{"id":5284,"date":"2024-10-27T20:31:30","date_gmt":"2024-12-10T03:42:19","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/?p=5284"},"modified":"2024-12-10T03:42:19","modified_gmt":"2024-12-10T03:42:19","slug":"hmn-does-cigna-cover-wegovy-ozempic-mounjaro-zepbound-in-2025","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-does-cigna-cover-wegovy-ozempic-mounjaro-zepbound-in-2025\/","title":{"rendered":"HMN: Does Cigna cover Wegovy, Ozempic, Mounjaro &#038; Zepbound in 2025?"},"content":{"rendered":"<p>\n<br \/>Do you know:  Does Cigna cover Wegovy, Ozempic, Mounjaro &#038; Zepbound? in 2025<\/p>\n<div id=\"main-content\">\n<div id=\"post-intro\">\n<div id=\"takeaways\">\n<h2>Key takeaways<\/h2>\n<ul>\n<li>\n<p><span style=\"font-weight: 400;\">GLP-1 agonists are FDA-approved drugs for Type 2 diabetes or weight management. There are several different GLP-1 agonists, with Ozempic, Wegovy, Zepbound, and Mounjaro being popular choices.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">Cigna insurance plans do not typically cover Wegovy, Zepbound, and Mounjaro without prior authorization. Ozempic coverage varies based on your medical history and the reason it\u2019s prescribed.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">If you don\u2019t have any insurance coverage for your GLP-1 drug through Cigna, consider using a <\/span><span style=\"font-weight: 400;\"> prescription discount card<\/span><span style=\"font-weight: 400;\"> to save money.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<section class=\"table-of-contents\">\n<div class=\"anchorLinks\">\n<div class=\"mobile-only\">\n<div class=\"dropdownLists\">\n<div class=\"dropdownBtn\"><span class=\"listsIcon\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/union.svg\" width=\"14\" height=\"20\"\/><\/span><br \/>\n\t\t\t\t\t\t\t<label><\/label><br \/>\n\t\t\t\t\t\t\t<span class=\"downArrow\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/dropDownArrow.svg\" width=\"24\" height=\"24\"\/><br \/>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<p><span style=\"font-weight: 400;\">Injectable drugs called <\/span><span style=\"font-weight: 400;\">GLP-1 agonists<\/span><span style=\"font-weight: 400;\"> 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.\u00a0<\/span><\/p>\n<p><span data-sheets-root=\"1\"><\/p>\n<section class=\"compass-ads-new\" data-compass-id=\"628437\">\n<aside class=\"top-section no-isi\">\n<figure class=\"col-1\">\n<div class=\"banner-heading\">\n<p><h3>\n\t\t\t\t\t\t\tPrescription Weight Loss Program\t\t\t\t\t\t<\/h3>\n<\/p><\/div>\n<\/figure>\n<figure class=\"col-2\">\n<\/figure>\n<figure class=\"col-3 no-supplimental-links-alt-layout no-client-approval-code\">\n<\/figure>\n<\/aside>\n<\/section>\n<p><\/span><\/p>\n<p><span style=\"font-weight: 400;\">Zepbound<\/span><span style=\"font-weight: 400;\"> and <\/span><span style=\"font-weight: 400;\">Mounjaro<\/span><span style=\"font-weight: 400;\"> contain the same active ingredient, tirzepatide, while <\/span><span style=\"font-weight: 400;\">Ozempic<\/span><span style=\"font-weight: 400;\"> and <\/span><span style=\"font-weight: 400;\">Wegovy<\/span><span style=\"font-weight: 400;\"> 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.<\/span><\/p>\n<p><b> <\/b><b>Can I take Ozempic if I\u2019m not diabetic?<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Why is this important? It\u2019s because the FDA approval of a GLP-1 agonist often affects whether and how your insurance will cover the drug when it\u2019s prescribed to you. If you have a Cigna health insurance plan, for example, it may cover Ozempic\u2014but only when it\u2019s prescribed for Type 2 diabetes since Ozempic isn\u2019t FDA approved for weight loss. Here\u2019s what you need to know about Cigna coverage for the GLP-1 agonists Ozempic, Wegovy, Mounjaro, and Zepbound.<\/span><\/p>\n<h2 id=\"does-cigna-cover-weight-loss-drugs-ozempic-wegovy-mounjaro-and-zepbound\"><span style=\"font-weight: 400;\">Does Cigna cover weight-loss drugs? Ozempic, Wegovy, Mounjaro, and Zepbound<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">In general, Cigna insurance plans <\/span><a href=\"https:\/\/static.cigna.com\/assets\/chcp\/pdf\/coveragePolicies\/pharmacy\/ip_0420_coveragepositioncriteria_weight_loss_medications.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">don\u2019t cover weight-loss medicines<\/span><\/a><span style=\"font-weight: 400;\"> as a broad category, though a select few medications (<\/span><span style=\"font-weight: 400;\">Contrave<\/span><span style=\"font-weight: 400;\">, <\/span><span style=\"font-weight: 400;\">Adipex-P<\/span><span style=\"font-weight: 400;\">, and <\/span><span style=\"font-weight: 400;\">Qsymia<\/span><span style=\"font-weight: 400;\">, for example), are covered when they meet certain criteria requirements for medically necessary drugs.