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Kaiser Permanente Northwest

Does Kaiser Permanente Northwest cover Wegovy for Liver Disease (MASH)?

Yes. Kaiser Permanente Northwest covers Wegovy for liver disease (MASH) 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 Liver Disease (MASH) (1 plan type)

Applies to Employer plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Initiation for MASH — standard pathway

All of:

  • No personal or family history of MTC or MEN 2
  • Diagnosis of metabolic dysfunction-associated steatohepatitis (MASH)
  • Hepatology provider consulted and endorsed use
  • Age ≥ 18 years
  • Fibrosis stage F2 or F3 confirmed by FibroScan, ultrasound elastography, MRE, or liver biopsy within 1 year OR history of known F2/F3 currently on GLP-1 agonist without F4
  • At least one qualifying criterion from group (f) met (see any of)
  • Failed adequate trial of semaglutide (Ozempic) (does not apply to Medicare Part D patients)
  • Not taking resmetirom
  • None of the following: regular use of MASLD-associated drugs, ALT/AST > 5x ULN from other chronic liver disease etiology, significant alcohol consumption (≥7 drinks/week females or ≥14 drinks/week males), active serious disease with life expectancy < 2 years

Plus any one of:

  • BMI ≥ 30 kg/m2 OR (BMI 27-29 kg/m2 with T2DM, hypertension, or hyperlipidemia) AND failed adequate trial (≥3 months) of at least two of: phentermine, diethylpropion, topiramate, Qsymia, Contrave with goal of 7-10% weight loss — OR allergy/intolerance/contraindication to all (not applicable to Medicare Part D patients)
  • Failed adequate trial of formal weight loss program (without oral weight loss medication) AND hepatology provider recommends use
  • Disease refractory to weight loss of 7-10%
  • Currently taking a GLP-1 agonist

New member already taking Wegovy for MASH

All of:

  • Patient is using for MASH
  • Failed adequate trial of semaglutide (Ozempic) (does not apply to Medicare Part D patients)

Documentation to bring

  • Diagnosis documentation of metabolic dysfunction-associated steatohepatitis (MASH)
  • Documentation of hepatology provider consultation and endorsement of Wegovy use
  • Documentation of patient age ≥ 18 years
  • Fibrosis staging documentation (F2 or F3) by FibroScan, ultrasound elastography, MRE, or liver biopsy within the past 12 months — OR documentation of known F2/F3 history while currently on GLP-1 agonist without F4
  • Documentation satisfying at least one group (f) pathway: BMI with prior weight loss drug step therapy, OR failed formal weight loss program with hepatology recommendation, OR disease refractory to 7-10% weight loss, OR documentation of current GLP-1 agonist use
  • Documentation of failed adequate trial (≥ 3 months) of semaglutide (Ozempic) — or inapplicable for Medicare Part D
  • Confirmation patient is not taking resmetirom
  • Confirmation of no regular use of MASLD-associated drugs
  • ALT/AST lab results to confirm not > 5x ULN from other chronic liver disease etiology
  • Alcohol consumption history confirming < 7 drinks/week (females) or < 14 drinks/week (males)
  • Confirmation of no active serious disease with life expectancy < 2 years
  • Confirmation of no personal or family history of MTC or MEN 2

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Continuation requires: (1) no progression to fibrosis F4/cirrhosis; (2) no disease progression (increased fibrosis) after ≥ 18 months on semaglutide without further hepatology consultation; (3) no regular use of MASLD-associated drugs; (4) adherence to medication, diet, lifestyle, alcohol abstinence, and follow-up labs; (5) no active serious disease with life expectancy < 2 years; AND updated fibrosis staging by FibroScan, ultrasound elastography, MRE, or liver biopsy AND hepatology provider follow-up within 2 years after semaglutide initiation.

Not covered when

  • Fibrosis stage F4 (cirrhosis) — unless currently on GLP-1 agonist with known prior F2/F3 and no current F4
  • Currently taking resmetirom
  • Regular use of drugs associated with MASLD
  • ALT/AST > 5x ULN likely from other etiology of chronic liver disease
  • Significant alcohol consumption (≥ 7 drinks/week females or ≥ 14 drinks/week males)
  • Active serious medical disease with likely life expectancy < 2 years

Policy note: Non-formulary; covered for 12 months per approval cycle. The Ozempic prior trial requirement and the non-Medicare Part D BMI/step-therapy pathway in criterion (f) do NOT apply to Medicare Part D patients. Alcohol limits are specified in drinks per week: 7 for females and 14 for males (approximately 98g/week and 196g/week respectively at ~14g/drink — exact gram values not stated in document). Continuation requires updated fibrosis staging AND hepatology follow-up within 2 years of semaglutide initiation. Specialist (hepatology) is required at both initiation and continuation. Continuation criteria do not re-check the Ozempic prior trial requirement or BMI/step-therapy pathways.

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 liver disease (MASH) 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 Kaiser Permanente Northwest?
Liver Disease (MASH) — Applies to Employer plans. Initial approval: 12 months. Renewal: every 12 months.
What does Kaiser Permanente Northwest require to renew Wegovy?
Liver Disease (MASH) — Applies to Employer plans. Continuation requires: (1) no progression to fibrosis F4/cirrhosis; (2) no disease progression (increased fibrosis) after ≥ 18 months on semaglutide without further hepatology consultation; (3) no regular use of MASLD-associated drugs; (4) adherence to medication, diet, lifestyle, alcohol abstinence, and follow-up labs; (5) no active serious disease with life expectancy < 2 years; AND updated fibrosis staging by FibroScan, ultrasound elastography, MRE, or liver biopsy AND hepatology provider follow-up within 2 years after semaglutide initiation.
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.