewal.

Not covered when

Decompensated cirrhosis
Moderate to severe hepatic impairment (Child-Pugh Class B or C)
Any other liver disease (e.g., Wilson's disease, hepatocellular carcinoma, hepatitis)
Alcohol consumption >= 20 g/day (female) or >= 30 g/day (male)
Cirrhotic MASH (must be noncirrhotic)

Policy note: Policy specifies Wegovy INJECTION only for MASH indication — Wegovy tablets are NOT included in the MASH pathway. MASH was formerly known as nonalcoholic steatohepatitis (NASH). Alcohol limit: one standard drink contains roughly 14 grams of pure alcohol (12 oz regular beer, 5 oz wine, or 1.5 oz distilled spirits). At renewal, fibrosis staging confirmation is not re-required, but alcohol limits and hepatic exclusions remain.

Policy effective June 1, 2026 · verified June 4, 2026 · source: WY_Weight_Management_PAQL_ProgSum.pdf

Why Wegovy requests get denied by BCBS Wyoming

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

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.
BMI not documented in the chart notes (or documented without a baseline weight and date).
Qualifying weight-related condition not documented with its own diagnosis code.
No documented diet and exercise program.
Prescriber isn't the specialist the plan requires.
Baseline weight wasn't recorded at the start, so the required weight loss can't be shown at renewal.

Frequently asked questions

Does BCBS Wyoming cover Wegovy?: BCBS Wyoming covers Wegovy for weight loss with prior authorization on Employer / Commercial Insurance and ACA Marketplace.
What BMI do you need for Wegovy under BCBS Wyoming?: For weight loss on Employer / Commercial Insurance plans, BCBS Wyoming requires a BMI of 30 or higher, or 27 or higher with a qualifying weight-related condition. Other plan types may differ — see each plan type below.
How long does a Wegovy approval last with BCBS Wyoming?: Initial approvals last 12 months, and renewals are granted in 12-month periods.
What does BCBS Wyoming require to renew Wegovy?: At least 5% weight loss from the starting weight, at least 5% reduction in BMI, For renewal (after 52 weeks), adult patients must have achieved and maintained >= 5% weight loss from baseline, OR pediatric patients must have achieved and maintained >= 5% BMI reduction from baseline. Patients with < 52 weeks on therapy on maximum-tolerated dose may also qualify. Renewal also requires: obesity not restricted from benefit, continuing current weight loss course of therapy, pediatric patients (12-17) must have current BMI >= 85th percentile for age and sex, not combining with another weight loss agent, maintaining low-calorie diet/increased physical activity/behavioral modifications, not combining with another GLP-1 agonist, and no FDA labeled contraindications, and at least 52 weeks on therapy before the first renewal.
How current is this information?: This page reflects BCBS Wyoming's written policy as of June 1, 2026, last verified against the source document on June 4, 2026.

Does BCBS Wyoming cover Wegovy?

Quick answer · Weight Loss

Wegovy for Weight Loss

Employer / Commercial Insurance

What you need to qualify

Qualification pathways

Documentation to bring

Quantity limits

Approval and renewal

Not covered when

ACA Marketplace

What you need to qualify

Qualification pathways

Documentation to bring

Quantity limits

Approval and renewal

Not covered when

Wegovy for Heart Disease Risk Reduction

Employer / Commercial Insurance

What you need to qualify

Qualification pathways

Documentation to bring

Quantity limits

Approval and renewal

Not covered when

ACA Marketplace

What you need to qualify

Qualification pathways

Documentation to bring

Quantity limits

Approval and renewal

Not covered when

Wegovy for Liver Disease (MASH)

Employer / Commercial Insurance

What you need to qualify

Qualification pathways

Documentation to bring

Quantity limits

Approval and renewal

Not covered when

ACA Marketplace

What you need to qualify

Qualification pathways

Documentation to bring

Quantity limits

Approval and renewal

Not covered when

Why Wegovy requests get denied by BCBS Wyoming

Frequently asked questions

Other medications under BCBS Wyoming

Wegovy coverage under other plans