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Regence

Does Regence cover Wegovy for Weight Loss?

It depends on your benefits. Regence covers Wegovy for weight loss only when your plan includes that benefit and the policy requirements are met.

Policy documents

  • Employer: Depends on your plan's benefit. See the qualification pathways below.
  • ACA Marketplace: Depends on your plan's benefit. See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Weight Loss (2 plan types)

Applies to Employer plans.

Depends on your plan's benefit

Coverage requires that the member benefit contract allows for coverage of medications for weight loss in obesity/overweight; weight loss must NOT be excluded from the pharmacy benefit

Qualification pathways

You can qualify through any one of these.

Adults with obesity

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age ≥ 18 years
  • BMI ≥ 30 kg/m2
  • Attestation medication will be used with lifestyle modification

Adults with overweight and comorbidity

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age ≥ 18 years
  • BMI ≥ 27 kg/m2
  • Attestation medication will be used with lifestyle modification

Plus any one of:

  • Hypertension
  • Dyslipidemia
  • Type 2 diabetes mellitus
  • Pre-diabetes
  • Insulin resistance
  • Obstructive sleep apnea
  • Cardiovascular disease
  • Symptomatic arthritis of lower extremities

Pediatrics (12-17 years) with obesity

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age 12 through 17 years
  • BMI ≥ 95th percentile standardized for age and sex
  • Attestation medication will be used with lifestyle modification

Continuation of therapy - established on therapy prior to current health plan membership

All of:

  • Patient was established on therapy prior to current health plan membership
  • Documentation that medication was covered by another health plan
  • Clinical benefit such as disease stability
  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight

Documentation to bring

  • Clinical documentation (e.g., chart notes) confirming BMI ≥ 30 kg/m2 (adults with obesity) OR BMI ≥ 27 kg/m2 with at least one weight-related comorbid condition (adults overweight) OR BMI ≥ 95th percentile for age and sex (pediatrics 12-17)
  • Attestation that medication will be used concomitantly with lifestyle modification
  • For continuation: attestation of ≥ 5% body weight reduction from pretreatment baseline OR documentation that dose is currently being titrated upwards (adults); BMI reduction OR titration upward documentation (pediatrics)

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: Adults (≥18 years): ≥ 5% body weight reduction from pretreatment baseline OR dose currently being titrated upwards. Pediatrics (12-17 years): reduction from pretreatment baseline BMI OR dose currently being titrated upwards. Attestation required that medication continues to be used with lifestyle modification. Benefit contract coverage eligibility re-verified at each renewal.

Not covered when

  • Co-administration with other weight loss medications (Contrave, Qsymia, or other GLP-1 agents in this policy) considered investigational
  • Used for type 2 diabetes without obesity or overweight — considered not medically necessary
  • Diabetic ketoacidosis (DKA)
  • Type 1 diabetes

Policy note: Policy dru787.5 covers only GLP-1 formulations NOT specifically approved for diabetes. Wegovy tablets (oral semaglutide) authorized at parity with Wegovy injection. Wegovy HD (semaglutide) added 6/4/2026 at parity. Coverage for weight loss is explicitly gated on member benefit contract allowing coverage for weight loss medications. Pediatric use (12-17 years) is explicitly allowed for Wegovy. T2DM patients without obesity/overweight are excluded. Policy does not apply to Mounjaro or Ozempic (covered under separate policy dru750). BMI percentile threshold of 95th percentile applies to pediatric patients aged 12-17 years.

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

Applies to ACA Marketplace plans.

Depends on your plan's benefit

Coverage requires that the member benefit contract allows for coverage of medications for weight loss in obesity/overweight. Not coverable when the member benefit contract excludes obesity/overweight treatments.

Qualification pathways

You can qualify through any one of these.

