GLP-1 Prior Authorization Requirements by Insurer: The 2026 Policy Register

Weight Loss Provider Guide Research · By the WPG Research Team
Last verified and updated: August 1, 2026 · Dataset version 1.0

GLP-1 prior authorization requirements by insurer do not reduce to one rule per carrier. Seven adult chronic-weight-management criteria sets across six numbered policy documents from Cigna, UnitedHealthcare, and Highmark—all governing Wegovy and Zepbound—use four BMI-only entry floors: 30, 32, 35, and 40. Four of the seven sit above BMI 30.

The differences continue after approval. Initial Wegovy periods run from 5 to 8 months and initial Zepbound periods from 6 to 8 months. Six of the seven criteria sets require at least 5% weight loss to continue Wegovy or Zepbound; Highmark Enhanced requires 7.5%. Five criteria sets state a prior lifestyle period, and those periods run from 3 to 6 months.

Cigna's BMI ≥32 policy says its adult thresholds “are not based on clinical data.” Highmark's BMI ≥40 policy says BMI at the morbid-obesity level is “more closely correlated with increased risks of serious health complications.” Those sentences appear in current payer documents governing the same two drugs.

We read all six source documents end to end and verified them on August 1, 2026. UnitedHealthcare Sections 2 and 3 count as separate criteria sets because the same numbered document applies different chronic-weight-management rules to its general program and North Dakota fully insured essential-health-benefit plans.

Which means the question “what does my insurer require for a GLP-1?” has no single insurer-level answer. The governing unit is the exact policy or policy section attached to the plan, benefit design, line of business, state, drug, and indication—not the logo on the insurance card.

Here is what those documents actually say.

GLP-1 prior authorization requirements by insurer: the register at a glance

Seven criteria sets use four BMI-only floors, four different initial Wegovy periods, three different initial Zepbound periods, and two different chronic-weight renewal thresholds. Every number below is traceable to the downloadable seven-row register.

Table 1. GLP-1 chronic-weight-management prior authorization criteria, by exact policy or policy section

Source: Cigna IP0206, Cigna IP0621, Cigna IP0739, UnitedHealthcare 2026 P 1114-21, Highmark J-1389-010 Standard, and Highmark J-1388-014 Enhanced. Adult chronic-weight-management pathways. Compiled and verified by Weight Loss Provider Guide Research, August 1, 2026.

For context, the current FDA labels describe adult weight-reduction use for patients with obesity, or overweight with at least one weight-related condition. The labels' adult weight-reduction trial populations use BMI ≥30 for obesity and BMI 27 to under 30 with at least one condition for overweight. That is a clinical-label reference point, not a promise that an insurance plan will use the same threshold. See the current FDA labels for Wegovy, Zepbound, Saxenda, and Foundayo.

Download the data behind the findings

• Policy register CSV, version 1.0
• Official-source manifest with retrieval dates and SHA-256 hashes

The CSV is the calculation source for every seven-policy statistic on this page. The source manifest records the six official files that support it, including each URL, effective date, page count, retrieval date, file size, and SHA-256 hash.

What does this GLP-1 policy data show—and what does it not show?

It shows that a carrier name is not enough to identify a GLP-1 prior authorization rule. Cigna, UnitedHealthcare, and Highmark each apply materially different chronic-weight-management criteria within the same organization.

It shows four BMI-only floors across seven criteria sets: 30, 32, 35, and 40. The widest within-organization gaps are ten BMI points: UnitedHealthcare's general and North Dakota EHB criteria use 30 and 40, and Highmark Standard and Enhanced use 30 and 40. Cigna's three IP-series policies use 30, 32, and 35.

It shows that entry criteria are only part of the rule. The documents also disagree on how many comorbidities are required, what lifestyle history must be proven, which product is preferred, how long the first authorization lasts, what weight is used as baseline, and whether renewal requires 5% or 7.5% weight loss.

It does not show that a stricter policy is medically or administratively improper. This register describes what the documents say. It does not rank the policies as best, worst, easiest, hardest, most generous, or most restrictive.

