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BCBS Wyoming

Does BCBS Wyoming cover Wegovy?

Yes. BCBS Wyoming covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.

Policy document

  • Employer and ACA Marketplace: Covered with requirements. See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Weight Loss (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

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
  • Renewal: At least 5% reduction in BMI.
  • Renewal: 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.
  • Renewal: At least 52 weeks on therapy before the first renewal.

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 Prog Sum · View policy document (PDF)

Open on its own page →

Full requirements: Wegovy for Heart Disease Risk Reduction (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

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
  • Renewal: 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 Prog Sum · View policy document (PDF)

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Full requirements: Wegovy for Liver Disease (MASH) (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

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
  • Renewal: 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 Prog Sum · View policy document (PDF)

Open on its own page →

Questions people ask
Does BCBS Wyoming cover Wegovy?
Yes. BCBS Wyoming covers Wegovy for weight loss with prior authorization if your BMI is 30 or higher, or 27 or higher with a related condition. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with BCBS Wyoming?
Weight Loss — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months. Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months. Liver Disease (MASH) — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does BCBS Wyoming require to renew Wegovy?
Weight Loss — Applies to Employer and ACA Marketplace plans. 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. At least 52 weeks on therapy before the first renewal. Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. 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. Liver Disease (MASH) — Applies to Employer and ACA Marketplace plans. 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.
How current is this information?
The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under BCBS Wyoming: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Wyoming Medicaid, BCBS Alabama, BCBS Arizona, BCBS Arkansas, BCBS Louisiana, BCBS Massachusetts, BCBS Michigan, BCBS Minnesota

All insurance plans · All medications

Summary of BCBS Wyoming's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.