Premera

Does Premera cover Wegovy?

Quick answer · Weight Loss

Premera covers Wegovy for weight loss with prior authorization on Employer / Commercial Insurance.

  • Employer / Commercial Insurance: Covered with requirements. BMI of 30 or higher

Last verified June 3, 2026. Policy effective April 1, 2026. Source: 5.01.621.pdf. How we verify this data →

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Wegovy for Weight Loss

What Premera requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Age 12 and older
  • BMI of 30 or higher
  • BMI of 27 or higher with a weight-related condition (Asthma, CVD, COPD, Coronary artery disease, Dyslipidemia, HTN, Knee osteoarthritis, MASH/NAFLD, OSA, PCOS, and T2DM)
  • BMI at or above the 95th percentile for age and sex
  • 3 months of a documented diet and exercise program

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
  • To renew, the plan looks for at least 5% weight loss from the starting weight, 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, and staying on a maintenance dose of at least 2.4 mg. Make sure your starting weight and date are in the chart now — renewal is measured against it.

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.pdf

Wegovy for Heart Disease Risk Reduction

What Premera requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Age 18 and older
  • BMI of 27 or higher
  • Established cardiovascular disease (prior_MI, prior_stroke, and symptomatic_PAD)
  • On guideline-directed medical therapy (optimized drug therapy for established cardiovascular disease)

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
  • To renew, the plan looks for 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 and 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.pdf

Why Wegovy requests get denied by Premera

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.
  2. BMI not documented in the chart notes (or documented without a baseline weight and date).
  3. Qualifying weight-related condition not documented with its own diagnosis code.
  4. No documented diet and exercise program.
  5. Baseline weight wasn't recorded at the start, so the required weight loss can't be shown at renewal.

Frequently asked questions

Does Premera cover Wegovy?
Premera covers Wegovy for weight loss with prior authorization on Employer / Commercial Insurance.
What BMI do you need for Wegovy under Premera?
For weight loss on Employer / Commercial Insurance plans, Premera requires a BMI of 30 or higher, or 27 or higher with a qualifying weight-related condition.
How long does a Wegovy approval last with Premera?
Initial approvals last 7 months, and renewals are granted in 12-month periods.
What does Premera require to renew Wegovy?
At least 5% weight loss from the starting weight, 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, and staying on a maintenance dose of at least 2.4 mg.
How current is this information?
This page reflects Premera's written policy as of April 1, 2026, last verified against the source document on June 3, 2026.

Other medications under Premera

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes Premera's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.