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Elevance Health

Does Elevance Health cover Wegovy?

It depends on your benefits. Elevance Health covers Wegovy for weight loss only when your plan includes that benefit and the policy requirements are met.

Policy document

  • Employer and ACA Marketplace: Depends on your plan's benefit. See the qualification pathways below.

Earliest policy review June 2, 2026. How we verify · Check your exact plan

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

Applies to Employer and ACA Marketplace plans.

Depends on your plan's benefit

Coverage applies only when member's benefit covers weight loss drugs and requires prior authorization. Employer or plan must have weight loss drug benefit.

Qualification pathways

You can qualify through any one of these.

Adult initial approval - BMI ≥ 30

All of:

  • Age ≥ 18 years
  • BMI ≥ 30 kg/m2 documented within 90 days of request
  • Trial and failure of healthcare provider supervised comprehensive lifestyle program for ≥ 6 months including calorie deficit ~30%, ≥ 150 min/week exercise, and inability to achieve ≥ 5% weight reduction
  • Currently maintained on healthcare provider supervised lifestyle program
  • Not receiving two or more medications for weight loss simultaneously
  • Healthcare provider consultation regarding risks, benefits, and realistic expectations

Adult initial approval - BMI ≥ 27 with weight-related comorbidity

All of:

  • Age ≥ 18 years
  • BMI ≥ 27 kg/m2 documented within 90 days of request
  • Trial and failure of healthcare provider supervised comprehensive lifestyle program for ≥ 6 months including calorie deficit ~30%, ≥ 150 min/week exercise, and inability to achieve ≥ 5% weight reduction
  • Currently maintained on healthcare provider supervised lifestyle program
  • Not receiving two or more medications for weight loss simultaneously
  • Healthcare provider consultation regarding risks, benefits, and realistic expectations

Plus any one of:

  • Hypertension (treated or SBP ≥ 130 mmHg or DBP ≥ 80 mmHg)
  • Type II Diabetes Mellitus
  • Dyslipidemia (treated or LDL ≥ 160 mg/dL or triglycerides ≥ 150 mg/dL or HDL <40 mg/dL [men] or <50 mg/dL [women])
  • Obstructive sleep apnea (as a result of BMI ≥ 27)
  • Cardiovascular disease (ischemic CVD or NYHA Class I-III heart failure)

Adolescent initial approval (ages 12-17)

All of:

  • Age 12 to 17 years
  • BMI ≥ 95th percentile for age and sex documented within 90 days of request
  • Individual and caregiver utilized healthy nutrition and behavior counseling for ≥ 6 months with inadequate weight reduction
  • Currently maintained on healthy nutrition and behavior counseling
  • Not receiving two or more medications for weight loss simultaneously
  • Healthcare provider consultation regarding risks, benefits, and realistic expectations

Documentation to bring

  • Documentation of BMI ≥ 30 kg/m2 (adults) or BMI ≥ 95th percentile for age and sex (adolescents) within 90 days of request
  • For adults with BMI 27-29: documentation of at least one weight-related comorbidity (HTN, T2DM, dyslipidemia, OSA from BMI ≥ 27, or CVD)
  • Documentation of prior trial and failure of healthcare provider supervised comprehensive lifestyle program for ≥ 6 months (adults: including calorie deficit ~30%, ≥ 150 min/week exercise, and inability to achieve ≥ 5% weight reduction; adolescents: healthy nutrition and behavior counseling for ≥ 6 months with inadequate weight reduction)
  • Documentation of current enrollment and maintenance in healthcare provider supervised lifestyle program
  • Documentation that individual is NOT receiving two or more weight loss medications simultaneously
  • Documentation of healthcare provider consultation regarding risks, benefits, realistic expectations, and need for long-term follow-up and behavior modification adherence
  • For continuation (adults): Documentation of achieved/maintained ≥ 5% weight loss within 90 days of continuation request
  • For continuation (adolescents): Documentation of achieved/maintained >4% reduction from baseline BMI within 90 days of continuation request
  • For continuation: Documentation of continued engagement in comprehensive lifestyle program (adults) or healthy nutrition and behavior counseling (adolescents)

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg, 7.2mg — Subject to quantity limit (specific limit not detailed in document)

Approval and renewal

  • Initial approval: 7 months
  • Renewal: every 6 months
  • Renewal: At least 5% weight loss from the starting weight.
  • Renewal: At least 4% reduction in BMI.
  • Renewal: Adults: Documentation of achieved/maintained initial 5% weight loss (required within 90 days of each continuation request). BMI eligibility criteria are re-verified based on BMI at initiation of therapy (not current BMI). Continued engagement in comprehensive lifestyle program required. Adolescents: Documentation of achieved/maintained >4% reduction from baseline BMI (required within 90 days of each continuation request). Continued healthy nutrition and behavior counseling required. Note: The 5% continuation threshold applies to adults; the 4% BMI reduction threshold applies to adolescents.

