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Cigna

Does Cigna cover Zepbound?

Yes. Cigna covers Zepbound 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 2, 2026. How we verify · Check your exact plan

Full requirements: Zepbound 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.

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

Continuation - Adult Weight Loss

All of:

  • Patient is ≥ 18 years of age
  • Baseline BMI ≥ 30 kg/m2 OR (BMI ≥ 27 kg/m2 with qualifying comorbidity) (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

Documentation to bring

  • Baseline BMI documentation (≥ 30 kg/m2, or ≥ 27 kg/m2 with qualifying comorbidity, prior to any GLP-1 or GLP-1/GIP agonist)
  • Documentation of at least 3-month trial of behavioral modification and dietary restriction (initial therapy)
  • Documentation of qualifying weight-related comorbidity if baseline BMI 27-29.9 kg/m2
  • Documentation of ≥ 5% baseline body weight loss (continuation)

Approval and renewal

  • Initial approval: 8 months
  • Renewal: every 12 months
  • Renewal: Must have lost ≥ 5% of baseline body weight (baseline = prior to any GLP-1 or GLP-1/GIP agonist). Ongoing behavioral modification and reduced-calorie diet required. BMI threshold re-verified at continuation; 3-month lifestyle program not re-checked.

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: Zepbound weight loss indication is for adults only (age ≥ 18); no pediatric indication for weight loss. Initial approval is 8 months; continuation is 1 year. Baseline BMI is defined as prior to any GLP-1 or GLP-1/GIP agonist (not just prior to Zepbound).

Policy effective April 15, 2026 · verified June 2, 2026 · source: Cigna — GLP-1 coverage criteria (Policy 684) · View policy document (PDF)

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Full requirements: Zepbound for Obstructive Sleep Apnea (OSA) (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Initial Approval - Moderate to Severe OSA with Obesity

All of:

  • Patient is ≥ 18 years of age
  • Baseline BMI ≥ 30 kg/m2 (prior to any GLP-1 or GLP-1/GIP agonist)
  • Sleep study showing diagnosis of moderate to severe OSA
  • Sleep study showing apnea-hypopnea index (AHI) ≥ 15 events per hour
  • Patient does NOT have central sleep apnea
  • Patient does NOT have Cheyne Stokes respiration
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Continuation - Moderate to Severe OSA with Obesity

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 completed ≥ 1 year of therapy with Zepbound
  • Patient has lost ≥ 10% of baseline body weight
  • Prescriber attests patient has stability in OSA signs or symptoms
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Documentation to bring

  • Baseline BMI documentation (≥ 30 kg/m2, prior to any GLP-1 or GLP-1/GIP agonist)
  • Sleep study results documenting moderate to severe OSA diagnosis
  • Sleep study results documenting AHI ≥ 15 events per hour
  • Confirmation patient does not have central sleep apnea or Cheyne Stokes respiration
  • Documentation of ≥ 10% baseline body weight loss (continuation)
  • Prescriber attestation of stability in OSA signs or symptoms (continuation)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Continuation requires: ≥ 10% baseline body weight loss AND prescriber attestation of stability in OSA signs or symptoms (e.g., snoring, excessive daytime sleepiness, fatigue). Patient must have completed ≥ 1 year of initial therapy. PAP therapy status is NOT re-evaluated at continuation. OSA AHI is not re-measured at continuation.

Not covered when

  • Central sleep apnea is excluded
  • Cheyne Stokes respiration is excluded
  • Concomitant use with other GLP-1 agonists or GLP-1/GIP agonists is not covered

Policy note: PAP/CPAP trial is NOT required prior to approval; patients using PAP therapy or not using PAP therapy are both eligible. Sleep study must document AHI ≥ 15 events/hour but there is no specific timeframe requirement for how recent the sleep study must be (a prior requirement for within 1 year was removed in May 2025). Moderate OSA = AHI ≥ 15; Severe OSA = AHI ≥ 30. Continuation requires ≥ 10% body weight loss (higher than the 5% threshold for weight loss indication). No pediatric indication for OSA.

Policy effective April 15, 2026 · verified June 2, 2026 · source: Cigna — GLP-1 coverage criteria (Policy 684) · View policy document (PDF)

Open on its own page →

Questions people ask
Does Cigna cover Zepbound?
Yes. Cigna covers Zepbound 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 Zepbound approval last with Cigna?
Weight Loss — Applies to Employer and ACA Marketplace plans. Initial approval: 8 months. Renewal: every 12 months. Obstructive Sleep Apnea (OSA) — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does Cigna require to renew Zepbound?
Weight Loss — Applies to Employer and ACA Marketplace plans. Must have lost ≥ 5% of baseline body weight (baseline = prior to any GLP-1 or GLP-1/GIP agonist). Ongoing behavioral modification and reduced-calorie diet required. BMI threshold re-verified at continuation; 3-month lifestyle program not re-checked. Obstructive Sleep Apnea (OSA) — Applies to Employer and ACA Marketplace plans. Continuation requires: ≥ 10% baseline body weight loss AND prescriber attestation of stability in OSA signs or symptoms (e.g., snoring, excessive daytime sleepiness, fatigue). Patient must have completed ≥ 1 year of initial therapy. PAP therapy status is NOT re-evaluated at continuation. OSA AHI is not re-measured at continuation.
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.

Also under Cigna: Mounjaro, Ozempic, Wegovy

Zepbound under other plans: Aetna, Centene, Medicare GLP-1 Bridge (CMS), UnitedHealthcare, Alabama Medicaid, BCBS Alabama, BCBS Arizona, BCBS Arkansas

All insurance plans · All medications

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