Does Cigna cover GLP-1s?
What Cigna Healthcare (The Cigna Group) says on its own pages (cigna.com), sorted by topic. Your own plan documents decide what you get.
Read Sep 28, 2026. Each line names the plan type it applies to.
Does it cover GLP-1s for weight loss?
- Cigna Healthcare’s newsroom (July 17, 2025) says Cigna Pharmacy has seen weight-management GLP-1 claims rise as more employers, about 20% as of the start of 2025, add this coverage.Employer and commercial plans:
Cigna Pharmacy has also seen a steady increase in weight management GLP-1 claims as more employers – about 20% as of the start of 2025 – add this coverage.
newsroom.cigna.com, Sep 29, 2026 - Evernorth, The Cigna Group’s health services division, announced on May 21, 2025 a pharmacy-benefit option for Wegovy and Zepbound under which patients’ monthly cost will not exceed $200.Employer and commercial plans:
Evernorth, the health services division of The Cigna Group (NYSE: CI) announced a first-of-its-kind pharmacy benefit offering that make weight loss medications WEGOVY® and ZEPBOUND® more available to patients. Through direct negotiations with the medications’ manufacturers, Evernorth has ensured that patients’ monthly cost will not exceed $200.
evernorth.com, Sep 29, 2026 - The Cigna Group’s milestones page says it completed the sale of its Medicare Advantage and Medicare Part D businesses to Health Care Service Corporation (listed under 2025).Medicare:
Completed the sale of our Medicare Advantage, Cigna Supplemental Benefits, Medicare Part D, and CareAllies businesses to Health Care Service Corporation, enabling us to drive further innovation to support customers.
thecignagroup.com, Sep 29, 2026
Does it depend on your employer or plan?
- Cigna Healthcare newsroom (May 11, 2023): Cigna covers Wegovy and Saxenda on its formularies for clients who elect to cover weight-loss medications.Employer and commercial plans:
Cigna Healthcare covers Wegovy and Saxenda on their drug formularies for clients who elect to cover weight loss medications in their benefit plan.
newsroom.cigna.com, Sep 29, 2026 - Express Scripts (Cigna-owned PBM) says some patients taking a GLP-1 for weight loss must be in a lifestyle program before getting the drug, and that this requirement is chosen by the employer or health plan.Employer and commercial plans:
Please note that a subset of patients taking a GLP-1 for weight loss will need to be enrolled and engaged in a lifestyle modification program before receiving the medication. This requirement is chosen by your employer or health plan.
express-scripts.com, Sep 29, 2026 - Express Scripts (Cigna-owned PBM) says GLP-1s may be covered by the member’s plan.Employer and commercial plans:
Glucagon-like peptide-1 receptor agonists (GLP-1s) or semaglutide are usually prescribed for diabetes and obesity and may be covered by your plan. GLP-1s and medications with the active ingredient semaglutide are a class of medications that mimic a hormone released in the intestines after a meal. Its effect impacts feelings of fullness and appetite.
express-scripts.com, Sep 29, 2026 - Cigna says a customer’s own plan document may contain a specific exclusion, and where it conflicts with a coverage policy, the plan document always wins.Employer and commercial plans:
For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Policy. In the event of a conflict, a customer’s benefit plan document always supersedes the information in the Coverage Policies.
static.cigna.com, Sep 28, 2026
Prior authorization criteria
- Evernorth’s EncircleRx GLP-1 program (Evernorth is The Cigna Group’s health services division; Express Scripts is its PBM) requires a BMI of 32 or more, or 27 or more with two weight-related health issues.Employer and commercial plans:
Patients must have a body mass index (BMI) of 32 or higher. They also qualify if they have a BMI of 27 or higher along with two weight-related health issues.
evernorth.com, Sep 29, 2026 - Under EncircleRx, prior authorization cannot be completed until the patient enrolls in a lifestyle modification program.Employer and commercial plans:
Prior authorization cannot be completed before your patient enrolls in a lifestyle modification program.
evernorth.com, Sep 29, 2026 - EncircleRx defines active engagement in the lifestyle program as four weigh-ins and four app engagements per month.Employer and commercial plans:
Active engagement is defined as four weigh-ins and four app engagements per month.
evernorth.com, Sep 29, 2026 - EncircleRx says there is currently no limit on how long an approved patient can stay on the GLP-1.Employer and commercial plans:
Currently there are no limits to how long your patient can be on their GLP-1 medication.
evernorth.com, Sep 29, 2026 - Cigna’s newsroom (July 17, 2025) says EncircleRx for Cigna Healthcare launched January 1, 2025, targets people with higher BMIs, and requires participation in Omada lifestyle management.Employer and commercial plans:
Launched January 1, 2025, EncircleRx for Cigna Healthcare is a comprehensive program focused on those with higher BMIs and at highest risk to offer enhanced clinical support, promote better outcomes, and provide financial predictability. The program requires participation in Omada lifestyle management, with regular check-ins and built-in digital monitoring.
