FEP Blue coverage for Wegovy (Weight Loss)

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