What factors determine if my insurance will cover Wegovy or Zepbound?

Insurance coverage for Wegovy and Zepbound depends on several key factors: your specific plan's formulary, whether weight loss is an included benefit, your clinical eligibility (typically BMI ≥30 or ≥27 with comorbidities), and whether you've met step therapy requirements. Commercial plans that include weight loss benefits are more likely to cover these medications, while plans focused solely on medical conditions may exclude them.

Additional factors include your employer's plan design (self-insured plans have more flexibility), your state's insurance mandates, and whether your plan has negotiated contracts with the manufacturers. Some plans require you to use specific pharmacies or mail-order services. Documentation of obesity-related health conditions like sleep apnea, hypertension, or type 2 diabetes can strengthen your case for coverage approval.