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">As for the GLP-1 agonists, Cigna coverage is a little trickier to parse through. According to <\/span><a href=\"https:\/\/www.linkedin.com\/in\/roy-moore-59329b6\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Roy Moore<\/span><\/a><span style=\"font-weight: 400;\">, senior healthcare research and data analyst at information services agency Clarivate, Cigna\u2019s national plan lists Zepbound and Wegovy as \u201cexcluded drugs\u201d and Mounjaro and Ozempic as \u201cnot covered.\u201d\u00a0<\/span><\/p>\n<p><b>Related: <\/b><b>How to get Wegovy covered by insurance<\/b><\/p>\n<p><span style=\"font-weight: 400;\">However, that doesn\u2019t mean you can\u2019t <\/span><i><span style=\"font-weight: 400;\">ever <\/span><\/i><span style=\"font-weight: 400;\">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\u2019s formulary\u2014the list of medications it will cover in some circumstances. But they\u2019re 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.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If that sounds confusing, we understand. Unfortunately, there\u2019s no single answer for whether Cigna will cover these drugs. Receiving any type of coverage is contingent upon your specific plan. \u201cThere may be variances between Cigna\u2019s self-insured plans, where employers assume all risk, and fully insured products, where Cigna bears the risk,\u201d said Moore.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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 <\/span><i><span style=\"font-weight: 400;\">highly <\/span><\/i><span style=\"font-weight: 400;\">dependent on your individual plan.\u00a0\u00a0<\/span><\/p>\n<table class=\" singlecare-table\">\n<thead>\n<tr>\n<th>\n<h3 id=\"cigna-drug-coverage-for-weight-loss\"><span class=\"title\">Cigna drug coverage for weight loss<\/span><\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><span style=\"font-weight: 400;\">Ozempic<\/span><\/td>\n<td><span style=\"font-weight: 400;\">For adults with Type 2 diabetes<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Yes<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Must have a diagnosis of Type 2 diabetes and be 18 years or older<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Wegovy<\/span><\/td>\n<td><span style=\"font-weight: 400;\">For the treatment of obesity and overweight in people ages 12 and older<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Yes<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Must have engaged in behavioral modification and dietary restriction for at least three months<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Adults must have an initial BMI of 30 or higher or an initial BMI of 27 or higher (overweight) with at least one weight-related health condition, such as high cholesterol, high blood pressure, or Type 2 diabetes<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Patients 12 and older must have an initial BMI at the 95th percentile or higher for age and sex<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Mounjaro<\/span><\/td>\n<td><span style=\"font-weight: 400;\">For adults with Type 2 diabetes<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Yes<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Must have a diagnosis of Type 2 diabetes and be 18 years or older<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Zepbound<\/span><\/td>\n<td><span style=\"font-weight: 400;\">For the treatment of obesity and overweight in adults<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Yes<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Must be 18 years or older and must have engaged in behavioral modification and dietary restriction for at least three months<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Must have an initial BMI of 30 or higher or an initial BMI of 27 or higher (overweight) with at least one weight-related health condition<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3 id=\"does-cigna-cover-ozempic\"><span style=\"font-weight: 400;\">Does Cigna cover Ozempic?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">In general, yes, Cigna covers Ozempic <\/span><a href=\"https:\/\/static.cigna.com\/assets\/chcp\/pdf\/coveragePolicies\/cnf\/cnf_360_coveragepositioncriteria_glucagon-like_peptide-1_agonists_pa.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">as long as it\u2019s prescribed for Type 2 diabetes<\/span><\/a><span style=\"font-weight: 400;\">. It\u2019s not approved for use as a weight loss treatment, for treating Type 1 diabetes, diabetes prevention, or metabolic syndrome alone.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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 <\/span><a href=\"https:\/\/newsroom.cigna.com\/appropriate-use-of-prescription-medications-for-diabetes-weight-loss\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">after treatment with metformin failed<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n<p><b> <\/b><b>How much does Ozempic cost without insurance?