Cigna

Does Cigna cover Wegovy?

Quick answer · Weight Loss

Cigna covers Wegovy for weight loss with prior authorization on Employer / Commercial Insurance and ACA Marketplace.

  • Employer / Commercial Insurance: Covered with requirements. BMI of 30 or higher
  • ACA Marketplace: Covered with requirements. BMI of 30 or higher

Last verified June 2, 2026. Policy effective April 15, 2026. Source: cnf_684_coveragepositioncriteria_weight_loss_glp1_agonists_pa.pdf. How we verify this data →

Check your card for your exact plan →

Wegovy for Weight Loss

What Cigna 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 (HTN, T2DM, dyslipidemia, OSA, CVD, knee_osteoarthritis, asthma, COPD, MASLD/NAFLD, PCOS, and CAD)
  • BMI at or above the 95th percentile for age and sex
  • 3 months of a documented diet and exercise program

Qualification pathways

You can qualify through any one of these.

Initial Approval - Adult Weight Loss (BMI >= 30)

All of:

  • Patient is >= 18 years of age
  • Baseline BMI >= 30 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has engaged in a trial of behavioral modification and dietary restriction for at least 3 months
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Initial Approval - Adult Weight Loss (BMI >= 27 with comorbidity)

All of:

  • Patient is >= 18 years of age
  • Baseline BMI >= 27 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has engaged in a trial of behavioral modification and dietary restriction for at least 3 months
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Plus any one of:

  • At baseline or currently: hypertension
  • At baseline or currently: type 2 diabetes
  • At baseline or currently: dyslipidemia
  • At baseline or currently: obstructive sleep apnea
  • At baseline or currently: cardiovascular disease
  • At baseline or currently: knee osteoarthritis
  • At baseline or currently: asthma
  • At baseline or currently: COPD
  • At baseline or currently: MASLD/NAFLD
  • At baseline or currently: polycystic ovarian syndrome
  • At baseline or currently: coronary artery disease

Initial Approval - Pediatric Weight Loss (age 12-17)

All of:

  • Patient is >= 12 years of age and < 18 years of age
  • Baseline BMI >= 95th percentile for age and sex (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has engaged in a trial of behavioral modification and dietary restriction for at least 3 months
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Continuation - Adult Weight Loss (BMI >= 30)

All of:

  • Patient is >= 18 years of age
  • Baseline BMI >= 30 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has lost >= 5% of baseline body weight
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient has completed >= 8 months of initial therapy

Continuation - Adult Weight Loss (BMI >= 27 with comorbidity)

All of:

  • Patient is >= 18 years of age
  • Baseline BMI >= 27 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has lost >= 5% of baseline body weight
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient has completed >= 8 months of initial therapy

Plus any one of:

  • At baseline or currently: hypertension
  • At baseline or currently: type 2 diabetes
  • At baseline or currently: dyslipidemia
  • At baseline or currently: obstructive sleep apnea
  • At baseline or currently: cardiovascular disease
  • At baseline or currently: knee osteoarthritis
  • At baseline or currently: asthma
  • At baseline or currently: COPD
  • At baseline or currently: MASLD/NAFLD
  • At baseline or currently: polycystic ovarian syndrome
  • At baseline or currently: coronary artery disease

Continuation - Pediatric Weight Loss (age 12-17)

All of:

  • Patient is >= 12 years of age and < 18 years of age
  • Baseline BMI >= 95th percentile for age and sex (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has had a reduction in BMI of >= 1% from baseline
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient has completed >= 7 months of initial therapy with Wegovy injection, Wegovy HD injection, and/or Wegovy tablet

Documentation to bring

  • Baseline BMI documentation (>= 30 kg/m2, or >= 27 kg/m2 with qualifying comorbidity)
  • Documentation of at least 3-month trial of behavioral modification and dietary restriction (initial therapy)
  • Documentation of qualifying weight-related comorbidity if BMI 27-29.9 kg/m2
  • Documentation of >= 5% baseline body weight loss (continuation, adult)
  • Documentation of >= 1% BMI reduction from baseline (continuation, pediatric)

Approval and renewal

  • Initial approval: 8 months
  • Renewal: every 12 months
  • To renew, the plan looks for at least 5% weight loss from the starting weight, at least 1% reduction in BMI, and Adults: must have lost >= 5% of baseline body weight. Pediatric (age 12-17): must have had >= 1% reduction in BMI from baseline. Baseline BMI/weight re-verified at continuation, but 3-month lifestyle program requirement is not re-checked. Make sure your starting weight and date are in the chart now — renewal is measured against it.

