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Premera

Does Premera cover Wegovy?

Yes. Premera 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 3, 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 weight management (18+) — BMI ≥ 30

All of:

  • Age ≥ 18 years
  • BMI ≥ 30 kg/m2
  • Trial of behavioral modification and dietary restriction for at least 3 months
  • Medication used as adjunct to reduced-calorie diet and increased physical activity
  • Dose limited to 2.4 mg once weekly
  • Quantity limited to 4 pens per 28 days
  • Not used concurrently with other weight loss medications

Adult weight management (18+) — BMI ≥ 27 with comorbidity

All of:

  • Age ≥ 18 years
  • BMI ≥ 27 kg/m2
  • Trial of behavioral modification and dietary restriction for at least 3 months
  • Medication used as adjunct to reduced-calorie diet and increased physical activity
  • Dose limited to 2.4 mg once weekly
  • Quantity limited to 4 pens per 28 days
  • Not used concurrently with other weight loss medications

Plus any one of:

  • Asthma
  • Cardiovascular disease
  • COPD
  • Coronary artery disease
  • Dyslipidemia
  • Hypertension
  • Knee osteoarthritis
  • Metabolic-dysfunction associated steatotic liver disease/non-alcoholic fatty liver disease
  • Obstructive sleep apnea
  • Polycystic ovarian syndrome
  • Type 2 diabetes mellitus

Pediatric weight management (12-17)

All of:

  • Age 12-17 years
  • BMI ≥ 95th percentile for age and sex
  • Trial of behavioral modification and dietary restriction for at least 3 months
  • Medication used as adjunct to reduced-calorie diet and increased physical activity
  • Dose limited to 2.4 mg once weekly
  • Quantity limited to 4 pens per 28 days
  • Not used concurrently with other weight loss medications

Documentation to bring

  • Office visit notes containing baseline body weight and BMI
  • Documentation of relevant history including any weight-related comorbidities
  • Documentation of dietary plan and physical activity plan
  • Documentation of at least 3-month trial of behavioral modification and dietary restriction
  • Medication dosage documentation

Quantity limits

  • 2.4 mg — 4 pens per 28 days

Approval and renewal

  • Initial approval: 7 months
  • Renewal: every 12 months
  • Renewal: At least 1% reduction in BMI.
  • Renewal: Adults: ≥5% baseline body weight loss after 7 months of treatment AND able to tolerate Wegovy maintenance dose of 2.4 mg once weekly AND continues adherence to reduced-calorie diet and increased physical activity. Pediatric (12-17): ≥1% baseline BMI loss after 7 months AND able to tolerate maintenance dose of 1.7 mg or 2.4 mg once weekly AND continues adherence to reduced-calorie diet and increased physical activity. Non-formulary exception reviews may be approved up to 12 months.
  • Renewal: At least 28 weeks on therapy before the first renewal.
  • Renewal: Staying on a maintenance dose of at least 2.4 mg.

Not covered when

  • Concurrent use with other weight loss medications (phentermine, phentermine/topiramate ER, benzphetamine, diethylpropion, phendimetrazine, Alli, Contrave, liraglutide 18 mg/3 mL pen, Qsymia, Saxenda, Wegovy tablets, Xenical, Zepbound)
  • All uses other than FDA-approved dosage and administration are considered investigational
  • Coverage subject to benefit plan; many plans exclude weight management drugs

Policy note: This entry covers both Wegovy injection and Wegovy tablets for weight management; they share the same clinical criteria but differ in formulation/dosing. Wegovy injection: dose limited to 2.4 mg once weekly, quantity 4 pens per 28 days. Wegovy tablets: dose limited to 25 mg daily, quantity 1 tablet daily. Pediatric coverage applies to ages 12-17. Non-formulary exception reviews may be approved up to 12 months. This medical policy does not apply to Medicare Advantage.

