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Kaiser Permanente Northern California

Does Kaiser Permanente Northern California cover Wegovy?

Yes. Kaiser Permanente Northern California 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

  • Standard Commercial Guidelines 6 1 26 Excerpted

    Kaiser Permanente Northern California · PA policy · Employer

    Effective June 1, 2026. Verified June 5, 2026.

    View PDF Download Original insurer source
  • 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.

Weight Loss — Initial Approval: Adult (age ≥ 18)

All of:

  • Age ≥ 18 years
  • Actively enrolled in an exercise and caloric reduction program
  • No concurrent use of another GLP-1 receptor agonist or GLP-1/GIP receptor agonist

Plus any one of:

  • BMI ≥ 30 kg/m² (general population)
  • BMI ≥ 27.5 kg/m² (Asian patients)
  • BMI ≥ 27 kg/m² AND at least one weight-related comorbidity (HTN, T2DM, dyslipidemia, CVD, CAD, sleep apnea, osteoarthritis of knees, PCOS, NASH/NAFLD, asthma, or COPD) (general population)
  • BMI ≥ 25 kg/m² AND at least one weight-related comorbidity (Asian patients)

Weight Loss — Initial Approval: Adolescent (age 12–17)

All of:

  • Age 12 to 17 years
  • Initial BMI ≥ 95th percentile for age and sex
  • Actively enrolled in an exercise and caloric reduction program
  • No concurrent use of another GLP-1 receptor agonist or GLP-1/GIP receptor agonist

Weight Loss — Renewal: Adult (age ≥ 18)

All of:

  • No concurrent use of another GLP-1 receptor agonist or GLP-1/GIP receptor agonist
  • Baseline BMI eligibility re-confirmed (same thresholds as initial criteria)
  • Achieved or maintained at least 5% weight loss of baseline body weight

Weight Loss — Renewal: Adolescent (age 12–17)

All of:

  • Age 12 to 17 years
  • No concurrent use of another GLP-1 receptor agonist or GLP-1/GIP receptor agonist
  • Achieved or maintained at least 5% reduction of baseline BMI

Documentation to bring

  • Documentation of patient age
  • Baseline BMI documentation: ≥ 30 kg/m² (general adult), or ≥ 27.5 kg/m² (Asian adult), or ≥ 27 kg/m² with qualifying comorbidity (general adult), or ≥ 25 kg/m² with qualifying comorbidity (Asian adult), or ≥ 95th percentile for age/sex (adolescents 12–17)
  • Documentation of at least one weight-related comorbidity if using lower BMI threshold (HTN, T2DM, dyslipidemia, CVD, CAD, sleep apnea, osteoarthritis of knees, PCOS, NASH/NAFLD, asthma, or COPD)
  • Attestation of active enrollment in an exercise and caloric reduction program
  • Confirmation of no concurrent GLP-1 receptor agonist or GLP-1/GIP receptor agonist use
  • For renewal: documentation of ≥ 5% weight loss from baseline body weight (adults) or ≥ 5% BMI reduction from baseline (adolescents 12–17)

Approval and renewal

  • Renewal: At least 5% reduction in BMI.
  • Renewal: Renewal requires: (1) no concurrent GLP-1 or GLP-1/GIP agonist; (2) for adults (≥18): re-verification of baseline BMI eligibility criteria AND at least 5% weight loss of baseline body weight achieved or maintained; (3) for adolescents (12–17): at least 5% reduction of baseline BMI achieved or maintained. Note: the 5% threshold for adults is 5% of baseline body weight; for adolescents it is 5% of baseline BMI. Active lifestyle program enrollment is NOT explicitly re-verified at renewal.