Not covered when

  • Concomitant use with other GLP-1 agonists or GLP-1/GIP agonists is not covered
  • Any use not meeting FDA-approved indications or criteria above is not medically necessary

Policy note: Wegovy injection (including Wegovy HD injection) and Wegovy tablet are both covered under the same weight loss criteria. Wegovy HD injection is intended for patients who have tolerated Wegovy 2.4 mg SC for >= 4 weeks and require additional weight reduction. Pediatric approval applies to Wegovy injection only (not Wegovy tablet, which is not FDA-approved for pediatric use). Initial approval is for 8 months; continuation is for 1 year. For pediatric continuation, patient must have completed >= 7 months of initial therapy (note: policy states 7 months in the pediatric continuation note, while adult states 8 months).

Policy effective April 15, 2026 · verified June 2, 2026 · source: cnf_684_coveragepositioncriteria_weight_loss_glp1_agonists_pa.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 (HTN, T2DM, dyslipidemia, OSA, CVD, knee_osteoarthritis, asthma, COPD, MASLD/NAFLD, PCOS, and CAD)
  • BMI at or above the 95th percentile for age and sex
  • 3 months of a documented diet and exercise program

Qualification pathways

You can qualify through any one of these.

Initial Approval - Adult Weight Loss (BMI >= 30)

All of:

  • Patient is >= 18 years of age
  • Baseline BMI >= 30 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has engaged in a trial of behavioral modification and dietary restriction for at least 3 months
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Initial Approval - Adult Weight Loss (BMI >= 27 with comorbidity)

All of:

  • Patient is >= 18 years of age
  • Baseline BMI >= 27 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has engaged in a trial of behavioral modification and dietary restriction for at least 3 months
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Plus any one of:

  • At baseline or currently: hypertension
  • At baseline or currently: type 2 diabetes
  • At baseline or currently: dyslipidemia
  • At baseline or currently: obstructive sleep apnea
  • At baseline or currently: cardiovascular disease
  • At baseline or currently: knee osteoarthritis
  • At baseline or currently: asthma
  • At baseline or currently: COPD
  • At baseline or currently: MASLD/NAFLD
  • At baseline or currently: polycystic ovarian syndrome
  • At baseline or currently: coronary artery disease

Initial Approval - Pediatric Weight Loss (age 12-17)

All of:

  • Patient is >= 12 years of age and < 18 years of age
  • Baseline BMI >= 95th percentile for age and sex (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has engaged in a trial of behavioral modification and dietary restriction for at least 3 months
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Continuation - Adult Weight Loss (BMI >= 30)

All of:

  • Patient is >= 18 years of age
  • Baseline BMI >= 30 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has lost >= 5% of baseline body weight
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient has completed >= 8 months of initial therapy

Continuation - Adult Weight Loss (BMI >= 27 with comorbidity)

All of:

  • Patient is >= 18 years of age
  • Baseline BMI >= 27 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has lost >= 5% of baseline body weight
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient has completed >= 8 months of initial therapy

Plus any one of:

  • At baseline or currently: hypertension
  • At baseline or currently: type 2 diabetes
  • At baseline or currently: dyslipidemia
  • At baseline or currently: obstructive sleep apnea
  • At baseline or currently: cardiovascular disease
  • At baseline or currently: knee osteoarthritis
  • At baseline or currently: asthma
  • At baseline or currently: COPD
  • At baseline or currently: MASLD/NAFLD
  • At baseline or currently: polycystic ovarian syndrome
  • At baseline or currently: coronary artery disease

Continuation - Pediatric Weight Loss (age 12-17)

All of:

