in 22 days NovoCare Pharmacy self-pay — Wegovy® tablets (oral semaglutide) 4 mg moves to $199/month See the changelog
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From the payers' own documents

Coverage policy, by payer

Prior-authorization criteria, step therapy, quantity limits, appeal routes and dated formulary changes — drawn from the payers' own published documents wherever they exist, with a confidence grade on everything else.

These are each payer's standard template. Employer plans customize them, so the same PBM can cover a drug for one employer and exclude it for another — a status here is a starting point, not your plan. A benefit exclusion is also a different fight from a PA denial. Always request your own plan's criteria in writing; you are entitled to them.

Aetna (CVS Health)

Insurer (Caremark-administered)

  • Foundayo™ (orforglipron) Covered
  • Wegovy® (semaglutide injection) Preferred
  • Wegovy® tablets (oral semaglutide) Preferred
  • Zepbound® (tirzepatide) Exception only

Criteria are essentially identical to the Caremark template (same BMI wording, 6-month program requirement, 5% reauth gate, same quantity limits). The difference is formulary architecture: standard Aetna commercial formularies made Zepbound exception-only after July 2025 with a step through Wegovy, while FE-compatible plans kept it PA-covered. Many Aetna plans exclude weight-loss drugs entirely (CPB 0039).

180 days to appeal 3 dated changes on record Updated Aug 8, 2026 PA criteriahigh

Blue Cross Blue Shield Federal Employee Program (FEP)

National uniform plan (published criteria)

  • Foundayo™ (orforglipron) Unknown
  • Saxenda® (liraglutide) Covered
  • Wegovy® (semaglutide injection) Covered
  • Wegovy® tablets (oral semaglutide) Covered
  • Zepbound® (tirzepatide) Exception only

Restructured the class for 2026 citing GLP-1 cost growth: Zepbound moved to the Standard-option excluded list (obtainable only via formulary exception meeting policy 5.99.031, which adds a new two-oral-agents step plus preferred-product trial), while Wegovy and Saxenda held at Tier 3 with PA. Focus option does not cover anti-obesity drugs at all. One uniform national plan with genuinely published criteria — the most transparent payer in this corpus.

1 dated change on record Updated Aug 8, 2026 PA criteriahigh

CVS Caremark

PBM standard commercial template

  • Foundayo™ (orforglipron) Covered
  • Saxenda® (liraglutide) Covered
  • Wegovy® (semaglutide injection) Preferred
  • Wegovy® tablets (oral semaglutide) Covered
  • Zepbound® (tirzepatide) Excluded

Largest US PBM. Removed Zepbound from standard commercial template formularies July 1, 2025 (Wegovy preferred); returns Zepbound as an additional preferred option October 1, 2026 at ~$25/month for eligible commercial members. Template criteria — plan sponsors customize, and many employer plans exclude weight-loss drugs entirely.

180 days to appeal 4 dated changes on record Updated Aug 8, 2026 PA criteriahigh

Elevance Health / Anthem (CarelonRx)

Insurer + PBM

  • Foundayo™ (orforglipron) Preferred
  • Saxenda® (liraglutide) Non preferred
  • Wegovy® (semaglutide injection) Preferred
  • Wegovy® tablets (oral semaglutide) Preferred
  • Zepbound® (tirzepatide) Preferred

The stable one: kept Wegovy AND Zepbound dual-preferred (Tier 2, PA/QL) through the 2025 upheavals, and added Foundayo fastest of the majors (May 15, 2026). Coverage still contingent on the employer including a weight-loss benefit. No single national criteria PDF — criteria served per-drug via the Anthem Drug List Search.

180 days to appeal 3 dated changes on record Updated Aug 8, 2026 PA criteriamedium

Express Scripts (Evernorth / Cigna)

PBM standard commercial template (National Preferred Formulary)

  • Foundayo™ (orforglipron) Preferred
  • Saxenda® (liraglutide) Non preferred
  • Wegovy® (semaglutide injection) Preferred
  • Wegovy® tablets (oral semaglutide) Preferred
  • Zepbound® (tirzepatide) Preferred

Kept both Wegovy and Zepbound single-dose pens preferred through the 2025 upheaval. 2026 NPF: Zepbound pens, Wegovy (pens, HD, tablets), and Foundayo all preferred — but Zepbound KwikPens and vials are excluded (device-level steering). PA criteria run through the Cigna National Formulary policy cnf_684.

