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FEP Blue

Does FEP Blue cover Wegovy?

Yes. FEP Blue covers Wegovy 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 documents

  • Federal Employee Program: Covered with requirements. See the qualification pathways below.

Earliest policy review June 5, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Weight Loss (1 plan type)

Applies to Federal Employee Program plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Wegovy injection — Adult (18+) weight loss initial approval

All of:

  • Age 18 years or older
  • Diagnosis of chronic weight management
  • Participated in a comprehensive weight management program (e.g., Teladoc or another weight loss program)
  • NO dual therapy with other GLP-1 receptor agonists
  • NO dual therapy with another PA medication for weight loss

Plus any one of:

  • BMI ≥ 30 kg/m2
  • BMI ≥ 27 kg/m2 AND established cardiovascular disease (e.g., congenital heart disease, cerebrovascular disease, PAD, coronary heart disease, ACS, MI, unstable angina, coronary or other arterial revascularization, or prior PCI/CABG)
  • BMI ≥ 27 kg/m2 AND at least one weight-related comorbid condition (e.g., T2DM, dyslipidemia, or hypertension)

Wegovy injection — Pediatric (age 12-17) weight loss initial approval

All of:

  • Age 12 to 17 years
  • Diagnosis of chronic weight management
  • BMI ≥ 95th percentile for age
  • Participated in a comprehensive weight management program (e.g., Teladoc or another weight loss program)
  • NO dual therapy with other GLP-1 receptor agonists
  • NO dual therapy with another PA medication for weight loss

Wegovy tablets — Adult (18+) weight loss initial approval

All of:

  • Age 18 years or older
  • Diagnosis of chronic weight management
  • Participated in a comprehensive weight management program (e.g., Teladoc or another weight loss program)
  • NO dual therapy with other GLP-1 receptor agonists
  • NO dual therapy with another PA medication for weight loss

Plus any one of:

  • BMI ≥ 30 kg/m2
  • BMI ≥ 27 kg/m2 AND established cardiovascular disease (e.g., congenital heart disease, cerebrovascular disease, PAD, coronary heart disease, ACS, MI, unstable angina, coronary or other arterial revascularization, or prior PCI/CABG)
  • BMI ≥ 27 kg/m2 AND at least one weight-related comorbid condition (e.g., T2DM, dyslipidemia, or hypertension)

Documentation to bring

  • Documentation of BMI ≥ 30 kg/m2, OR BMI ≥ 27 kg/m2 with qualifying comorbidity or established CVD (adults 18+)
  • Documentation of BMI ≥ 95th percentile for age (ages 12-17)
  • Documentation of participation in a comprehensive weight management program (e.g., Teladoc or another weight loss program)
  • Attestation of no dual therapy with another GLP-1 receptor agonist
  • Attestation of no dual therapy with another PA-required weight loss medication

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg — 12 single-dose pens per 84 days (84-day)
  • 7.2mg — 12 single-dose pens per 84 days (84-day)
  • All (tablets) — 90 tablets per 90 days (84-day)

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: Adults (18+): patient has lost at least 5% of baseline body weight OR continued to maintain their initial 5% weight loss. Ages 12-17: patient has maintained clinically significant weight loss. Comprehensive weight management program participation also required at renewal. BMI/comorbidity thresholds are NOT re-verified at continuation.

Not covered when

  • Dual therapy with any other GLP-1 receptor agonist
  • Dual therapy with another PA-required weight loss medication

Policy note: Wegovy injection approved for ages 12+; Wegovy tablets approved for ages 18+ only. Quantity limit for Wegovy injection applies across all strengths (0.25mg–2.4mg and 7.2mg): 12 single-dose pens per 84 days. Wegovy tablets: 90 tablets per 90 days. Initial approval duration is 6 months; renewal duration is 12 months. The policy applies to both the injection and oral tablet formulations. CVD qualifying events listed for the 27 kg/m2 BMI pathway include: congenital heart disease, cerebrovascular disease, peripheral artery disease, coronary heart disease, ACS, MI, unstable angina, coronary or other arterial revascularization, or prior PCI/coronary bypass surgery. Policy approved by FEP Pharmacy and Medical Policy Committee.

Policy effective July 1, 2026 · verified July 27, 2026 · source: Fep Criteria Wegovy · View policy document (PDF)

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Full requirements: Wegovy for Heart Disease Risk Reduction (1 plan type)

Applies to Federal Employee Program plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CV risk reduction — injection or tablets (adults with established CVD and overweight/obesity)

All of:

  • Age 18 or older
  • Established cardiovascular disease (congenital heart disease, cerebrovascular disease, PAD, coronary heart disease, ACS, MI, unstable angina, coronary or other arterial revascularization, or prior PCI/CABG)
  • BMI ≥ 27 kg/m2
  • Participating in a comprehensive weight management program (e.g., Teladoc or another weight loss program)
  • No dual therapy with another GLP-1 receptor agonist
  • No dual therapy with another PA-required weight loss medication

Documentation to bring

  • Documentation of established cardiovascular disease (qualifying event or condition)
  • Documentation of BMI ≥ 27 kg/m2
  • Documentation of participation in a comprehensive weight management program
  • Confirmation of no concurrent GLP-1 receptor agonist therapy
  • Confirmation of no concurrent PA-required weight loss medication

Quantity limits

  • all injection strengths — 12 single-dose pens per 84 days (84-day)
  • tablet — 90 tablets per 90 days (84-day)

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: Patient must have lost at least 5% of baseline body weight OR maintained initial 5% weight loss. Comprehensive weight management program participation required. CV indication is covered under the weight management pathway with established CVD as a qualifying comorbidity (BMI ≥ 27 + established CVD).