It does not show that a particular member has the benefit. A published clinical policy states criteria that may apply when a plan covers the drug. The member's benefit document, formulary, employer election, state requirements, product type, and other utilization-management rules can still exclude the drug or add conditions.

It does not show how often a request is approved, denied, appealed, or abandoned. The source documents contain criteria, not outcomes. This dataset contains no approval-rate or denial-rate denominator, so it publishes no approval or denial percentage.

How was the 2026 GLP-1 prior authorization dataset built?

One row is one exact criteria set, not one insurer. That is the whole method. When one organization publishes multiple rules, collapsing them into one row destroys the finding.

We searched official public policy libraries and program materials for documents governing GLP-1 drugs used for adult chronic weight management. The seven-row core register was built from six numbered payer documents that were publicly accessible and current when checked on August 1, 2026.

UnitedHealthcare's document contains two separately labeled sections with different rules. Section 2 is the general coverage criteria. Section 3 applies to North Dakota fully insured EHB small-group and individual plans. They are separate rows because they are separate operational criteria sets, even though they live in one PDF.

For each row we recorded:

• organization and policy identifier;
• exact criteria-set scope;
• line of business and state or region;
• effective date;
• drugs and indication;
• minimum age;
• BMI-only threshold;
• alternate BMI and comorbidity route;
• prior lifestyle duration and documentation form;
• medication-sequencing requirements;
• initial authorization period by drug;
• renewal-response threshold;
• renewal duration;
• baseline-weight definition;
• official source URL; and
• verification date.

Inclusion rules

A core record had to meet all of the following conditions:

1. The source was published by the payer or policy-issuing organization.
2. The exact policy, section, line of business, or state scope could be identified.
3. The source contained an adult chronic-weight-management pathway for Wegovy and Zepbound.
4. BMI, initial-period, and renewal-response fields could be extracted without guessing.
5. The full source was opened and read, not inferred from a search snippet or secondary article.

Normalization rules

We compared the adult chronic-weight-management pathway, not cardiovascular risk reduction, obstructive sleep apnea, MASH, type 2 diabetes, or pediatric treatment. Those pathways remain separate because they use different criteria and sometimes different authorization periods.

“Not specified” means exactly that. It does not mean “not required.” A separate formulary, benefit exclusion, quantity-limit rule, state mandate, or member document may add a requirement absent from the clinical-policy PDF.

We did not turn a plan's wording into a cleaner number when the source did not support it. Highmark Standard, for example, defines initiation and continuation partly by months of previous therapy and also publishes drug-specific authorization durations. Both features are retained rather than flattened into a generic “about six months.”

Reproducibility and source-change detection

The seven-row CSV reproduces the headline counts and ranges directly. The source manifest records a SHA-256 hash for each of the six official policy files. A later download from the same URL that produces a different hash tells an editor that the underlying file changed and the row needs a fresh review—even when the payer silently replaces a PDF at the same address.

The summary figures describe these seven criteria sets. They are not estimates of the United States insurance market, carry no enrollment weighting, and cannot support a statement about what percentage of insurers, plans, or patients face a particular rule.

Why does the same insurer publish different GLP-1 BMI requirements?

The reason differs by organization. Cigna publishes threshold-specific policy variants, Highmark publishes Standard and Enhanced benefit designs, and UnitedHealthcare places a state-specific EHB rule beside its general criteria. In every case, the carrier name alone leaves out the rule that matters.

Cigna: three thresholds in one IP-series policy family

Cigna publishes at least three separate IP-series policies governing the same adult chronic-weight-management drugs—Foundayo, liraglutide/Saxenda, Wegovy, and Zepbound—with the BMI threshold written into the title:

• IP0206 — Weight Loss – Glucagon-Like Peptide-1 Agonists BMI ≥30, effective June 1, 2026
• IP0621 — Weight Loss – Glucagon-Like Peptide-1 Agonists BMI ≥32, effective April 30, 2026
• IP0739 — Weight Loss – Glucagon-Like Peptide-1 Agonists BMI ≥35, effective April 30, 2026

BMI 32 is neither the BMI-only entry point used in the adult FDA-label weight-reduction trial populations nor one of the 25, 30, 35, and 40 category breakpoints reproduced in Cigna IP0621's own clinical background.

