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Regence

Does Regence cover Wegovy for Liver Disease (MASH)?

Yes. Regence covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy documents

  • Employer: Covered with requirements. See the qualification pathways below.
  • ACA Marketplace: 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 Liver Disease (MASH) (2 plan types)

Applies to Employer plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Noncirrhotic MASH with F2 or F3 fibrosis

All of:

  • Diagnosis of MASH (noncirrhotic metabolic dysfunction-associated steatohepatitis / NASH) established by or in consultation with a gastroenterologist or hepatologist
  • Fibrosis stage F2 or F3 confirmed by one of the accepted methods (liver biopsy, VCTE, ELF score, or MRE)
  • Attestation medication will be used with lifestyle modification

Documentation to bring

  • Clinical documentation (e.g., chart notes) confirming diagnosis of MASH established by or in consultation with a gastroenterologist or hepatologist
  • Documentation of Stage F2 or F3 fibrosis confirmed by one of: liver biopsy, vibration-controlled transient elastography (VCTE), Enhanced Liver Fibrosis (ELF) score, or magnetic resonance elastography (MRE)
  • Attestation that medication will be used with lifestyle modification
  • For continuation: attestation of clinical benefit such as stability or improvement of liver fibrosis stage relative to baseline

Quantity limits

  • all strengths - injection — 4 pens per 28 days
  • all strengths - tablet — 30 tablets per 30 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Attestation that the medication is providing clinical benefit, such as stability or improvement of liver fibrosis stage relative to baseline.

Not covered when

  • Cirrhotic MASH (policy specifies noncirrhotic only)
  • Co-administration with other weight loss medications considered investigational
  • Diabetic ketoacidosis (DKA)
  • Type 1 diabetes

Policy note: MASH indication is NOT subject to the weight loss benefit contract language restriction — it qualifies under standard coverage without the obesity benefit rider requirement. Prior to 6/4/2026 revision, there was a requirement for prior failure to achieve weight loss goals with diet and exercise; this has been removed. Specialist (gastroenterologist or hepatologist) diagnosis or consultation is explicitly required. No lookback periods specified for confirmatory testing. Wegovy HD added at parity 6/4/2026. BMI ≥ 27 kg/m2 was observed in the ESSENCE trial population but is not listed as a policy coverage criterion.

Policy effective July 15, 2026 · verified July 16, 2026 · source: Dru787reg · View policy document (PDF)

Applies to ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Noncirrhotic MASH with F2-F3 fibrosis

All of:

  • Diagnosis of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH/NASH) established by or in consultation with a gastroenterologist or hepatologist
  • Stage F2 or F3 fibrosis confirmed by liver biopsy OR at least two of the following non-biopsy methods: FIB-4 score consistent with F2 or F3 fibrosis adjusted for age, Vibration-controlled transient elastography (VCTE), Enhanced liver fibrosis (ELF) score, Magnetic resonance elastography (MRE)
  • Attestation of failure to achieve weight-loss goals with diet and exercise
  • Attestation that medication will be used with lifestyle modification

Documentation to bring

  • Clinical documentation (such as chart notes) of MASH/NASH diagnosis established by or in consultation with a gastroenterologist or hepatologist
  • Documentation confirming noncirrhotic status
  • Fibrosis staging confirmation: liver biopsy showing F2 or F3 fibrosis OR at least two of the following: FIB-4 score consistent with F2/F3 adjusted for age, VCTE result, ELF score, MRE result
  • Attestation of failure to achieve weight-loss goals with diet and exercise

Quantity limits

  • all strengths - injection — 4 pens/28 days
  • all strengths - tablet — 30 tablets/30 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Attestation that the medication is providing clinical benefit, such as stability or improvement of liver fibrosis stage relative to baseline.

Not covered when

  • Cirrhotic MASH (policy specifies noncirrhotic only)
  • Co-administration with other medications for obesity or overweight (Contrave, Qsymia) is considered investigational

Policy note: MASH criteria were added to this policy effective 1/22/2026. The MASH indication does not appear to require the weight loss benefit rider. Fibrosis must be Stage F2 or F3 (not F1 or F4/cirrhotic). When biopsy is not used, at least TWO of the four non-biopsy tests must confirm F2/F3 fibrosis. The SELECT trial (BMI ≥27 kg/m2) informs the MASH evidence base, but no explicit BMI threshold is stated in the MASH coverage criteria. Policy notes AASLD guidelines endorse weight-loss and comorbidity management for MASH.

Policy effective March 15, 2026 · verified June 3, 2026 · source: Dru787reg · View policy document (PDF)

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Questions people ask
Does Regence cover Wegovy?
Yes. Regence covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Regence?
Liver Disease (MASH) — Applies to Employer plans. Initial approval: 12 months. Renewal: every 12 months. Liver Disease (MASH) — Applies to ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does Regence require to renew Wegovy?
Liver Disease (MASH) — Applies to Employer plans. Attestation that the medication is providing clinical benefit, such as stability or improvement of liver fibrosis stage relative to baseline. Liver Disease (MASH) — Applies to ACA Marketplace plans. Attestation that the medication is providing clinical benefit, such as stability or improvement of liver fibrosis stage relative to baseline.
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 Regence: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Kaiser Permanente Northwest, Molina Healthcare, Oregon Medicaid, PacificSource Health, Premera, Washington Medicaid, Elevance Health, HCSC

All insurance plans · All medications

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