Wegovy, a once-weekly injection containing semaglutide, helps adults with obesity or overweight manage chronic weight issues. It works by reducing appetite and slowing digestion. Many people turn to this medication for significant weight loss results.
Cigna, a major health insurance provider, administers benefits for millions through employer-sponsored plans, individual policies, and pharmacy benefit management. Coverage for weight loss drugs like Wegovy varies widely depending on the specific plan design chosen by employers or individuals.
As of 2026, questions about Does Cigna Cover Wegovy remain common due to evolving policies, high medication costs, and recent changes in how insurers handle GLP-1 drugs. This article breaks down the current landscape, requirements, and steps to explore coverage.
What Is Wegovy and Why Is Coverage Important?
Wegovy is FDA-approved for chronic weight management in adults with a BMI of 30 or higher (obesity) or 27 or higher with at least one weight-related condition like hypertension or type 2 diabetes. It also carries approvals for reducing cardiovascular risk and treating certain liver conditions.
Without insurance, Wegovy costs around $1,300-$1,500 per month. Coverage makes treatment more accessible and sustainable. Many patients rely on insurance to offset this expense.
Cigna plans often require proof of medical necessity before approving such medications. This ensures the drug aligns with FDA indications and patient needs.
How Cigna Handles Prescription Drug Coverage
Cigna maintains a national formulary, a list of covered medications. Drugs appear in different tiers that affect copays or coinsurance.
Weight loss medications fall under specialty drugs or non-preferred categories in many plans. Prior authorization (PA) is standard for high-cost or restricted drugs.
Employer-sponsored plans have flexibility in coverage decisions. Some exclude weight loss drugs entirely, while others include them with strict criteria.
Does Cigna Cover Wegovy?
Cigna coverage for Wegovy depends on your specific plan. Many Cigna plans cover Wegovy for its FDA-approved uses, such as chronic weight management or cardiovascular risk reduction, but only with prior authorization.
In 2025, Cigna introduced options to cap out-of-pocket costs at $200 per month for Wegovy and similar drugs through add-on programs for certain pharmacy benefit plans. This aims to encourage more employers to include coverage.
However, some plans exclude weight loss medications outright or limit them to type 2 diabetes indications. Starting in 2026, certain major insurers, including some Cigna policies, may restrict GLP-1 drugs to diabetes treatment only, impacting weight loss coverage.
Always verify with your plan documents or Cigna directly, as policies vary by group, location, and benefit design.
Prior Authorization Requirements for Wegovy
Prior authorization is usually required for Wegovy under Cigna. Your doctor submits documentation to prove medical necessity.
Common criteria include:
- BMI of 30+ (obese) or 27+ with weight-related comorbidity
- Participation in a supervised diet and exercise program (often 3-6 months)
- Failure or intolerance to other weight management approaches
- No contraindications to semaglutide
For continued coverage, patients must show at least 5% weight loss after initial treatment. Approvals often last 6-12 months before re-evaluation.
Cigna may also require specialist consultation for certain indications like liver disease treatment.
Steps to Check and Apply for Wegovy Coverage
Follow these practical steps to determine if your plan covers Wegovy.
Log Into Your Cigna Account
Access your member portal to view your formulary, drug list, and benefit details. Search for “Wegovy” or “semaglutide” to see status.
Contact Cigna Customer Service
Call the number on your insurance card. Ask about coverage for Wegovy, any exclusions, and prior authorization needs.
Work with Your Healthcare Provider
Your doctor reviews your medical history and submits the PA form. Provide records of BMI, comorbidities, and previous weight loss attempts.
Submit Required Documentation
Include lab results, chart notes, and proof of lifestyle efforts. This strengthens the approval chance.
Follow Up on the Request
Track the status through your doctor or Cigna. Appeals are possible if initially denied.