The policy explains its function directly. IP0621 calls itself a Benefit Exclusion Overrides product offering and states that its adult thresholds “are not based on clinical data” but are provided to let a subset of patients obtain the medications. That is not language inferred from pricing or plan design. It is the policy's own statement.

The threshold-specific family also has a dated origin. IP0206's revision history records a review on April 24, 2025, effective July 1, 2025, when its title changed from the unnumbered “Weight Loss – Glucagon-Like Peptide-1 Agonists” to the BMI ≥30 title. IP0621 and IP0739 both record “New policy” on the same April 24, 2025 review date, effective July 1, 2025.

The three policies are not identical apart from the number.

Table 2. What changes across Cigna's three IP-series BMI policies

Source: Cigna IP0206, Cigna IP0621, and Cigna IP0739. Verified August 1, 2026.

Two differences are easy to miss.

First, the lower-threshold override policy carries the broader documentation and engagement burden. IP0621 uses BMI 32 rather than 35, but it marks the adult BMI, comorbidity, and response fields for documentation and adds a recurring vendor requirement: four weigh-ins and four app engagements every month. An engagement can include a recorded meal, weight, glucose reading, blood-pressure reading, completed lesson, community-resource activity, or goal.

Second, the product lists diverge. Wegovy HD 7.2 mg was added to IP0206 on a May 14, 2026 review, effective June 1, 2026. It does not appear in the April 30 versions of IP0621 or IP0739. The policy attached to the plan can therefore change both the entry threshold and the formulations named in the document.

Cigna also publishes National Formulary and other policy-series documents for the same class. The claim here is not that three is Cigna's total policy count. It is that three simultaneously current IP-series documents alone produce three different adult BMI-only thresholds.

Highmark: Standard and Enhanced, same effective date, opposite rationale

Highmark publishes a matched pair of anti-obesity pharmacy policies:

• J-1389-010 Standard — Commercial
• J-1388-014 Enhanced — Commercial and Healthcare Reform

Both have an effective date of October 2, 2025 and a review date of September 17, 2025. Both address Wegovy, Zepbound, Saxenda/liraglutide, Contrave, Qsymia, and Xenical. Each points readers to the other policy.

Table 3. Highmark Standard vs. Enhanced for adult chronic weight management

Source: Highmark J-1389-010 Standard and Highmark J-1388-014 Enhanced. Verified August 1, 2026.

The Enhanced policy gives an explicit rationale for its higher threshold. It says BMI alone can miss muscle mass, fat distribution, and other metabolic factors, and then states that BMIs associated with morbid obesity, BMI ≥40, are “more closely correlated with increased risks of serious health complications.”

Set that beside Cigna's statement that the adult thresholds in its BMI ≥32 override offering are not based on clinical data. These are two payer documents taking different stated positions on why a threshold above the conventional BMI 30 entry point exists. Both statements are public. Both are dated. Neither should be blended into a generic “insurers usually require BMI 30” sentence.

Highmark Enhanced also applies a lower BMI floor to older anti-obesity drugs than to the GLP-1 pathway. Adults requesting Contrave, Qsymia, or Xenical need BMI ≥35. Adults requesting Wegovy, Saxenda/liraglutide, or Zepbound need BMI ≥40 plus the added metabolic or organ-dysfunction test. That is a documented difference in entry criteria. The direct product-sequencing rule appears separately: Zepbound is plan-preferred, and Wegovy or Saxenda requires documented intolerance or contraindication to Zepbound in the adult GLP-1 pathway.

UnitedHealthcare: two adult thresholds inside one numbered document

UnitedHealthcare takes a third approach. Clinical Pharmacy Program 2026 P 1114-21, effective July 1, 2026, places both adult chronic-weight thresholds inside one file.

Section 2, the general criteria, uses BMI ≥30 or BMI ≥27 with a weight-related condition. Section 3 applies to North Dakota fully insured EHB small-group and individual plans and uses BMI ≥40, with no lower-BMI comorbidity route for chronic weight management.