newsroom.cigna.com, Sep 29, 2026 - MASH: Cigna’s drug-policy index lists a Wegovy MASH benefit-exclusion-override policy for Individual and Family Plans (BEO004); the index shows only the title, the policy itself is a PDF.Individual (ACA) plans:
Hepatology – Metabolic Dysfunction-Associated Steatohepatitis – Wegovy Benefit Exclusion Overrides Policy for Individual and Family Plans - (BEO004)
static.cigna.com, Sep 29, 2026 - Cigna’s Foundayo coverage policy (IP0206, effective 09/01/2026) requires prior authorization for Foundayo.Employer and commercial plans:
Prior Authorization is required for benefit coverage of Foundayo.
static.cigna.com, Sep 28, 2026 - For Foundayo, Cigna approves a first course for 8 months; the criteria include age 18 or older and a trial of behavioral modification and dietary restriction for at least 3 months.Employer and commercial plans:
A) Initial Therapy. Approve for 8 months if the patient meets ALL of the following (i, ii, iii, and iv): i. Patient is ≥ 18 years of age; AND ii. Patient has engaged in a trial of behavioral modification and dietary restriction for at least 3 months; AND
static.cigna.com, Sep 28, 2026 - Cigna’s Foundayo criteria also require a BMI of 30 or more before any GLP-1 was started, or a BMI of 27 or more with at least one listed weight-related condition (the list includes hypertension, type 2 diabetes, dyslipidemia and obstructive sleep apnea).Employer and commercial plans:
a) At baseline, patient had a BMI ≥ 30 kg/m2; OR Note: This refers to baseline prior to any glucagon-like peptide-1 (GLP-1) agonist (e.g., liraglutide [Saxenda, generic], Wegovy) or GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonist (e.g., Zepbound). b) Patient meets BOTH of the following [(1) and (2)]: (1)At baseline, patient had a BMI ≥ 27 kg/m2; AND (2)At baseline, patient had, or patient currently has, at least ONE of the following weight-related comorbidities: hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cardiovascular disease, knee osteoarthritis, asthma, chronic obstructive pulmonary disease, metabolic dysfunction-associated steatotic liver disease/non-alcoholic fatty liver disease, polycystic ovarian syndrome, or coronary artery disease;
static.cigna.com, Sep 28, 2026 - People already taking Foundayo are approved for 1 year when they meet all the continuing criteria.Employer and commercial plans:
B) Patient is Currently Receiving Foundayo. Approve for 1 year if the patient meets ALL of the following (i, ii, iii, and iv):
static.cigna.com, Sep 28, 2026 - To continue Foundayo, the patient must have lost at least 5% of baseline body weight.Employer and commercial plans:
iii. Patient has lost ≥ 5% of baseline body weight; AND
static.cigna.com, Sep 28, 2026
Type 2 diabetes
- Cigna Healthcare newsroom (May 11, 2023): part of Cigna’s Ozempic coverage criteria requires a type 2 diabetes diagnosis and, when appropriate, a failed metformin trial.Employer and commercial plans:
For example, part of Cigna Healthcare’s coverage criteria for Ozempic requires that patients have been diagnosed with type 2 diabetes and have tried metformin without success, when appropriate.
newsroom.cigna.com, Sep 29, 2026 - Cigna’s newsroom (July 17, 2025) says that for type 2 diabetes, integrated clinical reviews using medical data at the point of sale remove prior-authorization delays.Employer and commercial plans:
For type 2 diabetes, integrated benefit clinical reviews using medical data to confirm diagnoses in real time at the point of sale eliminates prior authorization delays, providing quicker access to therapy.
newsroom.cigna.com, Sep 29, 2026
Recent changes
- Cigna’s revision history for policy IP0206 shows Foundayo added with new criteria (reviewed 04/16/2026, effective 04/30/2026).Employer and commercial plans:
Foundayo was added to the Policy; new criteria were created. 04/16/2026 04/30/2026
static.cigna.com, Sep 28, 2026
How to check your own plan
- Cigna members log in to myCigna and use the Price a Medication tool to see covered medications and coverage requirements.Employer and commercial plans:
If you’re a Cigna member, log in to myCigna® and use the Price a Medication tool to see the medications your plan covers and specific coverage requirements.
cigna.com, Sep 29, 2026 - Cigna’s Prescription Drug List Search Tool shows medications commonly covered by employer-sponsored plans (a separate tool covers individual and family plans).Employer and commercial plans:
Use the Prescription Drug List Search Tool to view medications commonly covered by employer-sponsored plans.
cigna.com, Sep 29, 2026 - Cigna’s Prescription Drug List Search Tool also covers individual and family plans.Individual (ACA) plans:
Use the Prescription Drug List Search Tool to view medications commonly covered by individual and family plans.
cigna.com, Sep 29, 2026 - Express Scripts (Cigna-owned PBM) tells members to use their Express Scripts online account to see if GLP-1s are covered.Employer and commercial plans:
Use your Express Scripts online account to see if these medications are covered by your plan.
express-scripts.com, Sep 29, 2026
What we could not confirm
- No web page from Cigna that we could read covers: sleep apnea (zepbound); heart risk (wegovy).
- More detail, such as exact BMI cutoffs, is in 7 PDF documents from Cigna, which we have not opened.
Next steps
- Prior authorization and appeal letter templates
- Can you use the maker's savings card with your coverage?
- If it is not covered: the lowest verified cash prices
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