Here is a simple table summarizing key coverage factors:
| Factor | Typical Requirement | Notes / Variations |
|---|---|---|
| FDA-Approved Use | Chronic weight management or CV risk | Must match indication; off-label unlikely |
| Prior Authorization | Required for most plans | Doctor submits; often 3-6 month trial needed |
| BMI Threshold | 30+ or 27+ with comorbidity | Documented with medical records |
| Lifestyle Program | Diet/exercise participation (3-6 months) | Proof may be required |
| Weight Loss Milestone | 5% loss for continuation | Re-evaluated periodically |
| Out-of-Pocket Cap Option | $200/month in some add-on programs | Available through select employer plans (2025+) |
What to Do If Cigna Denies Coverage
If denied, do not give up immediately. Many denials stem from incomplete documentation.
Appeal the decision with additional medical evidence. Your provider can help strengthen the case.
Explore manufacturer savings programs from Novo Nordisk. These often reduce costs to $25-$200 per month for eligible patients.
Consider discount cards like SingleCare or GoodRx for lower cash prices. Some pharmacies offer competitive rates.
Discuss alternatives with your doctor, such as other covered GLP-1 drugs or non-drug weight management options.
Costs Without Coverage and Savings Strategies
Without insurance, Wegovy remains expensive. Manufacturer direct offers provide temporary discounts, such as $199-$349 per month in early 2026 for certain doses.
Patient assistance programs help low-income individuals access free or low-cost medication. Eligibility requires income verification.
Compounded versions exist but carry risks and lack FDA approval. Stick to brand-name when possible.
Combining lifestyle changes with medication maximizes long-term success regardless of coverage.
Why Coverage Is Evolving in 2026
Rising demand for GLP-1 drugs has prompted insurers to refine policies. Some limit to diabetes due to cost pressures.
Cigna’s $200 cap initiative in 2025 aimed to expand access through employer plans. This reflects a push toward broader coverage.
Future changes may include more restrictions or new approvals. Stay informed through annual plan updates.
Tips for Maximizing Your Chances of Approval
Work closely with an experienced provider familiar with PA processes. Document everything thoroughly. Join a formal weight management program early. This satisfies many criteria upfront.
Maintain communication with Cigna and your pharmacy. Quick responses prevent delays. Monitor weight and health metrics regularly. Positive progress supports continuation requests.
Summary
Cigna coverage for Wegovy varies by plan but is possible for FDA-approved uses with prior authorization. Recent initiatives like $200 monthly caps make it more affordable in select programs. Check your specific benefits, as exclusions or diabetes-only limits may apply in 2026.
Prior authorization requires proof of BMI, lifestyle efforts, and medical need. If denied, appeal or explore savings options. Wegovy offers powerful weight management support when accessible.
Work with your doctor and Cigna to navigate the process for the best outcome.
FAQ
Does Cigna cover Wegovy for weight loss?
Coverage depends on your specific plan. Many Cigna plans cover Wegovy for chronic weight management with prior authorization if you meet criteria like BMI thresholds and lifestyle program participation. Some exclude it or limit to diabetes treatment.
What prior authorization does Cigna require for Wegovy?
Cigna usually needs documentation of BMI (30+ or 27+ with comorbidity), failed prior weight loss attempts, and diet/exercise participation. Continued coverage requires showing at least 5% weight loss.
How can I check if my Cigna plan covers Wegovy?
Log into your Cigna member portal, search the formulary for Wegovy, or call customer service. Review plan documents for exclusions, tiers, and PA needs.
What if Cigna denies coverage for Wegovy?
Appeal with more documentation. Use manufacturer savings programs (often $25-$200/month), discount cards, or discuss alternatives with your doctor. Some patients qualify for patient assistance.
Are there cost caps for Wegovy under Cigna in 2026?
Yes, some add-on programs cap out-of-pocket at $200 per month for eligible patients. This applies to certain employer plans and aims to improve access. Confirm with your plan.
Dr. Hamza is a medical content reviewer with over 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic conditions. His reviews are grounded in trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Hamza is intended for educational purposes and is not a substitute for professional medical advice.