The document describes itself as an optional program for clients or businesses that elected weight-loss product coverage with prior authorization or notification. It also says the program is designed to meet regulatory requirements in California, New Mexico, North Dakota EHB, and New York. The North Dakota section is therefore not a second “UnitedHealthcare rule” in the abstract. It is a separately scoped state-and-product rule inside the same numbered program.

The distinction survives beyond BMI. The general section covers a wider drug list. The North Dakota section is limited to Wegovy and Zepbound. Both sections give Wegovy five months initially, Zepbound six months initially, and twelve months on reauthorization. Both require continuation of lifestyle modification and at least 5% weight loss for the chronic-weight pathway.

What BMI is required for Wegovy or Zepbound prior authorization?

Across the seven verified criteria sets, the BMI-only floor for adult chronic weight management runs from 30 to 40. The alternate route, where one exists, begins at BMI 27 but requires either one or two qualifying conditions.

Table 4. Adult BMI and comorbidity entry routes

Source: the six core policy documents listed under Table 1 and current FDA labels for Wegovy, Zepbound, Saxenda, and Foundayo. Verified August 1, 2026.

Cigna's closed list is the same across IP0206, IP0621, and IP0739: hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cardiovascular disease, knee osteoarthritis, asthma, chronic obstructive pulmonary disease, metabolic dysfunction-associated steatotic liver disease or non-alcoholic fatty liver disease, polycystic ovarian syndrome, and coronary artery disease.

What changes is how many conditions are required. A person with BMI 28 and one listed condition meets the BMI-and-comorbidity structure in IP0206 but not IP0621 or IP0739. Same organization. Same drugs. Different numbered policy.

Highmark Enhanced is more specific still. BMI ≥40 is only the first gate. The member must also have either:

• prediabetes, triglycerides ≥150 mg/dL, and low HDL, all supported by tests within six months; or
• at least two listed manifestations of organ dysfunction directly caused by obesity.

The eleven manifestation categories include chronic severe knee or hip impairment; specified cardiovascular diseases; idiopathic intracranial hypertension; lower-limb lymphedema; male hypogonadism; microalbuminuria with reduced eGFR; obstructive sleep apnea; PCOS, anovulation, or oligo-menorrhea; recurrent or chronic urinary incontinence; reduced lung or diaphragmatic compliance causing hypoventilation, breathlessness, or wheezing; and significant age-adjusted limitations of mobility or basic activities of daily living.

That level of detail is why a carrier-level summary fails. “Highmark requires BMI 30” and “Highmark requires BMI 40 plus organ dysfunction” are both supported by current Highmark documents. Only the exact policy tells you which statement applies.

How long does an initial GLP-1 prior authorization last?

Initial approval is drug-specific as well as policy-specific. In the core register, Wegovy runs from 5 to 8 months and Zepbound from 6 to 8 months. Even one insurer can assign different periods to different products.

Table 5. Initial authorization period by drug and policy

Source: the six core policy documents listed under Table 1. “Not in policy” means the drug is not governed by that document; it does not mean the organization never covers it under another policy. Verified August 1, 2026.

Cigna's initial Wegovy period is eight months. UnitedHealthcare's is five. That is a three-month—or 60%—difference for the same chronic-weight drug pathway.

UnitedHealthcare publishes four initial periods across its broader list: three months for listed sympathomimetics; four for Contrave, Qsymia, and Saxenda; five for Wegovy; and six for Xenical and Zepbound.

Highmark Standard uses three named therapy stages for several products: initiation, continuation, and maintenance. Its authorization-duration section then assigns product-specific initial periods and twelve-month continuation and maintenance periods. A reader expecting the simpler two-stage structure used elsewhere can miss the middle stage if they scan only for “initial” and “renewal.”

Indication matters too. The table above is limited to chronic weight management. Cigna assigns one-year initial approvals to its Zepbound obstructive-sleep-apnea pathway and specified Wegovy non-weight pathways. Those do not belong in the chronic-weight range.

How much weight must be lost to renew GLP-1 coverage?

For Wegovy and Zepbound chronic weight management, six of the seven core criteria sets use a 5% response test and Highmark Enhanced uses 7.5%. Other drugs and indications use 3%, 4%, 5%, 7.5%, or 10% tests.

