Does Centene cover Wegovy?

Yes. Centene covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.

How long does a Wegovy approval last with Centene?

Heart Disease Risk Reduction — Applies to ACA Marketplace plans. Initial approval: 6 months. Renewal: every 12 months.

What does Centene require to renew Wegovy?

Heart Disease Risk Reduction — Applies to ACA Marketplace plans. First renewal: must have lost ≥ 5% of baseline body weight. Second and subsequent renewals: must have lost weight and/or maintained weight loss. Maintenance dose ≥ 1.7 mg/week (injection) or 25 mg/day (tablet) required. GDMT requirement and lifestyle program enrollment re-verified at continuation. Prior GLP-1 step therapy NOT re-checked at continuation. Staying on a maintenance dose of at least 1.7 mg.

How current is this information?

The oldest review date among the policies on this page is June 2, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Centene coverage for Wegovy (Heart Disease Risk

Applies to ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction — No Concurrent T2DM

All of:

Established CVD: history of MI, history of stroke, or symptomatic PAD (ABI < 0.85, peripheral arterial revascularization, or amputation due to atherosclerotic disease)
Age ≥ 18 years
BMI ≥ 27 kg/m2
Prescriber attestation of current cardiovascular standard of care management
Wegovy not prescribed concurrently with other semaglutide-containing products or any other GLP-1 receptor agonist
Active enrollment in physician-directed weight loss program for at least 6 months with plan to continue
Documentation of baseline body weight in kg
Dose within approved escalation schedule (up to 2.4 mg/week injection or 25 mg/day tablet)

CV Risk Reduction — With Concurrent T2DM

All of:

Established CVD: history of MI, history of stroke, or symptomatic PAD
Age ≥ 18 years
BMI ≥ 27 kg/m2
Prescriber attestation of current cardiovascular standard of care management
Wegovy not prescribed concurrently with other semaglutide-containing products or any other GLP-1 receptor agonist
Active enrollment in physician-directed weight loss program for at least 6 months with plan to continue
Documentation of baseline body weight in kg
Dose within approved escalation schedule
Trial of ≥ 3 consecutive months each of ALL of: Ozempic or Rybelsus, Trulicity, and liraglutide (generic Victoza), unless clinically significant adverse effects or all are contraindicated (Note: IL HIM requests exempt from step therapy as of 1/1/2026 per IL HB 5395)
If currently on a GLP-1 and switching to Wegovy: medical justification supports necessity (intolerance due to common GI adverse effects is NOT acceptable justification)

Documentation to bring

Office chart notes, lab results, or other clinical information supporting all approval criteria
Documentation of qualifying CVD event (history of MI, history of stroke, or symptomatic PAD with ABI < 0.85 / revascularization / amputation)
BMI documentation ≥ 27 kg/m2
Prescriber attestation that member is currently receiving cardiovascular standard of care management
Documentation of active enrollment in physician-directed weight loss program for at least 6 months
Documentation of member's baseline body weight in kg
For concurrent T2DM: documentation of ≥ 3-month trial each of Ozempic/Rybelsus, Trulicity, and liraglutide (generic Victoza) (unless adverse effects or all contraindicated), except IL HIM as of 1/1/2026
If switching from another GLP-1: medical justification supporting necessity for Wegovy specifically

Quantity limits

0.25mg, 0.5mg, 1mg
1.7mg, 2.4mg
1.5mg tablet, 4mg tablet, 9mg tablet, 25mg tablet — 1 tablet per day

Approval and renewal

Initial approval: 6 months
Renewal: every 12 months
Renewal: First renewal: must have lost ≥ 5% of baseline body weight. Second and subsequent renewals: must have lost weight and/or maintained weight loss. Maintenance dose ≥ 1.7 mg/week (injection) or 25 mg/day (tablet) required. GDMT requirement and lifestyle program enrollment re-verified at continuation. Prior GLP-1 step therapy NOT re-checked at continuation.
Renewal: Staying on a maintenance dose of at least 1.7 mg.

Not covered when

Concomitant use with other semaglutide-containing products
Concomitant use with any other GLP-1 receptor agonist
Personal or family history of medullary thyroid carcinoma (MTC) or MEN 2 (contraindication)
Known hypersensitivity to semaglutide or excipients

Exceptions

Illinois: Step therapy requirements for members with concurrent T2DM do not apply for Illinois HIM requests as of 1/1/2026 per IL HB 5395

Policy note: Symptomatic PAD defined per SELECT trial as intermittent claudication with ABI < 0.85 at rest, or peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease. Cardiovascular standard of care is broadly defined in Appendix D and includes condition-specific medications for dyslipidemia, hypertension, MI, stroke, and PAD. Wegovy tablets are approved only for CV event prevention indication (not MASH). Wegovy HD 7.2 mg injection formulation also available. IL HB 5395 exempts IL HIM requests from GLP-1 step therapy requirement for concurrent T2DM as of 1/1/2026.

Policy effective June 1, 2024 · verified June 2, 2026 · source: Cp.Pmn.295 · View policy document (PDF)

Does Centene cover Wegovy for Heart Disease Risk Reduction?

Policy document