FEP Blue

Does FEP Blue cover Wegovy?

Quick answer · Weight Loss

FEP Blue covers Wegovy for weight loss with prior authorization on Federal Employee Program.

  • Federal Employee Program: Covered with requirements. BMI of 30 or higher

Last verified July 27, 2026. Policy effective July 1, 2026. Source: FEP_Criteria_Wegovy.pdf. How we verify this data →

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Wegovy for Weight Loss

What FEP Blue requires, by plan type. Open this indication on its own page →

Federal Employee Program

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 (CVD, T2DM, dyslipidemia, and HTN)
  • BMI at or above the 95th percentile for age and sex
  • 6 months of a documented diet and exercise program

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
  • To renew, the plan looks for at least 5% weight loss from the starting weight and 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. Make sure your starting weight and date are in the chart now — renewal is measured against it.

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.pdf

Wegovy for Heart Disease Risk Reduction

What FEP Blue requires, by plan type. Open this indication on its own page →

Federal Employee Program

Covered with requirements

What you need to qualify

  • Age 18 and older
  • BMI of 27 or higher
  • 6 months of a documented diet and exercise program
  • Established cardiovascular disease (congenital heart disease, cerebrovascular disease, PAD, coronary heart disease, ACS, MI, unstable angina, coronary or other arterial revascularization, prior PCI, and prior CABG)

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
  • To renew, the plan looks for at least 5% weight loss from the starting weight and 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). Make sure your starting weight and date are in the chart now — renewal is measured against it.

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.pdf

Wegovy for Liver Disease (MASH)

What FEP Blue requires, by plan type. Open this indication on its own page →

Federal Employee Program

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, and MRE, fibrosis stage F2 to F3

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
  • To renew, the plan looks for 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.pdf

Why Wegovy requests get denied by FEP Blue

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 FEP Blue cover Wegovy?
FEP Blue covers Wegovy for weight loss with prior authorization on Federal Employee Program.
What BMI do you need for Wegovy under FEP Blue?
For weight loss on Federal Employee Program plans, FEP Blue requires a BMI of 30 or higher, or 27 or higher with a qualifying weight-related condition.
How long does a Wegovy approval last with FEP Blue?
Initial approvals last 6 months, and renewals are granted in 12-month periods.
What does FEP Blue require to renew Wegovy?
At least 5% weight loss from the starting weight and 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.
How current is this information?
This page reflects FEP Blue's written policy as of July 1, 2026, last verified against the source document on July 27, 2026.

Other medications under FEP Blue

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes FEP Blue'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.