Table 6. Weight-response requirements found in the verified core documents

Source: the six core policy documents listed under Table 1. Chronic-weight calculations use only the adult Wegovy and Zepbound rows; the additional pathways are shown to document within-policy variation. Verified August 1, 2026.

The baseline problem

The percentage is only half the test. The other half is the weight it is measured from.

Cigna is explicit. In all three IP-series policies, baseline means the member's weight before any GLP-1 or GLP-1/GIP receptor agonist, including a prior drug in the class. Switching from Wegovy to Zepbound does not create a new baseline under that definition.

UnitedHealthcare uses the phrase “baseline body weight” but does not define it in the reviewed program document.

Highmark requires baseline height, weight, and BMI at initiation and current values at continuation. Highmark Enhanced also explains that baseline BMI is measured immediately before starting weight-loss medication and can differ from a member's highest historical BMI.

That difference is operational, not semantic. A renewal packet can contain the correct current weight and still fail to answer the policy's question if the wrong starting weight is used.

Do insurers require diet, exercise, or a weight-management program before GLP-1 approval?

Five of the seven core criteria sets state an explicit preauthorization lifestyle period, ranging from three to six months. The required proof ranges from prescriber attestation to two categories of documentary evidence.

Table 7. Prior lifestyle requirement by criteria set

Source: the six core policy documents listed under Table 1. Verified August 1, 2026.

Highmark Enhanced publishes the most detailed evidence schedule in the core set. For physical activity, accepted examples include provider notes specifying type, duration, and frequency; recurring gym receipts paired with those notes; a wearable-device summary; or recurring personal-trainer appointments with notes. For diet, accepted examples include provider notes describing dietary changes or calorie deficit; a member-maintained dietary log; recurring nutritional counseling or medical nutrition therapy; or recurring receipts from a lifestyle program.

The policy names ten commercial programs—Noom, Weight Watchers, Vida, Lark, Signos, Wondr, Livongo, Omada, Newtopia, and Virta—plus plan-sponsored coaching programs. One document from each evidence column is required.

Cigna IP0621 uses a different mechanism: continued vendor engagement. It requires four weigh-ins and four app engagements per month. The policy says engagements may include lesson completion, recorded meals, weigh-ins, glucose readings, blood-pressure readings, community-resource activity, or setting or achieving a goal.

Current FDA labels require the drugs to be used with diet and physical activity. They do not contain Cigna's 4+4 vendor quota or Highmark's two-column proof schedule. Those are payer-created administrative requirements layered onto the labeled use.

Which policies exclude GLP-1 weight-management coverage or use separate indication pathways?

A weight-management exclusion is not always a drug-wide exclusion. The same product can be excluded for weight loss while remaining reviewable for cardiovascular risk reduction, obstructive sleep apnea, MASH, or another covered indication.

California Medi-Cal Rx shows the distinction clearly, but the current rule is more specific than a single “removed from coverage” sentence.

• Effective January 1, 2026, Wegovy is not eligible for weight-loss or weight-loss-related coverage. Effective April 1, 2026, Wegovy used for noncirrhotic MASH does not require an approved PA when the claim carries the specified ICD-10-CM codes; claims without those codes reject with Code 80. Other non-weight uses, including cardiovascular disease, may be reviewed for medical necessity.
• Zepbound and Saxenda were removed from the Contract Drugs List. Claims reject with Code 70 regardless of indication, although Zepbound PA requests may be considered for obstructive sleep apnea.
• Weight-loss requests for members under 21 may still be reviewed under the federal EPSDT benefit.

Those are three different claim mechanics inside one program notice.

The examples below were also read against their official sources on August 1, 2026. They are not included in the seven-row headline calculations because they do not form the same matched three-organization sample and include different products, lines of business, and exclusion structures.

Table 8. Additional verified public GLP-1 policy examples

Source: Aetna Non-Medicare 6450-C, Aetna Michigan HIDE, Cigna CNF 684, Kaiser Permanente Northwest Zepbound criteria, Humana Healthy Horizons in Virginia form, Centene CP.PMN.295, Molina Healthcare of Washington formulary page, and Medi-Cal Rx GLP-1 Coverage Considerations. Verified August 1, 2026. Excluded from core calculations.

