Does Cigna cover Wegovy, Ozempic, Mounjaro & Zepbound?

Injectable drugs called GLP-1 agonists have become popular lately, thanks to their high level of success in treating Type 2 diabetes (and their sometimes jaw-dropping side effect of extreme weight loss). These drugs work by stimulating the pancreas to produce more insulin, which helps lower blood glucose levels. They also tend to decrease appetite and slow digestion. Some of the most popular GLP-1 agonists available by prescription are Ozempic, Wegovy, Mounjaro, and Zepbound. All four work similarly but are still somewhat different. 

Zepbound and Mounjaro contain the same active ingredient, tirzepatide, while Ozempic and Wegovy contain semaglutide. Each medication is approved by the Food and Drug Administration (FDA) for different health issues. Wegovy and Zepbound are approved for weight management in adults with obesity or who are overweight, but Ozempic and Mounjaro are approved for the treatment of Type 2 diabetes.

Why is this important? It’s because the FDA approval of a GLP-1 agonist often affects whether and how your insurance will cover the drug when it’s prescribed to you. If you have a Cigna health insurance plan, for example, it may cover Ozempic—but only when it’s prescribed for Type 2 diabetes since Ozempic isn’t FDA approved for weight loss. Here’s what you need to know about Cigna coverage for the GLP-1 agonists Ozempic, Wegovy, Mounjaro, and Zepbound.

Does Cigna cover weight-loss drugs? Ozempic, Wegovy, Mounjaro, and Zepbound

In general, Cigna insurance plans don’t cover weight-loss medicines as a broad category, though a select few medications (Contrave, Adipex-P, and Qsymia, for example), are covered when they meet certain criteria requirements for medically necessary drugs. 

As for the GLP-1 agonists, Cigna coverage is a little trickier to parse through. According to Roy Moore, senior healthcare research and data analyst at information services agency Clarivate, Cigna’s national plan lists Zepbound and Wegovy as “excluded drugs” and Mounjaro and Ozempic as “not covered.” 

Related: How to get Wegovy covered by insurance

However, that doesn’t mean you can’t ever be approved for coverage of these medications; Moore said that despite being designated as excluded or not covered, these drugs are still included in Cigna’s formulary—the list of medications it will cover in some circumstances. But they’re usually included as tier-4 (nonpreferred) drugs, which means they will require prior authorization for coverage and are not typically covered under standard benefit terms, according to Moore.

If that sounds confusing, we understand. Unfortunately, there’s no single answer for whether Cigna will cover these drugs. Receiving any type of coverage is contingent upon your specific plan. “There may be variances between Cigna’s self-insured plans, where employers assume all risk, and fully insured products, where Cigna bears the risk,” said Moore.

Moore adds that Cigna is providing employers with some flexibility in choosing to cover GLP-1s for their employees, potentially offering cost-protection measures to employers to help mitigate their expenses. But ultimately, whether these drugs are covered for you is highly dependent on your individual plan.  

Does Cigna cover Ozempic?

In general, yes, Cigna covers Ozempic as long as it’s prescribed for Type 2 diabetes. It’s not approved for use as a weight loss treatment, for treating Type 1 diabetes, diabetes prevention, or metabolic syndrome alone. 

You may need to obtain prior authorization first, though, depending on your medical history. Ozempic is considered a first-line treatment for Type 2 diabetes only if you have cardiovascular disease (CV disease) or are at high risk for CV disease. Otherwise, metformin is the first-line treatment under most Cigna plans, so you would need to obtain prior authorization for Ozempic after treatment with metformin failed.  

However, you should always check that your specific plan benefits include potential coverage for GLP-1 agonists since all plans are different. This is true for Ozempic as well as Wegovy, Mounjaro, and Zepbound.

RELATED: How much does Ozempic cost without insurance?, How do I get Ozempic for $25 a month?

Does Cigna cover Wegovy?

Many Cigna plans will allow for coverage of Wegovy when prescribed for chronic weight management, though prior authorization and proof of medical necessity are required. To demonstrate medical necessity, you will need to have performed behavioral modifications and dietary restrictions for at least three months and also meet at least one of the following criteria:

• You have a body mass index (BMI) of 30 or higher.
• You have a BMI of 27 or higher plus a weight-related comorbidity approved by Cigna, including (but not limited to) hypertension, Type 2 diabetes, obstructive sleep apnea, and CV disease.

RELATED: How much does Wegovy cost without insurance?, Can you really get Wegovy for $25 a month?

Does Cigna cover Mounjaro?

Many Cigna plans would cover Mounjaro when it was prescribed for Type 2 diabetes only; coverage wouldn’t be approved for weight loss, Type 1 diabetes, diabetes prevention, or metabolic syndrome. When coverage for Mounjaro is allowed under your plan, prior authorization from your provider is required.

RELATED: How much does Mounjaro cost without insurance?, Does BCBS cover Mounjaro?

Does Cigna cover Zepbound?

Any Cigna coverage for Zepbound is evaluated using the same criteria as Wegovy, and just like Wegovy, prior authorization is required.  

Other drugs for weight loss

If you don’t qualify for coverage of any of these GLP-1 agonists, there are other types of drugs and weight management tools specifically approved by the FDA for weight loss, like Alli, Contrave, Xenical, and Plenity. As we noted, these drugs are typically not covered by Cigna, but you may obtain coverage if you meet certain criteria. Moore says that Cigna’s most recent prior authorization policy includes a provision to cover these drugs for weight management if individuals have a BMI exceeding 30 or have a comorbid condition, such as diabetes or hypertension, with a BMI over 27.

These policies change frequently, according to Moore. It’s important to continue seeking out the most current information or reaching out to Cigna directly to ask about coverage options for these medications within a specific plan.

How to save on weight-loss drugs without insurance

If your Cigna plan doesn’t cover your preferred or prescribed weight-loss drug, talk to your healthcare provider about other alternatives.

“Doctors can usually prescribe different medications within the same class, like GLP-1 receptor agonists, based on clinical judgment, although [this] varies due to factors like insurance requirements, formulary restrictions, medical history, and treatment goals,” said Yoshua Quinones, MD, an internist with Medical Offices of Manhattan and contributor to LabFinder.

Without GLP-1 insurance coverage, there are other ways to save money on your medication. Many drug manufacturers have copay cards that allow qualifying patients to receive the drug at little or no cost (especially if the list price of the drug is costly), and most manufacturers also have patient assistance programs to help people find ways to cut down on their out-of-pocket expenses. Contact the manufacturer for more information and eligibility requirements.

Of course, you can also use a SingleCare prescription discount card to save money on weight-loss drugs like Mounjaro, Zepbound, Ozempic, and Wegovy. The card allows you to search for pharmacies with the lowest drug prices so you can choose where to fill your prescription for maximum savings.