  • Patient is >= 12 years of age and < 18 years of age
  • Baseline BMI >= 95th percentile for age and sex (prior to any GLP-1 or GLP-1/GIP agonist)
  • Patient has had a reduction in BMI of >= 1% from baseline
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient has completed >= 7 months of initial therapy with Wegovy injection, Wegovy HD injection, and/or Wegovy tablet

Documentation to bring

  • Baseline BMI documentation (>= 30 kg/m2, or >= 27 kg/m2 with qualifying comorbidity)
  • Documentation of at least 3-month trial of behavioral modification and dietary restriction (initial therapy)
  • Documentation of qualifying weight-related comorbidity if BMI 27-29.9 kg/m2
  • Documentation of >= 5% baseline body weight loss (continuation, adult)
  • Documentation of >= 1% BMI reduction from baseline (continuation, pediatric)

Approval and renewal

  • Initial approval: 8 months
  • Renewal: every 12 months
  • To renew, the plan looks for at least 5% weight loss from the starting weight, at least 1% reduction in BMI, and Adults: must have lost >= 5% of baseline body weight. Pediatric (age 12-17): must have had >= 1% reduction in BMI from baseline. Baseline BMI/weight re-verified at continuation, but 3-month lifestyle program requirement is not re-checked. Make sure your starting weight and date are in the chart now — renewal is measured against it.

Not covered when

  • Concomitant use with other GLP-1 agonists or GLP-1/GIP agonists is not covered
  • Any use not meeting FDA-approved indications or criteria above is not medically necessary

Policy note: Wegovy injection (including Wegovy HD injection) and Wegovy tablet are both covered under the same weight loss criteria. Wegovy HD injection is intended for patients who have tolerated Wegovy 2.4 mg SC for >= 4 weeks and require additional weight reduction. Pediatric approval applies to Wegovy injection only (not Wegovy tablet, which is not FDA-approved for pediatric use). Initial approval is for 8 months; continuation is for 1 year. For pediatric continuation, patient must have completed >= 7 months of initial therapy (note: policy states 7 months in the pediatric continuation note, while adult states 8 months).

Policy effective April 15, 2026 · verified June 2, 2026 · source: cnf_684_coveragepositioncriteria_weight_loss_glp1_agonists_pa.pdf

Wegovy for Heart Disease Risk Reduction

What Cigna 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
  • BMI of 27 or higher
  • Established cardiovascular disease (MI, stroke, and PAD)
  • On guideline-directed medical therapy (optimized pharmacotherapy for established cardiovascular disease)

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction - Established CVD with Overweight or Obesity

All of:

  • Patient is >= 18 years of age
  • Baseline BMI >= 27 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • According to prescriber, medication will be used in combination with optimized pharmacotherapy for established cardiovascular disease
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Plus any one of:

  • Prior myocardial infarction
  • Prior stroke (not including TIA)
  • History of symptomatic peripheral arterial disease with intermittent claudication and ankle-brachial index < 0.85
  • History of symptomatic peripheral arterial disease with peripheral arterial revascularization procedure
  • History of symptomatic peripheral arterial disease with amputation due to atherosclerotic disease

Documentation to bring

  • Baseline BMI documentation (>= 27 kg/m2, prior to any GLP-1 or GLP-1/GIP agonist)
  • Documentation of qualifying established CV event (prior MI, prior stroke [not TIA], or symptomatic PAD with ABI < 0.85, peripheral arterial revascularization, or amputation due to atherosclerotic disease)
  • Prescriber attestation that medication will be used in combination with optimized pharmacotherapy for established cardiovascular disease

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Initial and continuation criteria are combined into a single 1-year approval; no separate weight loss response threshold is required for renewal. Baseline BMI >= 27 kg/m2, established CV disease, and GDMT use are the ongoing requirements. Diabetes exclusion does NOT apply — patients with or without diabetes may qualify.

Not covered when

  • Transient ischemic attack (TIA) does not qualify as prior stroke
  • Concomitant use with other GLP-1 agonists or GLP-1/GIP agonists is not covered

Policy note: Both Wegovy injection (including Wegovy HD injection) and Wegovy tablet are approved for this indication with identical criteria. Approval is for 1 year. Policy does not exclude patients with diabetes for this indication (unlike the SELECT trial population which excluded diabetes). No separate weight loss response threshold is required for renewal.