The additional examples reinforce the same methodological point. Aetna's public Non-Medicare policy uses BMI 35, while its Michigan HIDE Medicaid pathway uses BMI 40 and a much longer preferred-drug sequence. One “Aetna requirement” cannot represent both.

What are the Medicare GLP-1 prior authorization requirements in 2026?

CMS operates the Medicare GLP-1 Bridge from July 1, 2026 through December 31, 2027. It is a Section 402 demonstration outside the ordinary Medicare Part D coverage and payment flow, and it applies only to eligible Part D beneficiaries using specified products for weight management.

The Bridge stays outside the seven-row register because CMS sets the criteria centrally. It is not a carrier-selected commercial policy.

A provider must attest that the drug is prescribed to reduce excess body weight and maintain weight reduction with current, ongoing lifestyle modification, and that the beneficiary was at least 18 and met one of three routes when GLP-1 therapy began:

Table 9. Medicare GLP-1 Bridge clinical routes

Source: CMS, Information for Providers: Medicare GLP-1 Bridge, verified August 1, 2026.

Eligible Bridge products currently include all Foundayo formulations, Wegovy injection and tablets, and Zepbound KwikPen only. Zepbound single-dose vials and single-dose pens are not included.

The demonstration is specifically for weight management. CMS says type 2 diabetes, moderate-to-severe obstructive sleep apnea, and noncirrhotic MASH uses are eligible for ordinary Part D coverage and should go through the Part D plan. A prescription intended to reduce major cardiovascular events also belongs with the Part D plan rather than the Bridge.

The pharmacy typically sends the PA request to the prescriber within 24 to 72 hours after determining that authorization is required. CMS says an approval or denial is sent within 72 hours of submission. There is no appeal process inside the Bridge, but a prescriber can resubmit corrected, updated, or additional information.

The Bridge is time-limited and its product list can change. The CMS page—not an insurer summary—is the controlling current reference.

Why do 2026 GLP-1 policy dates matter?

These documents change fast enough that a threshold without a policy number, version, and verification date is not a durable fact. The same URL can serve a revised file while an undated summary continues describing the old one.

Three changes in the verified source set show why.

The product list moved

Cigna's April 2026 revisions added Foundayo to all three IP-series policies. IP0206 then added Wegovy HD on a May 14, 2026 review, effective June 1, 2026. The April 30 IP0621 and IP0739 versions do not list Wegovy HD.

UnitedHealthcare's change log says Wegovy tablets were added in February 2026 and differentiated by indication. The same program was revised again in April 2026 to clarify that its MASH pathway has no BMI requirement.

Indications split into separate coverage tracks

Wegovy now appears in payer documents under chronic weight management, cardiovascular risk reduction, and MASH. Zepbound appears under chronic weight management and obstructive sleep apnea. Those pathways use different documentation, BMI rules, response tests, and authorization periods.

Cigna's chronic-weight pathway uses a 5% continuation test for Zepbound. Its Zepbound OSA pathway uses a 10% weight-loss test plus prescriber-attested symptom stability after at least one year. One row labeled “Cigna — Zepbound” cannot hold both rules without specifying the indication.

Revision histories are long and quiet

Cigna IP0206 records eight effective versions from July 1, 2025 through June 1, 2026. The changes include a threshold-specific title, updated cardiovascular language, generic liraglutide, revised policy language, Wegovy tablets, Foundayo, and Wegovy HD.

UnitedHealthcare 2026 P 1114-21 lists 26 P&T approval dates from January 2008 through April 2026. Its current effective date is July 1, 2026.

That is why this register carries a dataset version, row-level verification date, official-source link, and a source-file hash. Freshness is not decoration here. It is part of the evidence.

Limitations

This register is built to show policy structure, not market prevalence. It can tell you exactly what seven criteria sets say. It cannot tell you what percentage of insured people are governed by them.

We would rather state the limits plainly than let a clean table imply more than the sources support.