Policy effective April 1, 2026 · verified June 3, 2026 · source: 5.01.621 · 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 — prior MI or stroke

All of:

  • Age ≥ 18 years
  • BMI ≥ 27 kg/m2
  • Medication used in combination with optimized drug therapy for established cardiovascular disease
  • Medication used as adjunct to reduced-calorie diet and increased physical activity
  • Dose limited to 2.4 mg once weekly (injection) or 25 mg daily (tablets)
  • Quantity limited per formulation
  • Not used concurrently with other weight loss medications

Plus any one of:

  • Prior heart attack
  • Prior stroke

CV risk reduction — symptomatic peripheral arterial disease

All of:

  • Age ≥ 18 years
  • BMI ≥ 27 kg/m2
  • History of symptomatic peripheral arterial disease
  • Medication used in combination with optimized drug therapy for established cardiovascular disease
  • Medication used as adjunct to reduced-calorie diet and increased physical activity
  • Dose limited to 2.4 mg once weekly (injection) or 25 mg daily (tablets)
  • Quantity limited per formulation
  • Not used concurrently with other weight loss medications

Plus any one of:

  • Intermittent claudication with ankle-brachial index < 0.85
  • Peripheral arterial revascularization procedure
  • Amputation due to atherosclerotic disease

Documentation to bring

  • Office visit notes containing baseline BMI (≥ 27 kg/m2)
  • Documentation of qualifying CV event (prior MI, prior stroke, or symptomatic PAD with supporting evidence)
  • Documentation of current use of optimized drug therapy for established cardiovascular disease
  • Medication dosage documentation

Quantity limits

  • 2.4 mg injection — 4 pens per 28 days
  • 25 mg tablet — 1 tablet daily

Approval and renewal

  • Initial approval: 7 months
  • Renewal: every 12 months
  • Renewal: Renewal requires re-verification of: age ≥ 18, baseline BMI ≥ 27 kg/m2 (at time of treatment initiation), qualifying CV event (prior MI, stroke, or symptomatic PAD), continued use in combination with optimized CV drug therapy, continued adherence to reduced-calorie diet and increased physical activity, dose 2.4 mg once weekly (injection) or 25 mg daily (tablets), quantity limit 4 pens/28 days (injection) or 1 tablet/day (tablets), and no concurrent weight loss medications.
  • Renewal: Staying on a maintenance dose of at least 2.4 mg.

Not covered when

  • Concurrent use with other weight loss medications (phentermine, phentermine/topiramate ER, benzphetamine, diethylpropion, phendimetrazine, Alli, Contrave, liraglutide 18 mg/3 mL pen, Qsymia, Saxenda, Wegovy tablets or injection [cross-listed], Xenical, Zepbound)
  • All uses other than FDA-approved dosage and administration are considered investigational
  • Coverage subject to benefit plan; many plans exclude weight management drugs
  • This medical policy does not apply to Medicare Advantage

Policy note: Covers both Wegovy injection (2.4 mg once weekly, 4 pens/28 days) and Wegovy tablets (25 mg daily, 1 tablet/day) for MACE risk reduction indication. PAD qualifying criteria include: intermittent claudication with ABI <0.85, peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease. The policy does not explicitly exclude diabetes for this indication. Renewal criteria re-verify full initial criteria including CV event qualification and GDMT use.

Policy effective April 1, 2026 · verified June 3, 2026 · source: 5.01.621 · View policy document (PDF)

Open on its own page →

Questions people ask
Does Premera cover Wegovy?
Yes. Premera 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 Premera?
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 Premera require to renew Wegovy?
Weight Loss — Applies to Employer plans. At least 1% reduction in BMI. Adults: ≥5% baseline body weight loss after 7 months of treatment AND able to tolerate Wegovy maintenance dose of 2.4 mg once weekly AND continues adherence to reduced-calorie diet and increased physical activity. Pediatric (12-17): ≥1% baseline BMI loss after 7 months AND able to tolerate maintenance dose of 1.7 mg or 2.4 mg once weekly AND continues adherence to reduced-calorie diet and increased physical activity. Non-formulary exception reviews may be approved up to 12 months. At least 28 weeks on therapy before the first renewal. Staying on a maintenance dose of at least 2.4 mg. Heart Disease Risk Reduction — Applies to Employer plans. Renewal requires re-verification of: age ≥ 18, baseline BMI ≥ 27 kg/m2 (at time of treatment initiation), qualifying CV event (prior MI, stroke, or symptomatic PAD), continued use in combination with optimized CV drug therapy, continued adherence to reduced-calorie diet and increased physical activity, dose 2.4 mg once weekly (injection) or 25 mg daily (tablets), quantity limit 4 pens/28 days (injection) or 1 tablet/day (tablets), and no concurrent weight loss medications. Staying on a maintenance dose of at least 2.4 mg.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Premera: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Kaiser Permanente Northwest, Molina Healthcare, Regence, Washington Medicaid, Elevance Health, HCSC, Highmark, Wellmark

All insurance plans · All medications

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