Applies to Employer and ACA Marketplace plans.
Depends on your plan's benefitThis is an optional program for clients/businesses that have elected to cover weight loss products. Not available on plans without weight loss medication coverage (those plans use a separate Nonformulary Wegovy criteria policy).
See the original policy for clinical requirements.
Policy note: Weight loss is explicitly excluded as a benefit under this program. This policy document only establishes criteria for cardiovascular risk reduction and MASH indications.
Policy effective May 1, 2026 · verified June 2, 2026 · source: PA Notification Weight Loss