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Premera

Does Premera cover Zepbound?

Yes. Premera covers Zepbound 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: Zepbound 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 15 mg once weekly
  • Quantity limited to 4 prefilled pens or single-dose vials per 28 days, OR 1 Kwikpen or multi-dose vial 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 15 mg once weekly
  • Quantity limited to 4 prefilled pens or single-dose vials per 28 days, OR 1 Kwikpen or multi-dose vial 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

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

  • 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg — 4 prefilled pens or single-dose vials per 28 days, OR 1 Kwikpen or multi-dose vial per 28 days

Approval and renewal

  • Initial approval: 7 months
  • Renewal: every 12 months
  • Renewal: Adults: ≥5% baseline body weight loss after 7 months of treatment AND able to tolerate Zepbound maintenance dose of up to 15 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 15 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, Xenical, Wegovy)
  • 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: No pediatric indication listed for Zepbound weight management in this policy (adults 18+ only). Quantity limit updated in 2026 to distinguish prefilled pens/single-dose vials (4 per 28 days) from Kwikpen/multi-dose vials (1 per 28 days).

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

Open on its own page →

Full requirements: Zepbound for Obstructive Sleep Apnea (OSA) (1 plan type)

Applies to Employer plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

OSA indication — moderate to severe OSA in adults with obesity

All of:

  • Age ≥ 18 years
  • BMI ≥ 30 kg/m2
  • Sleep study within the past 12 months showing AHI ≥ 15 events per hour
  • NOT diagnosed with central sleep apnea with ≥ 50% central apneas/hypopneas
  • NOT diagnosed with Cheyne Stokes respiration
  • Medication used as adjunct to reduced-calorie diet and increased physical activity
  • Dose limited to 15 mg once weekly
  • Quantity limited to 4 prefilled pens or single-dose vials per 28 days, OR 1 Kwikpen or multi-dose vial per 28 days
  • Not used concurrently with other weight loss medications

Documentation to bring

  • Office visit notes containing baseline body weight and BMI (≥ 30 kg/m2)
  • Sleep study results within the past 12 months documenting AHI ≥ 15 events per hour
  • Documentation confirming absence of central sleep apnea (≥ 50% central apneas/hypopneas) and absence of Cheyne Stokes respiration
  • Medication dosage documentation

Quantity limits

  • 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg — 4 prefilled pens or single-dose vials per 28 days, OR 1 Kwikpen or multi-dose vial per 28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: ≥10% baseline body weight loss after 12 months of treatment AND stability in OSA signs or symptoms such as snoring, excessive daytime sleepiness, and fatigue AND continued adherence to reduced-calorie diet and increased physical activity AND baseline BMI ≥ 30 kg/m2 AND age ≥ 18 years.
  • Renewal: At least 52 weeks on therapy before the first renewal.

Not covered when

  • Central sleep apnea with ≥ 50% of central apneas/hypopneas
  • Cheyne Stokes respiration
  • Concurrent use with other weight loss medications (phentermine, phentermine/topiramate ER, benzphetamine, diethylpropion, phendimetrazine, Alli, Contrave, liraglutide 18 mg/3 mL pen, Qsymia, Saxenda, Xenical, Wegovy)
  • 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: OSA indication requires moderate-to-severe OSA (AHI ≥ 15 events/hour) confirmed by sleep study within 12 months. No PAP/CPAP trial required. Obesity (BMI ≥ 30) required — lower BMI threshold with comorbidity does not apply to this indication. Continuation requires ≥10% weight loss after 12 months AND OSA symptom stability. Initial authorization is 12 months (same as non-formulary exception reviews).

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 Zepbound?
Yes. Premera covers Zepbound 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 Zepbound approval last with Premera?
Weight Loss — Applies to Employer plans. Initial approval: 7 months. Renewal: every 12 months. Obstructive Sleep Apnea (OSA) — Applies to Employer plans. Initial approval: 12 months. Renewal: every 12 months.
What does Premera require to renew Zepbound?
Weight Loss — Applies to Employer plans. Adults: ≥5% baseline body weight loss after 7 months of treatment AND able to tolerate Zepbound maintenance dose of up to 15 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 15 mg. Obstructive Sleep Apnea (OSA) — Applies to Employer plans. ≥10% baseline body weight loss after 12 months of treatment AND stability in OSA signs or symptoms such as snoring, excessive daytime sleepiness, and fatigue AND continued adherence to reduced-calorie diet and increased physical activity AND baseline BMI ≥ 30 kg/m2 AND age ≥ 18 years. At least 52 weeks on therapy before the first renewal.
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, Wegovy

Zepbound 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.