Not covered when

  • BMI < 18.5 kg/m2
  • Use for treatment of type 2 diabetes mellitus
  • Personal or family history of medullary thyroid carcinoma (MTC)
  • Diagnosis of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • History of pancreatitis
  • Concurrent use of another semaglutide agent or any other GLP-1 agonist
  • History of suicide attempts or active suicidal ideation
  • Receiving two or more medications for weight loss simultaneously

Policy note: Initial approval duration is 28 weeks (approximately 7 months) for both adults and adolescents. Continuation approvals are 6 months. Adults use injection or tablets (0.25 mg, 0.5 mg, 1 mg, 1.7 mg, 2.4 mg, 7.2 mg); adolescents use injection only (0.25 mg, 0.5 mg, 1 mg, 1.7 mg, 2.4 mg). Coverage is conditioned on member's benefit covering weight loss drugs. Adult continuation re-verifies BMI eligibility using BMI at initiation of therapy (not current). Adolescent continuation requires >4% reduction from baseline BMI. Weight loss for treatment of T2DM is explicitly excluded (use for T2DM treatment is a denial reason). T1DM is not explicitly listed as a weight loss exclusion for adolescents, but is listed for adults in the adult exclusion section. Document references both a 7.2 mg strength for adults (not listed for adolescents). Dyslipidemia qualifying comorbidity is specifically defined with lab thresholds. OSA as comorbidity requires it to be 'as a result of having a BMI of 27 or greater.' Exercise exception allowed for clinical limitations including cardiovascular conditions, physical limitations, or fall risk.

Policy effective April 3, 2026 · verified June 2, 2026 · source: Elevance Health ACA Marketplace prior authorization policy · View policy document (PDF)

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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 in adults without diabetes

All of:

  • Established cardiovascular disease (prior MI, prior stroke, or symptomatic PAD)
  • HbA1c < 6.5% (48 mmol/mol) — excludes Type 2 diabetes
  • BMI ≥ 27 kg/m2 documented within 90 days of request
  • Established on GDMT including antiplatelet/anticoagulant therapy, high-intensity statin, and blood pressure lowering therapy (unless not tolerated or not clinically warranted); beta blocker required for history of MI
  • Wegovy used as add-on to GDMT
  • Wegovy used in combination with healthy lifestyle counseling
  • Wegovy used in combination with reduced calorie diet and increased physical activity

Plus any one of:

  • Previous myocardial infarction
  • Previous stroke (ischemic or hemorrhagic)
  • Symptomatic peripheral arterial disease (intermittent claudication with ABI <0.85, peripheral arterial revascularization, or amputation due to atherosclerotic disease)

Documentation to bring

  • Documentation of qualifying established CVD event: prior MI, prior stroke, or symptomatic PAD (with ABI <0.85, revascularization, or amputation)
  • HbA1c lab result < 6.5% (48 mmol/mol)
  • BMI documentation ≥ 27 kg/m2 within 90 days of request
  • Documentation of current GDMT use (antiplatelet/anticoagulant, high-intensity statin, blood pressure lowering therapy) or clinical reason not appropriate
  • Documentation of beta blocker use for individuals with history of MI, or clinical reason not appropriate
  • Confirmation that Wegovy will be used as add-on to GDMT
  • Confirmation that Wegovy will be used with healthy lifestyle counseling and reduced calorie diet and increased physical activity

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg — Subject to quantity limit (specific limit not detailed in document)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Continuation criteria not explicitly detailed in the document beyond initial approval duration of 1 year. No separate continuation criteria listed for CV risk reduction indication.

Not covered when

  • BMI < 18.5 kg/m2
  • Type 2 diabetes (HbA1c ≥ 6.5%)
  • Personal or family history of Medullary Thyroid Carcinoma (MTC)
  • Diagnosis of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • Concurrent use of another semaglutide agent or any other GLP-1 agonist
  • History of suicide attempts or active suicidal ideation
  • Type 1 diabetes

Policy note: The CV risk reduction indication explicitly excludes both Type 1 and Type 2 diabetes (HbA1c must be < 6.5%). Symptomatic PAD is defined as intermittent claudication with ankle-brachial index <0.85 at rest, peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease. GDMT requirement has exceptions for intolerance or lack of clinical warrant. Beta blocker is only required for individuals with history of MI. BMI documentation must be within 90 days of request. Approval duration is 1 year.