Policy effective April 15, 2026 · verified June 2, 2026 · source: cnf_684_coveragepositioncriteria_weight_loss_glp1_agonists_pa.pdf

ACA Marketplace

Covered with requirements

What you need to qualify

  • Age 18 and older
  • BMI of 27 or higher
  • Established cardiovascular disease (MI, stroke, and PAD)
  • On guideline-directed medical therapy (optimized pharmacotherapy for established cardiovascular disease)

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction - Established CVD with Overweight or Obesity

All of:

  • Patient is >= 18 years of age
  • Baseline BMI >= 27 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • According to prescriber, medication will be used in combination with optimized pharmacotherapy for established cardiovascular disease
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Plus any one of:

  • Prior myocardial infarction
  • Prior stroke (not including TIA)
  • History of symptomatic peripheral arterial disease with intermittent claudication and ankle-brachial index < 0.85
  • History of symptomatic peripheral arterial disease with peripheral arterial revascularization procedure
  • History of symptomatic peripheral arterial disease with amputation due to atherosclerotic disease

Documentation to bring

  • Baseline BMI documentation (>= 27 kg/m2, prior to any GLP-1 or GLP-1/GIP agonist)
  • Documentation of qualifying established CV event (prior MI, prior stroke [not TIA], or symptomatic PAD with ABI < 0.85, peripheral arterial revascularization, or amputation due to atherosclerotic disease)
  • Prescriber attestation that medication will be used in combination with optimized pharmacotherapy for established cardiovascular disease

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Initial and continuation criteria are combined into a single 1-year approval; no separate weight loss response threshold is required for renewal. Baseline BMI >= 27 kg/m2, established CV disease, and GDMT use are the ongoing requirements. Diabetes exclusion does NOT apply — patients with or without diabetes may qualify.

Not covered when

  • Transient ischemic attack (TIA) does not qualify as prior stroke
  • Concomitant use with other GLP-1 agonists or GLP-1/GIP agonists is not covered

Policy note: Both Wegovy injection (including Wegovy HD injection) and Wegovy tablet are approved for this indication with identical criteria. Approval is for 1 year. Policy does not exclude patients with diabetes for this indication (unlike the SELECT trial population which excluded diabetes). No separate weight loss response threshold is required for renewal.

Policy effective April 15, 2026 · verified June 2, 2026 · source: cnf_684_coveragepositioncriteria_weight_loss_glp1_agonists_pa.pdf

Wegovy for Liver Disease (MASH)

What Cigna 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, MRE, and ELF_test, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

Initial Approval - MASH/NASH with F2-F3 Fibrosis

All of:

  • Patient is >= 18 years of age
  • Patient does not have cirrhosis (F4)
  • Patient has stage F2 or F3 fibrosis confirmed by an accepted diagnostic test prior to initiating treatment [documentation required]
  • Patient has one or more metabolic risk factors managed per standard of care (central obesity, hypertriglyceridemia, reduced HDL-C, hypertension, or elevated fasting plasma glucose/diabetes/pre-diabetes)
  • Medication will be used in combination with appropriate diet and exercise therapy
  • Medication prescribed by or in consultation with an endocrinologist, gastroenterologist, or hepatologist

Plus any one of:

  • Liver biopsy within 3 years preceding treatment showing F2 or F3 fibrosis [documentation required]
  • VCTE within 6 months preceding treatment showing F2 or F3 fibrosis [documentation required]
  • MRE within 6 months preceding treatment showing F2 or F3 fibrosis [documentation required]
  • ELF test within 6 months preceding treatment with score >= 9.2 to <= 10.5 [documentation required]

Initial Approval - MASH/NASH Alcohol Limit (Female)

All of:

  • Female patient: alcohol consumption < 20 grams/day

Initial Approval - MASH/NASH Alcohol Limit (Male)

All of:

  • Male patient: alcohol consumption < 30 grams/day

Continuation - MASH/NASH (Year 2+)

All of:

