Most commercial insurers restrict patient access to Novo Nordisk’s Wegovy to those who are morbidly obese, have multiple comorbidities or who have tried and failed other weight loss drugs, diet and exercise programs.
| Insurer | Payer coverage | Coverage restrictions | Step therapy* |
|---|---|---|---|
| Aetna | Yes | More restrictive than FDA | Yes |
| Blue Cross Blue Shield North Carolina | Yes | More restrictive than FDA | Yes |
| Florida Blue | No public policy | No public policy | No public policy |
| Blue Cross Blue Shield Michigan | No public policy | No public policy | No public policy |
| Horizon Blue Cross Blue Shield of New Jersey | No public policy | No public policy | No public policy |
| Blue Cross Blue Shield of Tennessee | No public policy | No public policy | No public policy |
| EmblemHealth | No public policy | No public policy | No public policy |
| Humana | No public policy | No public policy | No public policy |
| Centene | Yes | Consistent with FDA | No |
| Highmark Health | Yes | Consistent with FDA | No |
| Independence Blue Cross | Yes | More restrictive than FDA | No |
| Elevance Health | Yes | More restrictive than FDA | Yes |
| Blue Cross Blue Shield of Massachusetts | Yes | More restrictive than FDA | Yes |
| CareFirst Blue Cross Blue Shield | Yes | More restrictive than FDA | Yes |
| Cigna | Yes | More restrictive than FDA | Yes |
| Health Care Service Corp. | Yes | More restrictive than FDA | No |
| Kaiser Foundation Health Plan | Yes | More restrictive than FDA | Yes |
| UnitedHealthcare | No public policy | No public policy | No public policy |
Researchers reviewed carriers’ public coverage documents from December 2022.
* Most insurers require step therapy, i.e. they require enrollees to try and fail other drugs, as well as exercise and diet program.