This is a purposeful sample, not a representative one. The seven core criteria sets were selected because they make within-organization variation directly comparable. Nothing here supports a claim about the share of insurers, plans, employers, or patients facing a BMI floor, step requirement, or renewal threshold.

No enrollment weighting exists. The organizations do not publish how many members sit under each exact criteria set. Three Cigna policy variants tell us that the structure exists; they do not tell us how many people are in each variant.

A public clinical policy is not a member's benefit document. Coverage can still depend on the plan's formulary, employer election, certificate or evidence of coverage, state requirements, quantity limits, and other policies. Meeting every criterion in a public document does not prove the drug is covered.

Public availability is uneven. Some plans publish full policies. Others publish forms, formulary statements, or only member-facing summaries. Private employer-specific rules can be inaccessible to anyone outside the plan.

Silence is not absence. “No fixed prior lifestyle duration stated” means the reviewed document did not state one. It does not prove that no other governing document requires it.

Different indications are not interchangeable. Chronic weight management, cardiovascular risk reduction, obstructive sleep apnea, MASH, and type 2 diabetes must be analyzed separately, even when the same brand appears in each pathway.

The source documents describe rules, not outcomes. This dataset contains no claims-level approval, denial, appeal, abandonment, or adherence data. It therefore publishes no rate for any of those outcomes.

This page is educational, not medical or benefits advice. Medication choice and clinical appropriateness belong with a qualified clinician. Member-specific coverage belongs with the plan and the current governing documents.

How can you verify the GLP-1 prior authorization rule for your own plan?

Ask for the exact governing policy, version, and benefit status. “Cigna requires BMI 30” is not a complete answer. “Cigna IP0621, effective April 30, 2026, applies to this plan” is.

1. Get the policy name and number

Ask the plan or prescriber's office for the exact clinical policy or prior authorization criteria document governing the requested drug and indication. Record the policy identifier, section, effective date, and line of business.

2. Confirm the benefit before arguing the criteria

Ask whether chronic weight-management medication is a covered pharmacy benefit under the specific plan. Clinical eligibility and benefit coverage are separate. A complete BMI and lifestyle record cannot satisfy a benefit that is excluded.

3. Match the drug and indication

Confirm whether the request is for chronic weight management, cardiovascular risk reduction, obstructive sleep apnea, MASH, or another use. The same product can follow different rules under different indications.

4. Check the baseline definition before renewal

Ask which weight the plan has recorded as baseline and what date it came from. Cigna's reviewed policies use the weight before any GLP-1 or GLP-1/GIP agonist. UnitedHealthcare's reviewed document does not define its baseline phrase. The correct current weight paired with the wrong baseline can produce the wrong renewal calculation.

5. Verify the source date

Compare the effective date on the document with the current version in the issuer's policy library. A saved PDF can be accurate and still no longer be current.

A source that states what “the insurer” requires without naming the policy, section, plan scope, indication, and date is leaving out the fields that decide whether its statement applies.

Frequently asked questions

Does every insurance plan require prior authorization for GLP-1 medications?

Every criteria set in the seven-row core register requires prior authorization for Wegovy and Zepbound used for chronic weight management. This purposeful sample does not establish what every insurer or plan does.

Does meeting the BMI requirement mean the medication is covered?

No. BMI is a clinical eligibility condition inside a benefit. A plan can exclude weight-management medication coverage even when a member satisfies every clinical criterion in a published policy.

What BMI is required for Wegovy or Zepbound?

It depends on the exact policy that governs the plan. The seven verified criteria sets use BMI-only floors of 30, 32, 35, or 40. Some also allow BMI 27 with one or two qualifying conditions.

Why do two plans from the same insurer have different requirements?

The same organization can publish different policies for different products, benefit designs, lines of business, or state requirements. The register documents this inside Cigna, Highmark, and UnitedHealthcare materials.

Do insurance plans require trying other medications first?

Some do. The sequence is policy-specific. Highmark Enhanced makes Zepbound plan-preferred before Wegovy or Saxenda in its adult GLP-1 pathway, while Kaiser Permanente Northwest publishes a separate Zepbound sequence involving older therapies and a semaglutide trial unless an exception applies.

How much weight do I have to lose to keep coverage?

