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Kaiser Permanente Northwest

Does Kaiser Permanente Northwest cover Wegovy for Heart Disease Risk Reduction?

Yes. Kaiser Permanente Northwest covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. 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 Heart Disease Risk Reduction (1 plan type)

Applies to Employer plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Initiation for cardiovascular risk reduction

All of:

  • No personal or family history of MTC or MEN 2
  • Patient does not have diabetes
  • BMI ≥ 27 kg/m2
  • Currently following a diet and exercise program
  • Age 55 to 74 years
  • History of STEMI or Type 1 NSTEMI
  • Occurrence of a STEMI or Type 1 NSTEMI while on semaglutide (Ozempic) 2 mg (does not apply to Medicare Part D patients)

Documentation to bring

  • Confirmation that patient does not have diabetes
  • Documentation of BMI ≥ 27 kg/m2
  • Documentation of patient age (55-74 years)
  • Documentation of history of STEMI or Type 1 NSTEMI
  • Documentation of occurrence of STEMI or Type 1 NSTEMI while on semaglutide (Ozempic) 2 mg
  • Documentation of current diet and exercise program participation
  • Confirmation of no personal or family history of MTC or MEN 2

Approval and renewal

  • Initial approval: 12 months

Not covered when

  • Active diabetes

Policy note: CV risk reduction indication requires the patient to have had a STEMI or Type 1 NSTEMI while specifically on semaglutide (Ozempic) 2 mg — this is a highly specific step-therapy requirement unique to this indication. This requirement does NOT apply to Medicare Part D patients. Non-formulary; covered for 12 months per approval. Continuation criteria for CV indication not explicitly stated in the document.

Policy effective February 5, 2026 · verified June 5, 2026 · source: Kp Criteria Wegovy Nw En Commercial · View policy document (PDF)

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Questions people ask
Does Kaiser Permanente Northwest cover Wegovy?
Yes. Kaiser Permanente Northwest covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Kaiser Permanente Northwest?
Heart Disease Risk Reduction — Applies to Employer plans. Initial approval: 12 months.
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 Northwest: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Molina Healthcare, Oregon Medicaid, PacificSource Health, Premera, Regence, Washington Medicaid, Alabama Medicaid, California Medicaid

All insurance plans · All medications

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