Policy effective April 3, 2026 · verified June 2, 2026 · source: Elevance Health ACA Marketplace prior authorization policy · View policy document (PDF)

Open on its own page →

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 diagnosis verification via imaging alone

All of:

  • Age ≥ 18 years
  • Diagnosis of noncirrhotic, nonalcoholic MASH
  • Steatosis confirmed by FibroScan VCTE or MRE within the past year
  • Moderate to advanced liver fibrosis consistent with stages F2 or F3
  • Prior trial and inadequate response to healthcare provider supervised comprehensive lifestyle program
  • Will continue to be maintained on healthcare provider supervised comprehensive lifestyle program

MASH diagnosis verification via liver biopsy with NAS score

All of:

  • Age ≥ 18 years
  • Diagnosis of noncirrhotic, nonalcoholic MASH
  • Liver biopsy within the past 3 years
  • NAS score ≥ 4
  • Score of at least 1 in two or more NAS components (steatosis, hepatocellular ballooning, lobular inflammation)
  • Moderate to advanced liver fibrosis consistent with stages F2 or F3
  • Prior trial and inadequate response to healthcare provider supervised comprehensive lifestyle program
  • Will continue to be maintained on healthcare provider supervised comprehensive lifestyle program

Documentation to bring

  • Documentation of age ≥ 18 years
  • Diagnosis of noncirrhotic MASH (formerly NASH)
  • Imaging or biopsy confirming diagnosis: FibroScan VCTE or MRE within the past year, OR liver biopsy within the past 3 years with NAS score ≥ 4 and score of at least 1 in two or more NAS components
  • Documentation of moderate to advanced liver fibrosis (F2 or F3)
  • Documentation of prior trial and inadequate response to healthcare provider supervised comprehensive lifestyle program (worsening or no improvement in NAS score, NAS components, or fibrosis stage)
  • Documentation that individual will continue to be maintained on healthcare provider supervised comprehensive lifestyle program

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg — Subject to quantity limit (specific limit not detailed in document)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Improvement from baseline in NAFLD Activity Score (NAS) without worsening of fibrosis stage; OR improvement from baseline in fibrosis stage with no worsening of NAS; OR improvement in fibrosis stage based on FibroScan VCTE or MRE. Continued enrollment in healthcare provider supervised comprehensive lifestyle program required.

Not covered when

  • BMI < 18.5 kg/m2
  • Cirrhosis (stage 4 fibrosis)
  • Evidence of other forms of chronic liver disease
  • Personal or family history of Medullary Thyroid Carcinoma (MTC)
  • Diagnosis of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • History of pancreatitis
  • Severe gastroparesis
  • History of suicide attempts or active suicidal ideation
  • Concurrent use of other semaglutide-containing products or any other GLP-1 receptor agonist (including Ozempic, Rybelsus, Zepbound, Mounjaro, Saxenda, Victoza)
  • Type 1 diabetes

Policy note: Diagnosis must be noncirrhotic MASH. Imaging confirmation (FibroScan VCTE or MRE) lookback is 12 months; liver biopsy lookback is 36 months. Continuation requires improvement in NAS or fibrosis stage. Pregnancy exclusion not explicitly listed in document but is a standard GLP-1 exclusion; document does not state it explicitly so set to false.

Policy effective April 3, 2026 · verified June 2, 2026 · source: Elevance Health ACA Marketplace prior authorization policy · View policy document (PDF)

Open on its own page →

If weight loss isn't covered on your plan

Elevance Health has separate Wegovy policies that don't depend on that benefit:

Questions people ask
Does Elevance Health cover Wegovy?
It depends on your benefits. Elevance Health covers Wegovy for weight loss only when your plan includes that benefit and the policy requirements are met.
How long does a Wegovy approval last with Elevance Health?
Weight Loss — Applies to Employer and ACA Marketplace plans. Initial approval: 7 months. Renewal: every 6 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 Elevance Health require to renew Wegovy?
Weight Loss — Applies to Employer and ACA Marketplace plans. At least 5% weight loss from the starting weight. At least 4% reduction in BMI. Adults: Documentation of achieved/maintained initial 5% weight loss (required within 90 days of each continuation request). BMI eligibility criteria are re-verified based on BMI at initiation of therapy (not current BMI). Continued engagement in comprehensive lifestyle program required. Adolescents: Documentation of achieved/maintained >4% reduction from baseline BMI (required within 90 days of each continuation request). Continued healthy nutrition and behavior counseling required. Note: The 5% continuation threshold applies to adults; the 4% BMI reduction threshold applies to adolescents. Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. Continuation criteria not explicitly detailed in the document beyond initial approval duration of 1 year. No separate continuation criteria listed for CV risk reduction indication. Liver Disease (MASH) — Applies to Employer and ACA Marketplace plans. Improvement from baseline in NAFLD Activity Score (NAS) without worsening of fibrosis stage; OR improvement from baseline in fibrosis stage with no worsening of NAS; OR improvement in fibrosis stage based on FibroScan VCTE or MRE. Continued enrollment in healthcare provider supervised comprehensive lifestyle program required.
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 Elevance Health: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: California Medicaid, Colorado Medicaid, Connecticut Medicaid, EmblemHealth, Excellus BCBS, Highmark, Independent Health, Indiana Medicaid

All insurance plans · All medications

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