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Commercial employer-sponsored plans (2026 data): 18% include Wegovy on formulary with prior authorization 11% cover Wegovy only for diabetes-related obesity (off-label coverage of Ozempic is more common) 71% exclude Wegovy entirely from the formulary Medicare Part D plans administered by CVS Caremark: 0% cover Wegovy (federal law prohibits Medicare coverage of weight-loss medications) Some plans cover Ozempic for type 2 diabetes, which patients sometimes use off-label for weight loss Medicaid managed care plans: Coverage varies by state 14 states with CVS Caremark-administered Medicaid plans cover Wegovy as of April 2026 All require prior authorization and BMI 35+ (stricter than commercial plans) The 18% commercial coverage rate represents a decline from 23% in 2024

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doi: 10.3389/fphar.2022.998816 [DOI] [PMC free article] [PubMed] [Google Scholar] 39.Borner T., et al., Glucagon-like peptide-1 in diabetes care: Can glycaemic control be achieved without nausea and vomiting