PacificSource Health coverage for Wegovy (Weight Loss)

Use for weight loss (no MACE or MASH diagnosis) is explicitly excluded. Diagnosis of type 1 or type 2 diabetes without MACE or MASH is also excluded.

Policy note: Wegovy is explicitly excluded for weight loss unless the patient has a qualifying MACE or MASH diagnosis. Type 1 or type 2 diabetes without MACE or MASH also does not qualify.

Policy effective June 22, 2026 · verified June 10, 2026 · source: cw577pv8jf

Use for weight loss (no MACE or MASH diagnosis) is explicitly excluded. Diagnosis of type 1 or type 2 diabetes without MACE or MASH is also excluded.

Policy note: Wegovy is explicitly excluded for weight loss unless the patient has a qualifying MACE or MASH diagnosis. Type 1 or type 2 diabetes without MACE or MASH also does not qualify.

Policy effective June 22, 2026 · verified June 10, 2026 · source: cw577pv8jf