Not covered when

  • Concurrent use of another GLP-1 receptor agonist (liraglutide, exenatide, semaglutide other products) or GLP-1/GIP receptor agonist (tirzepatide products)

Policy note: The weight loss indication covers both adults (age ≥ 18) and adolescents (age 12–17). For Asian adults, BMI min asian = 27.5 kg/m² (no comorbidity required) or 25 kg/m² with comorbidity. For renewal, adults must re-verify both BMI eligibility AND 5% weight loss; adolescents only need 5% BMI reduction. The continuation weight loss percent (5%) and continuation BMI reduction percent (5%) reflect different metrics: 5% body weight for adults, 5% of baseline BMI for adolescents. Pregnancy/Type 1 diabetes/bariatric surgery exclusions are not explicitly stated in this document but are standard; marked false here since not explicitly documented.

Policy effective June 1, 2026 · verified June 5, 2026 · source: Standard Commercial Guidelines 6 1 26 Excerpted · View policy document (PDF)

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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:

  • Age ≥ 18 years
  • BMI ≥ 27 kg/m² (or ≥ 25 kg/m² if Asian)
  • Established cardiovascular disease (prior MI, prior stroke [ischemic or hemorrhagic], carotid artery stenosis ≥50%, or symptomatic PAD with ABI <0.85, peripheral arterial revascularization, or amputation due to atherosclerotic disease)
  • History of and continued use of, or contraindication to, ALL GDMT: antiplatelet agent (unless history of hemorrhagic stroke), statin, and blood pressure medication (ACEi, ARB, or beta blocker)
  • Used in combination with reduced calorie diet and increased physical activity
  • No concurrent use of another GLP-1 receptor agonist or GLP-1/GIP receptor agonist

Documentation to bring

  • Documentation of age ≥ 18 years
  • Baseline BMI documentation (≥ 27 kg/m² general, or ≥ 25 kg/m² for Asian patients)
  • Documentation of qualifying established CVD event (prior MI, prior stroke, carotid artery stenosis ≥50%, or symptomatic PAD with ABI <0.85 at rest, peripheral arterial revascularization, or amputation due to atherosclerotic disease)
  • Documentation of current GDMT use or clinical reason GDMT is contraindicated: antiplatelet agent, statin, and blood pressure medication (ACEi, ARB, or beta blocker)
  • Documentation that Wegovy will be used with reduced calorie diet and increased physical activity
  • Confirmation of no concurrent GLP-1 receptor agonist or GLP-1/GIP receptor agonist use

Approval and renewal

  • Renewal: Renewal requires: (1) confirmed cardiovascular disease (prior MI, prior stroke, carotid artery stenosis ≥50%, or symptomatic PAD); (2) continued use with reduced calorie diet and increased physical activity; (3) no concurrent GLP-1 or GLP-1/GIP agonist; (4) continued history of use or contraindication to GDMT (antiplatelet, statin, blood pressure medication). BMI threshold and age are NOT re-verified at renewal.

Not covered when

  • Concurrent use of another GLP-1 receptor agonist (liraglutide, exenatide, semaglutide other products) or GLP-1/GIP receptor agonist (tirzepatide products)

Policy note: GDMT antiplatelet requirement has an exception: if the patient has a history of hemorrhagic stroke, antiplatelet is not required. At renewal, the BMI threshold is not re-verified — only CV disease confirmation, GDMT, diet/activity, and no concurrent GLP-1 are checked.

Policy effective June 1, 2026 · verified June 5, 2026 · source: Standard Commercial Guidelines 6 1 26 Excerpted · View policy document (PDF)

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

Applies to Employer plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

MASH — Initial Approval

All of:

  • Age ≥ 18 years
  • Diagnosis of noncirrhotic MASH/NASH
  • Therapy prescribed by or in consultation with a hepatologist, gastroenterologist, or endocrinologist
  • Patient is enrolled in or has completed a lifestyle intervention (dietary, exercise, psychology)
  • Biopsy or non-invasive test (elastography or ELF testing) within the past 12 months demonstrating liver fibrosis stage 2 or 3
  • No concurrent use of Rezdiffra (resmetirom), another GLP-1 receptor agonist, or GLP-1/GIP receptor agonist