For chronic weight management with Wegovy or Zepbound, six of the seven core criteria sets require at least 5% weight loss and Highmark Enhanced requires at least 7.5%. Other drugs and other indications can use different thresholds.

What does baseline weight mean at renewal?

It varies by policy. Cigna defines baseline as the weight before any GLP-1 or GLP-1/GIP receptor agonist. UnitedHealthcare uses the phrase baseline body weight without defining it in the reviewed document. Highmark requires baseline height, weight, and BMI at initiation.

How long does an initial approval last?

In the core register, initial Wegovy periods run from 5 to 8 months and initial Zepbound periods run from 6 to 8 months. All seven core criteria sets use a 12-month renewal period for those chronic-weight pathways.

Can Wegovy be covered for another indication when weight-management coverage is excluded?

It can be. A policy may exclude weight-management use while maintaining a separate pathway for an FDA-approved indication such as cardiovascular risk reduction or MASH. The exact rule still depends on the plan and indication.

Does Medicare cover GLP-1 medications for weight management in 2026?

CMS operates the Medicare GLP-1 Bridge from July 1, 2026 through December 31, 2027 for eligible Part D beneficiaries using specified products for weight management and meeting the demonstration criteria. Uses eligible for ordinary Part D coverage follow the Part D plan instead.

Related research on GLP-1 access and cost

Coverage rules determine whether a plan will pay; affordability determines the burden when it does not. The 2026 GLP-1 Affordability Index measures the separate wage burden of paying for GLP-1 medication without coverage by state.

Sources

The six documents supporting the seven-row core register were retrieved, read in full, and hashed on August 1, 2026.

1. Cigna, Weight Loss – Glucagon-Like Peptide-1 Agonists BMI ≥30, Coverage Policy IP0206, effective June 1, 2026.
2. Cigna, Weight Loss – Glucagon-Like Peptide-1 Agonists BMI ≥32, Coverage Policy IP0621, effective April 30, 2026.
3. Cigna, Weight Loss – Glucagon-Like Peptide-1 Agonists BMI ≥35, Coverage Policy IP0739, effective April 30, 2026.
4. UnitedHealthcare, Prior Authorization/Notification – Plans with Weight Loss/Appetite Suppression Medication Coverage, Clinical Pharmacy Program 2026 P 1114-21, effective July 1, 2026.
5. Highmark, Anti-Obesity (Standard) – Commercial, Pharmacy Policy Bulletin J-1389, version J-1389-010, effective October 2, 2025.
6. Highmark, Anti-Obesity (Enhanced) – Commercial and Healthcare Reform, Pharmacy Policy Bulletin J-1388, version J-1388-014, effective October 2, 2025.

Additional primary sources used for context and the extended register:

• Aetna Non-Medicare policy 6450-C P08-2025 v8
• Aetna Michigan HIDE HMO D-SNP Medicaid criteria
• Cigna National Formulary policy CNF 684
• Kaiser Permanente Northwest Zepbound coverage criteria
• Humana Healthy Horizons in Virginia weight-loss authorization form
• Centene CP.PMN.295 Semaglutide/Wegovy policy
• Molina Healthcare of Washington Medicaid formulary page
• California Medi-Cal Rx, GLP-1 Coverage Considerations, last updated April 6, 2026
• CMS, Medicare GLP-1 Bridge information for providers
• FDA prescribing information for Wegovy, Zepbound, Saxenda, and Foundayo

How to cite this page

Weight Loss Provider Guide Research. “GLP-1 Prior Authorization Requirements by Insurer: The 2026 Policy Register.” Weight Loss Provider Guide Research. Last verified August 1, 2026. https://weightlossproviderguide.com/research/glp-1-prior-authorization-requirements-by-insurer/

Dataset citation: WPG Research Team. WLPG GLP-1 Prior Authorization Policy Register, version 1.0. Weight Loss Provider Guide Research. August 1, 2026. https://weightlossproviderguide.com/research/data/wlpg-glp1-pa-policy-register-v1.0.csv

Weight Loss Provider Guide Research is an independent research and reference resource covering access, coverage, and policy for medical weight-management care.