180 days to appeal 2 dated changes on record Updated Aug 8, 2026 PA criteriahigh

Humana

Medicare-focused (no employer commercial book)

  • Foundayo™ (orforglipron) Excluded
  • Saxenda® (liraglutide) Excluded
  • Wegovy® (semaglutide injection) Excluded
  • Zepbound® (tirzepatide) Excluded

Humana exited employer-group commercial medical (completed ~2024) — treat 'Humana commercial' as N/A; several consumer sites erroneously describe active plans. Its Part D formularies exclude weight-loss GLP-1s (statute), covering CV/MASH/OSA indications with PA on some formularies. Unusual dual role: Humana is CMS's central processor for the Medicare GLP-1 Bridge (BIN 028918, PCN MEDDGLP1BR), adjudicating $50 Bridge claims for all Medicare beneficiaries nationwide.

65 days to appeal 2 dated changes on record Updated Aug 8, 2026 PA criteriamedium

Kaiser Permanente

Integrated system (regional formularies)

  • Foundayo™ (orforglipron) Unknown
  • Saxenda® (liraglutide) Varies
  • Wegovy® (semaglutide injection) Varies
  • Wegovy® tablets (oral semaglutide) Unknown
  • Zepbound® (tirzepatide) Varies

Regional variance is the defining feature, and Kaiser runs the strictest step therapy of any major payer: the NW region requires failing TWO oral weight-loss agents AND a 6-month semaglutide trial before Zepbound. California base commercial plans removed Wegovy for BMI < 40 effective 1/1/2025 (employer opt-in otherwise). Formulary exceptions are functionally in-house bariatric-medicine reviews.

60 days to appeal 3 dated changes on record Updated Aug 8, 2026 PA criteriahigh

Medicaid (state-by-state)

State programs + BALANCE model

  • Wegovy® (semaglutide injection) Varies
  • Zepbound® (tirzepatide) Varies

Coverage of GLP-1s for obesity is state-by-state: 13 states as of Jan 2026 (KFF count). Four states ELIMINATED coverage Jan 1, 2026 (CA, NH, PA, SC). The CMS BALANCE model lets states buy in at negotiated prices with rolling starts May 2026 - Jan 2027; the participating-state list was still unpublished as of Aug 8, 2026 (applications closed July 31).

60 days to appeal 3 dated changes on record Updated Aug 8, 2026 PA criteriamedium

Medicare (Part D + GLP-1 Bridge)

Federal program

  • Foundayo™ (orforglipron) Covered
  • Ozempic® (semaglutide) Covered
  • Saxenda® (liraglutide) Excluded
  • Wegovy® (semaglutide injection) Covered
  • Wegovy® tablets (oral semaglutide) Covered
  • Zepbound® (tirzepatide) Covered

Weight-loss-only GLP-1 use remains statutorily EXCLUDED from Part D (2003 MMA). The temporary Medicare GLP-1 Bridge (July 1, 2026 - Dec 31, 2027) fills the gap at a flat $50/month for Foundayo, Wegovy (all forms), and Zepbound KwikPen — running entirely outside the Part D plan. Diabetes (Ozempic/Mounjaro) and secondary indications (Zepbound-OSA, Wegovy-CV) route through standard Part D with PA.

65 days to appeal 3 dated changes on record Updated Aug 8, 2026 PA criteriahigh

Optum Rx (UnitedHealthcare)

PBM standard commercial template (Premium Standard Formulary)

  • Foundayo™ (orforglipron) Unknown
  • Saxenda® (liraglutide) Covered
  • Wegovy® (semaglutide injection) Covered
  • Wegovy® tablets (oral semaglutide) Covered
  • Zepbound® (tirzepatide) Covered

Kept both Wegovy and Zepbound covered throughout 2025-2026 — no CVS-style exclusion — but both sit at Tier 3 (non-preferred brand) with PA + quantity limits. Weight-loss coverage is an opt-in employer benefit. Foundayo not yet listed as of the retrieved 2026 documents.

180 days to appeal 3 dated changes on record Updated Aug 8, 2026 PA criteriahigh

What these coverage words mean

Formulary vocabulary turns up on denial letters with no explanation. Here is what each term means on this site — including the two that describe a gap in our data rather than a decision by your plan.

Preferred
On the formulary at the plan's best tier for this class. Usually still needs prior authorization — preferred is not the same as automatic.
Covered
On the formulary, but not the plan's first choice for this class. Often a higher copay tier than a preferred drug.
Non preferred
On the formulary at a disadvantaged tier, or reachable only after trying a preferred drug first.
Exception only
Not routinely covered. Obtainable only through a formulary-exception request that meets the plan's published criteria.
Excluded
Not on the formulary at all. A benefit exclusion is a different fight from a PA denial and is appealed differently.
Varies
The payer's own documents differ by plan or line of business, so a single answer here would be wrong.
Unknown
Not yet verified against a primary document. Recorded as absent rather than guessed.
N/A
Not applicable to this payer.