<\/b><b>, <\/b><b>How do I get Ozempic for $25 a month?<\/b><\/p>\n<h3 id=\"does-cigna-cover-wegovy\"><span style=\"font-weight: 400;\">Does Cigna cover Wegovy?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">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:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">You have a body mass index (BMI) of 30 or higher.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">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.<\/span><\/li>\n<\/ul>\n<p><b> <\/b><b>How much does Wegovy cost without insurance?<\/b><b>, <\/b><b>Can you really get Wegovy for $25 a month?<\/b><\/p>\n<h3 id=\"does-cigna-cover-mounjaro\"><span style=\"font-weight: 400;\">Does Cigna cover Mounjaro?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Many Cigna plans would <\/span><a href=\"https:\/\/static.cigna.com\/assets\/chcp\/pdf\/coveragePolicies\/cnf\/cnf_749_coveragepositioncriteria_diabetes_mounjaro_pa.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">cover Mounjaro<\/span><\/a><span style=\"font-weight: 400;\"> when it was prescribed for Type 2 diabetes only; coverage wouldn\u2019t 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.<\/span><\/p>\n<p><b> <\/b><b>How much does Mounjaro cost without insurance?<\/b><span style=\"font-weight: 400;\">, <\/span><b>Does BCBS cover Mounjaro?<\/b><\/p>\n<h3 id=\"does-cigna-cover-zepbound\"><span style=\"font-weight: 400;\">Does Cigna cover Zepbound?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Any Cigna coverage for Zepbound is evaluated using the same criteria as Wegovy, and just like Wegovy, prior authorization is required.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\t\t<\/p>\n<div class=\"singlecare-dynamic-newsletter-wrapper sin-newsletter-wrapper\">\n\t\t\t<span class=\"heading\">Get our weight management newsletter<\/span><\/p><\/div>\n<p>\t<\/span><\/p>\n<h2 id=\"other-drugs-for-weight-loss\"><span style=\"font-weight: 400;\">Other drugs for weight loss<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you don\u2019t qualify for coverage of any of these GLP-1 agonists, there are <\/span><span style=\"font-weight: 400;\">other types of drugs<\/span><span style=\"font-weight: 400;\"> 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\u2019s 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.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">These policies change frequently, according to Moore. It\u2019s 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.<\/span><\/p>\n<h2 id=\"how-to-save-on-weight-loss-drugs-without-insurance\"><span style=\"font-weight: 400;\">How to save on weight-loss drugs without insurance<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If your Cigna plan doesn\u2019t cover your preferred or prescribed weight-loss drug, talk to your healthcare provider about other alternatives.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cDoctors 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,\u201d said <\/span><a href=\"https:\/\/www.medicalofficesofmanhattan.com\/our-team\/dr-yoshua-quinones\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Yoshua Quinones, MD<\/span><\/a><span style=\"font-weight: 400;\">, an internist with Medical Offices of Manhattan and contributor to LabFinder.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Of course, you can also use a <\/span><span style=\"font-weight: 400;\"> prescription discount card<\/span><span style=\"font-weight: 400;\"> to save money on weight-loss drugs like <\/span><span style=\"font-weight: 400;\">Mounjaro<\/span><span style=\"font-weight: 400;\">, <\/span><span style=\"font-weight: 400;\">Zepbound<\/span><span style=\"font-weight: 400;\">, <\/span><span style=\"font-weight: 400;\">Ozempic<\/span><span style=\"font-weight: 400;\">, and <\/span><span style=\"font-weight: 400;\">Wegovy<\/span><span style=\"font-weight: 400;\">. 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There are several different GLP-1 agonists, with Ozempic, Wegovy, Zepbound, and Mounjaro being popular choices. Cigna insurance plans do not typically cover Wegovy, Zepbound, and Mounjaro without prior [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5284","post","type-post","status-publish","format-standard","hentry","category-health-news"],"blocksy_meta":[],"_links":{"self":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/5284","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/comments?post=5284"}],"version-history":[{"count":1,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/5284\/revisions"}],"predecessor-version":[{"id":5800,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/5284\/revisions\/5800"}],"wp:attachment":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/media?parent=5284"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/categories?post=5284"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/tags?post=5284"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}