Documentation to bring

  • Documentation of age ≥ 18 years
  • Diagnosis of noncirrhotic MASH/NASH
  • Prescriber attestation or consultation note from hepatologist, gastroenterologist, or endocrinologist
  • Documentation of enrollment in or completion of a lifestyle intervention program (dietary, exercise, or psychology-based)
  • Liver biopsy or non-invasive test result (elastography/FibroScan or ELF blood test) within the past 12 months demonstrating fibrosis stage F2 or F3
  • Confirmation of no concurrent use of Rezdiffra (resmetirom), GLP-1 receptor agonist, or GLP-1/GIP receptor agonist

Approval and renewal

  • Renewal: Renewal requires: (1) disease is stable or improved from baseline; (2) no concurrent use of Rezdiffra, GLP-1 agonist, or GLP-1/GIP agonist; (3) biopsy or non-invasive test (elastography or ELF) demonstrating fibrosis stage 2 or 3 — note the renewal fibrosis test does NOT specify a 12-month lookback (only the initial criteria do). Specialist prescribing/consultation and lifestyle program enrollment are NOT re-verified at renewal.

Not covered when

  • Cirrhotic liver disease (noncirrhotic MASH/NASH only)
  • Concurrent use of Rezdiffra (resmetirom)
  • Concurrent use of another GLP-1 receptor agonist or GLP-1/GIP receptor agonist (tirzepatide products)

Policy note: Fibrosis must be stage 2 or 3 (F2–F3). The policy explicitly requires 'noncirrhotic' MASH/NASH, excluding cirrhotic patients. At renewal, the 12-month lookback on the fibrosis test is not explicitly re-stated; renewal only requires evidence of fibrosis stage 2 or 3 without a specified timeframe. The MASH confirmation methods list is inferred from the document's examples: 'elastography' maps to FibroScan VCTE and 'Enhanced Liver Fibrosis [ELF] testing' maps to ELF test; liver biopsy is also explicitly listed.

Policy effective June 1, 2026 · verified June 5, 2026 · source: Standard Commercial Guidelines 6 1 26 Excerpted · View policy document (PDF)

Open on its own page →

Questions people ask
Does Kaiser Permanente Northern California cover Wegovy?
Yes. Kaiser Permanente Northern California 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.
What does Kaiser Permanente Northern California require to renew Wegovy?
Weight Loss — Applies to Employer plans. At least 5% reduction in BMI. Renewal requires: (1) no concurrent GLP-1 or GLP-1/GIP agonist; (2) for adults (≥18): re-verification of baseline BMI eligibility criteria AND at least 5% weight loss of baseline body weight achieved or maintained; (3) for adolescents (12–17): at least 5% reduction of baseline BMI achieved or maintained. Note: the 5% threshold for adults is 5% of baseline body weight; for adolescents it is 5% of baseline BMI. Active lifestyle program enrollment is NOT explicitly re-verified at renewal. Heart Disease Risk Reduction — Applies to Employer plans. Renewal requires: (1) confirmed cardiovascular disease (prior MI, prior stroke, carotid artery stenosis ≥50%, or symptomatic PAD); (2) continued use with reduced calorie diet and increased physical activity; (3) no concurrent GLP-1 or GLP-1/GIP agonist; (4) continued history of use or contraindication to GDMT (antiplatelet, statin, blood pressure medication). BMI threshold and age are NOT re-verified at renewal. Liver Disease (MASH) — Applies to Employer plans. Renewal requires: (1) disease is stable or improved from baseline; (2) no concurrent use of Rezdiffra, GLP-1 agonist, or GLP-1/GIP agonist; (3) biopsy or non-invasive test (elastography or ELF) demonstrating fibrosis stage 2 or 3 — note the renewal fibrosis test does NOT specify a 12-month lookback (only the initial criteria do). Specialist prescribing/consultation and lifestyle program enrollment are NOT re-verified at renewal.
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 Kaiser Permanente Northern California: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: California Medicaid, Elevance Health, Kaiser Permanente Southern California, Molina Healthcare, Alabama Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid

All insurance plans · All medications

Summary of Kaiser Permanente Northern California's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.