Adult obesity (≥18 years)

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age ≥ 18 years
  • BMI ≥ 30 kg/m2
  • Attestation that medication will be used with lifestyle modification (dietary/caloric restriction, exercise, weight management program, nutritional counseling, behavioral therapy)

Adult overweight with comorbidity (≥18 years)

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age ≥ 18 years
  • BMI ≥ 27 kg/m2
  • Attestation that medication will be used with lifestyle modification

Plus any one of:

  • Hypertension
  • Dyslipidemia
  • Type 2 diabetes mellitus (T2DM)
  • Pre-diabetes
  • Insulin resistance
  • Obstructive sleep apnea (OSA)
  • Cardiovascular disease (CVD)
  • Symptomatic arthritis of lower extremities

Pediatric obesity (12-17 years) - Wegovy

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age 12 through 17 years
  • BMI ≥ 95th percentile standardized for age and sex
  • Attestation that medication will be used with lifestyle modification

Documentation to bring

  • Clinical documentation (such as chart notes) confirming BMI ≥ 30 kg/m2 (obesity) OR BMI ≥ 27 kg/m2 with at least one weight-related comorbid condition
  • For pediatric patients: BMI ≥ 95th percentile standardized for age and sex (Wegovy)
  • Attestation that medication will be used with lifestyle modification (dietary/caloric restriction, exercise, weight management program, nutritional counseling, behavioral therapy)
  • Verification that member benefit contract allows coverage of medications for weight loss in obesity/overweight

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: Adults (≥18 years): ≥ 5% body weight reduction from pretreatment baseline OR dose currently being titrated upwards. Pediatrics (12-17 years): reduction from pretreatment baseline BMI OR dose currently being titrated upwards. Member benefit contract must continue to allow coverage for weight loss in obesity/overweight. Attestation required that medication will continue to be used with lifestyle modification.

Not covered when

  • Co-administration with other medications for obesity or overweight (including Contrave, Qsymia) is considered investigational and not covered
  • Use for type 2 diabetes without obesity or overweight is considered not medically necessary
  • Central or mixed sleep apnea
  • Cheyne-Stokes respiration
  • OSA with major craniofacial abnormalities
  • Type 1 diabetes

Policy note: Policy dru787 covers non-diabetic indications only. Mounjaro and Ozempic are addressed in a separate policy (dru750). Only Wegovy (semaglutide) and liraglutide generic/Saxenda are coverable for obesity in pediatrics (ages 12-17). Coverage for obesity/overweight indications is contingent on member benefit contract language allowing such coverage. Samples, coupons, promotions, or cash-pay prescriptions do not establish medical necessity. Continuation of therapy for patients established on therapy prior to current health plan membership requires: documentation that medication was covered by prior health plan, evidence of clinical benefit (disease stability), and confirmation that benefit contract allows coverage.

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

Open on its own page →

If weight loss isn't covered on your plan

A prior authorization can't override a benefit exclusion. Ask Regence about a formulary exception.

Questions people ask
Does Regence cover Wegovy?
It depends on your benefits. Regence covers Wegovy for weight loss only when your plan includes that benefit and the policy requirements are met.
How long does a Wegovy approval last with Regence?
Weight Loss — Applies to Employer plans. Initial approval: 12 months. Renewal: every 12 months. Weight Loss — Applies to ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does Regence require to renew Wegovy?
Weight Loss — Applies to Employer plans. Adults (≥18 years): ≥ 5% body weight reduction from pretreatment baseline OR dose currently being titrated upwards. Pediatrics (12-17 years): reduction from pretreatment baseline BMI OR dose currently being titrated upwards. Attestation required that medication continues to be used with lifestyle modification. Benefit contract coverage eligibility re-verified at each renewal. Weight Loss — Applies to ACA Marketplace plans. Adults (≥18 years): ≥ 5% body weight reduction from pretreatment baseline OR dose currently being titrated upwards. Pediatrics (12-17 years): reduction from pretreatment baseline BMI OR dose currently being titrated upwards. Member benefit contract must continue to allow coverage for weight loss in obesity/overweight. Attestation required that medication will continue to be used with lifestyle modification.
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.