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HMSA Hawaii

Does HMSA Hawaii cover Wegovy?

Yes. HMSA Hawaii 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 document

  • Employer: 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 Employer plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Adult (18+) Initial Approval — BMI ≥ 30

All of:

  • Patient is 18 years of age or older
  • Drug will be used with a reduced calorie diet and increased physical activity to reduce excess body weight
  • Patient has participated in a comprehensive weight management program (behavioral modification, reduced calorie diet, increased physical activity) with continuing follow-up for at least 6 months prior to drug therapy
  • Baseline BMI ≥ 30 kg/m2

Adult (18+) Initial Approval — BMI ≥ 27 with comorbidity

All of:

  • Patient is 18 years of age or older
  • Drug will be used with a reduced calorie diet and increased physical activity to reduce excess body weight
  • Patient has participated in a comprehensive weight management program (behavioral modification, reduced calorie diet, increased physical activity) with continuing follow-up for at least 6 months prior to drug therapy
  • Baseline BMI ≥ 27 kg/m2
  • At least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, dyslipidemia)

Adult (18+) Continuation of Therapy

All of:

  • Patient is 18 years of age or older
  • Patient has completed at least 3 months of therapy with the requested drug at a stable maintenance dose

Plus any one of:

  • Patient has lost at least 5% of baseline body weight
  • Patient has continued to maintain their initial 5% weight loss

Pediatric (12-17) Initial Approval — Obesity

All of:

  • Patient is 12 to 17 years of age
  • Drug will be used with a reduced calorie diet and increased physical activity to reduce excess body weight
  • Patient has participated in a comprehensive weight management program (behavioral modification, reduced calorie diet, increased physical activity) with continuing follow-up for at least 6 months prior to drug therapy
  • Baseline BMI ≥ 95th percentile standardized for age and sex (obesity)

Pediatric (12-17) Continuation of Therapy

All of:

  • Patient is 12 to 17 years of age
  • Request is for continuation of therapy
  • Patient has successfully titrated to a stable maintenance dose

Plus any one of:

  • Patient has had a reduction from baseline BMI
  • Patient has continued to maintain their reduction in BMI from baseline

Documentation to bring

  • Baseline BMI documentation (≥ 30 kg/m2 for BMI-only pathway, or ≥ 27 kg/m2 for comorbidity pathway)
  • Documentation of qualifying weight-related comorbid condition (if BMI 27-<30 pathway)
  • Documentation of participation in a comprehensive weight management program for at least 6 months prior to drug therapy (initial approval)
  • For pediatric patients: baseline BMI ≥ 95th percentile standardized for age and sex
  • For continuation (adults): documentation that patient has lost ≥ 5% of baseline body weight or has maintained initial 5% weight loss, after at least 3 months at stable maintenance dose
  • For continuation (pediatric): documentation of reduction from baseline BMI or maintenance of BMI reduction

Quantity limits

  • 0.25 mg/0.5 mL, 0.5 mg/0.5 mL, 1 mg/0.5 mL — 2 mL (1 package of 4 pens) / 21 days; 6 mL (3 packages of 4 pens) / 63 days (84-day)
  • 1.7 mg/0.75 mL, 2.4 mg/0.75 mL — 3 mL (1 package of 4 pens) / 21 days; 9 mL (3 packages of 4 pens) / 63 days (84-day)

Approval and renewal

  • Initial approval: 7 months
  • Renewal: every 12 months
  • Renewal: Adults (18+): Patient has lost at least 5% of baseline body weight OR has continued to maintain their initial 5% weight loss, after at least 3 months of therapy at a stable maintenance dose. Pediatric (12-17): Patient has had a reduction from baseline BMI OR has continued to maintain the reduction in BMI from baseline, after successfully titrating to a stable maintenance dose. Lifestyle program requirement is NOT re-verified at continuation.

Not covered when

  • Coadministration with other semaglutide-containing products is not recommended
  • Coadministration with any other GLP-1 receptor agonist is not recommended

Policy note: The 21-day supply is used for a 28-day fill period and 63-day supply is used for an 84-day fill period to allow time for refill processing. Policy number 4774-C, version UDR 08-2023 v2. Document references 'Action Required: Documentation is required for approval' for BMI, comorbidity, and weight loss outcome criteria. Pediatric indication is age 12+; adult pathway is age 18+.

verified June 5, 2026 · source: 14017 156760120 · View policy document (PDF)

Open on its own page →

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

Applies to Employer plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction — Initial Approval

All of:

  • Patient is an adult
  • Drug is being used with a reduced calorie diet and increased physical activity
  • Request is NOT for continuation of therapy
  • Patient has established cardiovascular disease with history of at least ONE qualifying CV event
  • Baseline BMI ≥ 27 kg/m2
  • Patient does NOT have type 2 diabetes
  • Patient is currently receiving GDMT for cardiovascular disease OR has clinical reason not to be treated with GDMT (e.g., lipid-lowering agent, antiplatelet, beta-blocker, renin-angiotensin inhibitor)

Plus any one of:

  • Previous myocardial infarction (MI)
  • Previous stroke
  • Symptomatic peripheral arterial disease (PAD) evidenced by intermittent claudication with ABI < 0.85 at rest, peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease
  • Prior history of revascularization (CABG, PCI, or angioplasty)

CV Risk Reduction — Continuation of Therapy

All of:

  • Request is for continuation of therapy
  • Patient has established cardiovascular disease with history of at least ONE qualifying CV event
  • Patient is being treated with a maintenance dosage of the requested drug

Plus any one of:

  • Previous myocardial infarction (MI)
  • Previous stroke
  • Symptomatic peripheral arterial disease (PAD) evidenced by intermittent claudication with ABI < 0.85 at rest, peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease
  • Prior history of revascularization (CABG, PCI, or angioplasty)

Documentation to bring

  • Documentation of qualifying cardiovascular disease event (previous MI, previous stroke, symptomatic PAD with ABI < 0.85 or revascularization or amputation, or prior CABG/PCI/angioplasty)
  • Baseline BMI documentation (≥ 27 kg/m2)
  • Documentation confirming patient does NOT have type 2 diabetes (initial approval only)
  • Documentation of current GDMT use (e.g., lipid-lowering agent, antiplatelet, beta-blocker, renin-angiotensin inhibitor) OR clinical reason GDMT is not appropriate (initial approval only)
  • For continuation: documentation that patient is being treated with a maintenance dosage of the requested drug

Quantity limits

  • 0.25 mg/0.5 mL, 0.5 mg/0.5 mL, 1 mg/0.5 mL — 2 mL (1 package of 4 pens) / 21 days; 6 mL (3 packages of 4 pens) / 63 days (84-day)
  • 1.7 mg/0.75 mL, 2.4 mg/0.75 mL — 3 mL (1 package of 4 pens) / 21 days; 9 mL (3 packages of 4 pens) / 63 days (84-day)

Approval and renewal

  • Initial approval: 7 months
  • Renewal: every 12 months
  • Renewal: Continuation requires: (1) established cardiovascular disease with history of qualifying CV event AND (2) patient is being treated with a maintenance dosage of the requested drug. T2DM exclusion, BMI requirement, and GDMT requirement are NOT re-verified at continuation.

Not covered when

  • Type 2 diabetes — patients with T2DM should use Ozempic for CV risk reduction per policy note
  • Coadministration with other semaglutide-containing products is not recommended
  • Coadministration with any other GLP-1 receptor agonist is not recommended

Policy note: Policy explicitly states that patients with type 2 diabetes should use Ozempic (not Wegovy) for CV risk reduction: 'Ozempic is indicated to reduce the risk of major cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease. Patients with type 2 diabetes may be treated for risk reduction of cardiovascular events with Ozempic.' PAD qualifying criterion requires ABI < 0.85 at rest, or peripheral arterial revascularization, or amputation due to atherosclerotic disease. GDMT examples listed: lipid-lowering agent, antiplatelet, beta-blocker, renin-angiotensin inhibitor. Policy number 4774-C, version UDR 08-2023 v2.

verified June 5, 2026 · source: 14017 156760120 · View policy document (PDF)

Open on its own page →

Questions people ask
Does HMSA Hawaii cover Wegovy?
Yes. HMSA Hawaii 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 HMSA Hawaii?
Weight Loss — Applies to Employer plans. Initial approval: 7 months. Renewal: every 12 months. Heart Disease Risk Reduction — Applies to Employer plans. Initial approval: 7 months. Renewal: every 12 months.
What does HMSA Hawaii require to renew Wegovy?
Weight Loss — Applies to Employer plans. Adults (18+): Patient has lost at least 5% of baseline body weight OR has continued to maintain their initial 5% weight loss, after at least 3 months of therapy at a stable maintenance dose. Pediatric (12-17): Patient has had a reduction from baseline BMI OR has continued to maintain the reduction in BMI from baseline, after successfully titrating to a stable maintenance dose. Lifestyle program requirement is NOT re-verified at continuation. Heart Disease Risk Reduction — Applies to Employer plans. Continuation requires: (1) established cardiovascular disease with history of qualifying CV event AND (2) patient is being treated with a maintenance dosage of the requested drug. T2DM exclusion, BMI requirement, and GDMT requirement are NOT re-verified at continuation.
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 HMSA Hawaii: 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 HMSA Hawaii's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.