Not covered when

  • Dual therapy with another GLP-1 receptor agonist
  • Dual therapy with another PA-required weight loss medication
  • Personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) [boxed warning contraindication]

Policy note: The policy does not have a standalone CV risk reduction section; this indication is covered under the weight management criteria with established CVD as a qualifying comorbidity for patients with BMI ≥ 27 kg/m2. The FDA-approved CV risk reduction indication (for adults with established CVD and obesity or overweight) is explicitly referenced in the regulatory status section for both injection and tablets. diabetes is not excluded for this pathway.

Policy effective February 13, 2026 · verified June 5, 2026 · source: Fep Criteria Wegovy · View policy document (PDF)

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Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Federal Employee Program plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Wegovy injection — MASH initial approval

All of:

  • Age 18 years or older
  • Diagnosis of noncirrhotic MASH (formerly noncirrhotic NASH)
  • Moderate to advanced liver fibrosis (stages F2 to F3) confirmed by liver biopsy within last 6 months OR elastography/CT/MRI within last 3 months
  • Patient is being monitored and/or treated for any comorbid conditions (e.g., CVD, diabetes, dyslipidemia, hypertension)
  • Prescribed by, or in consultation with, an endocrinologist, gastroenterologist, or hepatologist
  • Used in conjunction with diet and exercise

Documentation to bring

  • Diagnosis of noncirrhotic MASH (formerly noncirrhotic NASH)
  • Documentation of fibrosis stage F2 or F3 confirmed by: liver biopsy within last 6 months (NAS ≥ 4, OR if NAS < 4, hepatocyte ballooning and steatosis present) OR elastography (e.g., FibroScan), CT, or MRI within last 3 months
  • Documentation of monitoring and/or treatment for comorbid conditions (e.g., CVD, diabetes, dyslipidemia, hypertension)
  • Prescription from or consultation with an endocrinologist, gastroenterologist, or hepatologist
  • Attestation of no stage F4 fibrosis (cirrhosis)
  • Attestation of no significant alcohol consumption (< 2 alcoholic drinks/day for > 3 months in the last year)
  • Attestation of no hepatocellular carcinoma (HCC) diagnosis
  • Attestation of no chronic liver diseases (e.g., primary biliary cholangitis, primary sclerosing cholangitis, Hepatitis B positive, active Hepatitis C)

Quantity limits

  • 0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg — 12 single-dose pens per 84 days (84-day)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Improvement in fibrosis by at least 1 stage within 1 year of treatment OR no worsening of fibrosis after 2 years or more of therapy. Patient has not progressed to stage F4 (cirrhosis). Metabolic risks are managed to standard of care. Used in conjunction with diet and exercise.

Not covered when

  • Stage F4 liver fibrosis (cirrhosis)
  • Significant alcohol consumption (≥ 2 alcoholic drinks per day for > 3 months in the last year)
  • Diagnosis of hepatocellular carcinoma (HCC)
  • Chronic liver diseases (e.g., primary biliary cholangitis, primary sclerosing cholangitis, Hepatitis B positive, active Hepatitis C)
  • Pediatric patients under 18 years of age (safety and effectiveness not established for MASH in patients < 18)

Policy note: MASH indication applies to Wegovy injection only (not tablets). Wegovy injection only approved for MASH. Liver biopsy confirmation requires NAS ≥ 4 OR if NAS < 4, hepatocyte ballooning and steatosis must be present. Imaging confirmation (elastography, CT, or MRI) must be within last 3 months. Biopsy must be within last 6 months. Continuation requires fibrosis improvement of at least 1 stage within 1 year OR no worsening after 2+ years. Alcohol limit is stated as 'fewer than 2 alcoholic drinks per day' (i.e., < 2 drinks/day); exact grams not specified in document.

Policy effective July 1, 2026 · verified July 27, 2026 · source: Fep Criteria Wegovy · View policy document (PDF)

Open on its own page →

Questions people ask
Does FEP Blue cover Wegovy?
Yes. FEP Blue covers Wegovy 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 Wegovy approval last with FEP Blue?
Weight Loss — Applies to Federal Employee Program plans. Initial approval: 6 months. Renewal: every 12 months. Heart Disease Risk Reduction — Applies to Federal Employee Program plans. Initial approval: 6 months. Renewal: every 12 months. Liver Disease (MASH) — Applies to Federal Employee Program plans. Initial approval: 12 months. Renewal: every 12 months.
What does FEP Blue require to renew Wegovy?
Weight Loss — Applies to Federal Employee Program plans. Adults (18+): patient has lost at least 5% of baseline body weight OR continued to maintain their initial 5% weight loss. Ages 12-17: patient has maintained clinically significant weight loss. Comprehensive weight management program participation also required at renewal. BMI/comorbidity thresholds are NOT re-verified at continuation. Heart Disease Risk Reduction — Applies to Federal Employee Program plans. Patient must have lost at least 5% of baseline body weight OR maintained initial 5% weight loss. Comprehensive weight management program participation required. CV indication is covered under the weight management pathway with established CVD as a qualifying comorbidity (BMI ≥ 27 + established CVD). Liver Disease (MASH) — Applies to Federal Employee Program plans. Improvement in fibrosis by at least 1 stage within 1 year of treatment OR no worsening of fibrosis after 2 years or more of therapy. Patient has not progressed to stage F4 (cirrhosis). Metabolic risks are managed to standard of care. Used in conjunction with diet and exercise.
How current is this information?
The oldest review date among the policies on this page is June 5, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under FEP Blue: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: BCBS Alabama, BCBS Arizona, BCBS Arkansas, BCBS Louisiana, BCBS Massachusetts, BCBS Michigan, BCBS Minnesota, BCBS Nebraska

All insurance plans · All medications

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