Cigna · Heart Disease Risk Reduction

Cigna coverage for Wegovy (Heart Disease Risk Reduction)

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

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