Yes, Express Scripts does cover Wegovy on its 2026 National Preferred Formulary, both the injectable pens and the tablets. But formulary listing is not the same as coverage under your specific plan. Express Scripts is a pharmacy benefit manager, and your employer or health plan sponsor is the one that decides whether weight-loss drugs are a covered benefit at all. Roughly half of Cigna/Evernorth’s employer clients cover GLP-1 weight loss medications, which means roughly half don’t.
Wegovy’s 2026 Formulary Status
The Express Scripts National Preferred Formulary effective January 1 through December 31, 2026, lists Wegovy Pens and Wegovy Tablets as covered medications.1Express Scripts. 2026 National Preferred Formulary Neither appears on the 2026 exclusion list.2Express Scripts. 2026 National Preferred Formulary Exclusions Wegovy is actually named as a preferred alternative for Zepbound Vials, which were excluded effective April 1, 2026.
The formulary document itself carries a caveat: being on the national preferred list “does not guarantee coverage,” because individual plan sponsors can exclude medications or design benefits differently.3Express Scripts. Preferred Members Formulary Rx Guide So the formulary tells you Wegovy clears the first hurdle. The next hurdle is your own plan.
Why Your Employer Still Decides
Express Scripts administers prescription benefits on behalf of thousands of employers and health plans, and each plan sponsor chooses which drugs to cover and at what cost-sharing level. GLP-1 weight-loss drugs have been one of the most contested categories. As of early 2024, only about 25% of employers nationally covered GLP-1s for weight management.4Healthcare Dive. Cigna GLP-1 Cost Cap for Employers Among Evernorth’s own employer clients, that figure reached roughly 50% by mid-2025.5CNBC. Cigna, Eli Lilly, Novo Nordisk Weight Loss Drugs Cost is the main driver: annual price trends for weight-loss drugs have been running 40% to 50% for health plans.
The practical takeaway: if your employer has chosen to exclude weight-loss medications from the pharmacy benefit, Wegovy will not be covered no matter what the formulary says.
Prior Authorization Is Almost Always Required
When a plan does cover Wegovy, your prescriber will need to submit clinical documentation and get the prescription approved before the pharmacy can fill it. The criteria plans typically look for include:
- A BMI of 30 or higher, or 27 or higher with at least one weight-related condition such as hypertension, type 2 diabetes, or sleep apnea.
- Documentation of three to six months of diet and exercise efforts.
- No concurrent use of another GLP-1 medication such as Ozempic.
- For renewals, evidence of at least 5% weight loss from baseline.
Standard prior authorization reviews generally take up to 72 hours, with urgent reviews completed within 24 hours. Across all insurers, about 82% of GLP-1 claims are ultimately approved, according to data from the IRIS database tracked by Real Chemistry. The most common reasons for denial are missing documentation, unmet prior authorization requirements, or the drug simply not being covered by the plan.6Managed Healthcare Executive. Weighing GLP-1 Coverage
What You’ll Pay
Two negotiated programs can lower what you pay at the counter, but your employer has to opt in for either one to apply.
EncircleRx $200 Monthly Cap
Evernorth’s EncircleRx benefit option caps the monthly copay for GLP-1 weight-loss medications at no more than $200, with that amount counting toward your annual deductible.7Fierce Healthcare. New Evernorth Program Cap Out-of-Pocket Costs for Wegovy, Zepbound Evernorth estimates the cap saves patients up to $3,600 per year compared to manufacturer discount programs.8PR Newswire. Evernorth Launches New Benefit Option for Weight Loss Medicines
Patient Assurance Program $25 Copay
In July 2025, Express Scripts added Wegovy and Zepbound to its Patient Assurance Program through agreements with Novo Nordisk and Eli Lilly. For members in participating plans, the program caps out-of-pocket costs at $25 for up to a 34-day supply.9Evernorth. Express Scripts Expands Patient Assurance Program for GLP-1s
Without either program, your cost will be whatever tier Wegovy sits on in your plan’s standard pharmacy benefit.
If Your Plan Requires EncircleRx Participation
Some employer plans that cover Wegovy through Express Scripts require participation in the EncircleRx lifestyle management program as a condition of ongoing coverage. You enroll in a partnered virtual health program (such as Omada or 9amHealth, depending on the employer) and must stay actively engaged month to month. Active engagement is defined as completing at least four weigh-ins and four app interactions per rolling 30-day period. Fall out of compliance, and the pharmacy will not fill the next Wegovy prescription until you’re back in good standing.10Express Scripts. EncircleRx Patient FAQ There is no time limit on how long you can stay on the medication, provided clinical criteria and program participation hold.
If Your Prior Authorization Is Denied
Express Scripts lists three options after a denial: ask your doctor about covered alternatives, file a formal appeal, or pay full price out of pocket.11Express Scripts. What if My Coverage Review (Prior Authorization) Is Denied
Appeals must generally be submitted within six months of the denial notice. A successful appeal typically requires a letter of medical necessity from the prescribing physician, along with clinical documentation of your BMI, weight-related health conditions, and history of previous weight loss attempts.12Medical News Today. How To Appeal a Wegovy Denial Check the specific reason listed on your explanation of benefits before you file, because the strategy differs for a medical necessity denial, a step therapy denial, and a blanket plan exclusion. If the denial was based on a plan exclusion for weight-loss drugs, an appeal is unlikely to succeed; the problem is the benefit design, not the paperwork.
TRICARE and Medicare Beneficiaries
If your Express Scripts coverage is through TRICARE, Wegovy is covered for beneficiaries enrolled in TRICARE Prime or TRICARE Select, subject to an approved prior authorization from a TRICARE-authorized provider.13Express Scripts MilitaryRx. Are GLP-1 and Weight Loss Medications Covered Through TRICARE Pharmacy As of August 31, 2025, weight-loss medications are no longer covered for beneficiaries outside those two plans.14Express Scripts MilitaryRx. GLP-1 Medications for Diabetes and Weight Management
For Medicare Part D members, standard Part D plans exclude drugs prescribed solely for weight loss. Wegovy can be covered under Part D only when prescribed for cardiovascular risk reduction in patients with established cardiovascular disease, not for obesity alone. CMS launched a temporary Medicare GLP-1 Bridge running July 1 through December 31, 2026, covering Wegovy for weight loss outside the Part D structure with a $50 copay per 30-day supply. Humana processes those claims, not your Part D plan.15CMS. Medicare GLP-1 Bridge A follow-on BALANCE Model is set to replace the bridge on January 1, 2027, but Part D plan participation is voluntary; if your plan does not opt in, you would need to switch to a participating plan to keep coverage for the weight-loss indication.16KFF. What To Know About the BALANCE Model for GLP-1s in Medicare and Medicaid
How To Confirm Coverage Under Your Plan
Because Express Scripts manages benefits for thousands of different plan sponsors with different formularies and rules, the only reliable confirmation comes from your own plan. Log in at express-scripts.com and use the “Price a Medication” tool, or call the number on the back of your prescription ID card.17Express Scripts. Are GLP-1s or Semaglutide Covered by My Plan The lookup will show whether Wegovy is covered under your specific benefit, what tier it sits on, and what your copay or coinsurance would be. If you have both Wegovy coverage and a prescription in hand, ask whether your plan participates in EncircleRx or the Patient Assurance Program before you fill it; the difference in cost is substantial.