  • Patient has completed >= 1 year of therapy with Wegovy injection, Wegovy HD injection, and/or Wegovy tablet
  • Prescriber attests patient has not had worsening of fibrosis or MASH/NASH
  • Prescriber attests patient does not have cirrhosis (F4)
  • Prescriber attests metabolic risk factors are managed per standard of care
  • Medication will be used in combination with appropriate diet and exercise therapy
  • Medication prescribed by or in consultation with an endocrinologist, gastroenterologist, or hepatologist

Plus any one of:

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

Documentation to bring

  • Documentation of stage F2 or F3 fibrosis prior to treatment initiation [documentation required]
  • Liver biopsy report within 3 years preceding treatment (if biopsy used for staging) [documentation required]
  • VCTE results within 6 months preceding treatment (if VCTE used for staging) [documentation required]
  • MRE results within 6 months preceding treatment (if MRE used for staging) [documentation required]
  • ELF test result within 6 months preceding treatment with score >= 9.2 to <= 10.5 (if ELF used for staging) [documentation required]
  • Prescriber attestation of one or more metabolic risk factors managed per standard of care
  • Prescriber attestation of alcohol consumption limits (female < 20 g/day; male < 30 g/day)
  • Documentation that medication is prescribed by or in consultation with endocrinologist, gastroenterologist, or hepatologist
  • Confirmation patient does not have cirrhosis (F4)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Continuation requires: patient has completed >= 1 year of therapy; prescriber attests no worsening of fibrosis or MASH/NASH; no cirrhosis (F4); metabolic risk factors managed per standard of care; alcohol limits maintained; diet and exercise ongoing; specialist prescribing/consultation. Fibrosis staging documentation NOT re-required at continuation. ELF score, biopsy, VCTE, or MRE documentation NOT re-required at continuation.

Not covered when

  • Cirrhotic (F4) MASH is excluded
  • Alcohol consumption >= 20 g/day (female) or >= 30 g/day (male) is excluded
  • Concomitant use with other GLP-1 agonists or GLP-1/GIP agonists is not covered

Policy note: Applies to both Wegovy injection (including Wegovy HD injection) and Wegovy tablet. Specialist prescribing or consultation required (endocrinologist, gastroenterologist, or hepatologist). Documentation is required as noted throughout criteria. ELF score range of 9.2 to 10.5 is specifically required (not just >= 9.2). For continuation, fibrosis documentation is NOT re-required; prescriber attestation of no worsening is sufficient. Rezdiffra (resmetirom) is referenced as an alternative MASH treatment in the fibrosis staging lookback criteria.

Policy effective April 15, 2026 · verified June 2, 2026 · source: cnf_684_coveragepositioncriteria_weight_loss_glp1_agonists_pa.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, MRE, and ELF_test, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

Initial Approval - MASH/NASH with F2-F3 Fibrosis

All of:

  • Patient is >= 18 years of age
  • Patient does not have cirrhosis (F4)
  • Patient has stage F2 or F3 fibrosis confirmed by an accepted diagnostic test prior to initiating treatment [documentation required]
  • Patient has one or more metabolic risk factors managed per standard of care (central obesity, hypertriglyceridemia, reduced HDL-C, hypertension, or elevated fasting plasma glucose/diabetes/pre-diabetes)
  • Medication will be used in combination with appropriate diet and exercise therapy
  • Medication prescribed by or in consultation with an endocrinologist, gastroenterologist, or hepatologist

Plus any one of:

  • Liver biopsy within 3 years preceding treatment showing F2 or F3 fibrosis [documentation required]
  • VCTE within 6 months preceding treatment showing F2 or F3 fibrosis [documentation required]
  • MRE within 6 months preceding treatment showing F2 or F3 fibrosis [documentation required]
  • ELF test within 6 months preceding treatment with score >= 9.2 to <= 10.5 [documentation required]

Initial Approval - MASH/NASH Alcohol Limit (Female)

All of:

  • Female patient: alcohol consumption < 20 grams/day

Initial Approval - MASH/NASH Alcohol Limit (Male)

All of:

  • Male patient: alcohol consumption < 30 grams/day

Continuation - MASH/NASH (Year 2+)

All of:

  • Patient has completed >= 1 year of therapy with Wegovy injection, Wegovy HD injection, and/or Wegovy tablet
  • Prescriber attests patient has not had worsening of fibrosis or MASH/NASH
  • Prescriber attests patient does not have cirrhosis (F4)
  • Prescriber attests metabolic risk factors are managed per standard of care
  • Medication will be used in combination with appropriate diet and exercise therapy
  • Medication prescribed by or in consultation with an endocrinologist, gastroenterologist, or hepatologist

Plus any one of:

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

Documentation to bring

  • Documentation of stage F2 or F3 fibrosis prior to treatment initiation [documentation required]
  • Liver biopsy report within 3 years preceding treatment (if biopsy used for staging) [documentation required]
  • VCTE results within 6 months preceding treatment (if VCTE used for staging) [documentation required]
  • MRE results within 6 months preceding treatment (if MRE used for staging) [documentation required]
  • ELF test result within 6 months preceding treatment with score >= 9.2 to <= 10.5 (if ELF used for staging) [documentation required]
  • Prescriber attestation of one or more metabolic risk factors managed per standard of care
  • Prescriber attestation of alcohol consumption limits (female < 20 g/day; male < 30 g/day)
  • Documentation that medication is prescribed by or in consultation with endocrinologist, gastroenterologist, or hepatologist
  • Confirmation patient does not have cirrhosis (F4)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Continuation requires: patient has completed >= 1 year of therapy; prescriber attests no worsening of fibrosis or MASH/NASH; no cirrhosis (F4); metabolic risk factors managed per standard of care; alcohol limits maintained; diet and exercise ongoing; specialist prescribing/consultation. Fibrosis staging documentation NOT re-required at continuation. ELF score, biopsy, VCTE, or MRE documentation NOT re-required at continuation.

Not covered when

  • Cirrhotic (F4) MASH is excluded
  • Alcohol consumption >= 20 g/day (female) or >= 30 g/day (male) is excluded
  • Concomitant use with other GLP-1 agonists or GLP-1/GIP agonists is not covered

Policy note: Applies to both Wegovy injection (including Wegovy HD injection) and Wegovy tablet. Specialist prescribing or consultation required (endocrinologist, gastroenterologist, or hepatologist). Documentation is required as noted throughout criteria. ELF score range of 9.2 to 10.5 is specifically required (not just >= 9.2). For continuation, fibrosis documentation is NOT re-required; prescriber attestation of no worsening is sufficient. Rezdiffra (resmetirom) is referenced as an alternative MASH treatment in the fibrosis staging lookback criteria.

Policy effective April 15, 2026 · verified June 2, 2026 · source: cnf_684_coveragepositioncriteria_weight_loss_glp1_agonists_pa.pdf

Why Wegovy requests get denied by Cigna

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

  1. 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.
  2. BMI not documented in the chart notes (or documented without a baseline weight and date).
  3. Qualifying weight-related condition not documented with its own diagnosis code.
  4. No documented diet and exercise program.
  5. Prescriber isn't the specialist the plan requires.
  6. Baseline weight wasn't recorded at the start, so the required weight loss can't be shown at renewal.

Frequently asked questions

Does Cigna cover Wegovy?
Cigna covers Wegovy for weight loss with prior authorization on Employer / Commercial Insurance and ACA Marketplace.
What BMI do you need for Wegovy under Cigna?
For weight loss on Employer / Commercial Insurance plans, Cigna 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 Cigna?
Initial approvals last 8 months, and renewals are granted in 12-month periods.
What does Cigna require to renew Wegovy?
At least 5% weight loss from the starting weight, at least 1% reduction in BMI, and Adults: must have lost >= 5% of baseline body weight. Pediatric (age 12-17): must have had >= 1% reduction in BMI from baseline. Baseline BMI/weight re-verified at continuation, but 3-month lifestyle program requirement is not re-checked.
How current is this information?
This page reflects Cigna's written policy as of April 15, 2026, last verified against the source document on June 2, 2026.

Other medications under Cigna

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Cigna'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.