Does SelectHealth Cover Weight Loss Medication? By Plan Type

Whether SelectHealth covers weight loss medication depends entirely on which SelectHealth plan you have. Some commercial plans cover certain anti-obesity drugs with prior authorization, Medicare plans are barred by federal law from covering drugs prescribed for weight loss (with one limited exception starting in July 2026), and Medicaid coverage splits by state. Wegovy, Zepbound, and similar GLP-1 drugs are the most commonly asked about, and each sits in a different place on each formulary.

Commercial Plans

SelectHealth’s commercial plans use several different drug lists, mainly organized under its RxSelect and RxCore formularies. What your plan covers depends on which formulary applies and whether your employer has customized the benefit.

The Federal Employee Health Benefit (FEHB) formulary is one of the more inclusive commercial lists. It covers several anti-obesity medications, all with prior authorization and quantity limits:¹

Zepbound (tirzepatide) injectable at Tier 2
Qsymia (phentermine/topiramate) at Tier 3
Contrave (naltrexone/bupropion) at Tier 3
Phentermine at Tier 1
Orlistat at Tier 1

Wegovy is not on the FEHB list even though Zepbound is.¹ The standard Utah commercial RxCore formulary does not list Wegovy or Zepbound either, though it includes Mounjaro (the diabetes-branded version of tirzepatide) at Tier 3 with prior authorization.²

Because employers can customize their drug coverage, a drug covered under one SelectHealth commercial plan may not be covered under another. If your medication is not on your plan’s formulary, your provider can submit a non-formulary exception request through SelectHealth’s PromptPA system.³

Medicare Plans

SelectHealth Medicare Advantage and Part D plans cannot cover Wegovy, Zepbound, or other medications when prescribed solely for weight loss. Federal law excludes weight loss drugs from Part D coverage, and in April 2025 the Trump administration declined to finalize a Biden-era proposal to reinterpret that exclusion for people diagnosed with obesity.⁴ CMS stated in its Contract Year 2026 final rule that it “does not intend to finalize proposals to reinterpret the statutory exclusion on weight loss drugs.”⁵

Part D does still cover GLP-1 drugs when they are prescribed for other approved conditions, including type 2 diabetes, obstructive sleep apnea, and cardiovascular risk reduction.⁴

The Medicare GLP-1 Bridge Program

Starting July 1, 2026, a temporary federal program offers an alternate path. The Medicare GLP-1 Bridge Program sits outside the standard Part D benefit and is administered centrally by Humana as the claims processor rather than by individual plans like SelectHealth.⁶

SelectHealth Medicare Advantage members with prescription drug coverage are automatically eligible if they meet the clinical criteria; there is no separate enrollment. The provider submits a prior authorization request directly to the Bridge program’s central processor. Clinical requirements include being at least 18, meeting BMI thresholds (35 or higher; 30 or higher with certain comorbidities; or 27 or higher with other specified health conditions), and participating in ongoing lifestyle modifications.⁶

Approved beneficiaries pay a flat $50 monthly copay at the pharmacy, and that copay does not count toward the Part D deductible or out-of-pocket limits. Covered drugs include Wegovy injections and tablets, Zepbound, and Foundayo.⁷ The program is scheduled to run through December 31, 2026, though it was initially described as potentially extending through 2027.⁶

Medicaid Plans

SelectHealth operates Medicaid plans in two states, and the answer is different in each.

South Carolina: First Choice by Select Health

Effective January 1, 2026, the South Carolina Department of Health and Human Services removed Wegovy, Saxenda, and their generics from the state Medicaid preferred drug list for the treatment of obesity.⁸ Because First Choice follows the state’s preferred drug list, SelectHealth Medicaid members in South Carolina no longer have coverage for these drugs when prescribed for weight loss.⁹ Coverage remains in place when the same medications are prescribed to manage type 2 diabetes.

Utah Medicaid

Utah went the other direction. As of July 1, 2025, the state began covering select GLP-1 medications for weight loss, including Wegovy, Saxenda, and Zepbound, for Fee-for-Service Medicaid members. Adults must have a BMI of 30 or higher, or a BMI of 27 to 29.9 with at least one weight-related comorbidity. Children must be at or above the 95th percentile for BMI. Prior authorization is required.¹⁰

This coverage currently applies only to Fee-for-Service members. It is not part of the unified preferred drug list used by Utah’s Accountable Care Organizations, which is how many beneficiaries actually get their coverage. If you are enrolled through an ACO, including SelectHealth Community Care, contact your plan directly, because the policy may be different.¹⁰

A Cash-Pay Alternative Through Intermountain

If your plan will not cover the medication, SelectHealth’s parent organization, Intermountain Health, runs a virtual weight loss program that operates largely outside insurance. Patients consult with a clinical pharmacist virtually, and medications are shipped to them. The program is available to adults 18 and older in Colorado, Utah, Idaho, Wyoming, Montana, and Nevada with a BMI above 30 for new treatment or above 25 for continuation.¹¹

The consultation fee is $49. Medication costs are separate. Commercially insured patients can use manufacturer savings cards for Zepbound and Wegovy, but those cards are not available to people with government insurance like Medicare, Medicaid, or Tricare. The program prescribes only commercially available GLP-1 products (Zepbound, Wegovy, and Foundayo); no compounded medications. Treatment is capped at 19 months or until a BMI of 25 is reached.¹¹

Appealing a Denial

Initial denials are common and are not final. Under federal rules, insurers must give you a specific reason for any denial and tell you how to dispute it. The process has two stages: an internal appeal where SelectHealth reviews its own decision, and an external review by an independent third party if the internal appeal fails.¹²

For weight loss drugs specifically, a strong appeal usually includes a letter of medical necessity from the prescribing provider that documents your BMI, weight history, prior weight loss attempts, and any related conditions such as diabetes or cardiovascular disease. If the denial was based on clinical criteria you supposedly did not meet, the provider should address those criteria directly and explain why this medication is the appropriate treatment. Documenting failed attempts with alternative therapies strengthens the case.¹³

If you have an employer-sponsored SelectHealth plan, there is one more option: your provider can write a letter that you submit to your employer’s HR or benefits department asking that anti-obesity medications be added to the base plan.¹³ For ERISA-governed employer plans, the insurer must respond to claims within 60 days.¹⁴

How to Confirm Your Own Coverage

Because SelectHealth runs separate formularies for each plan type and employers can further customize what the plan covers, the only reliable way to confirm a specific drug is to check your own plan.

Log in to your member account at selecthealth.org to search for a specific medication and see how your plan covers it.¹⁵
Review the published formulary documents. SelectHealth posts its RxCore, RxSelect, Medicare, and Community Care drug lists online in searchable and PDF formats.³
Call Member Services. Commercial and Medicaid members can use the number on the back of the insurance card. Medicare members can reach Member Services at 1-855-442-9900.¹⁶

1
SelectHealth. FEHB Formulary
2
SelectHealth. Utah 5-Tier RxCore Formulary
3
SelectHealth. Lists and Formularies
4
American Gastroenterological Association. Anti-Obesity Drugs Will Not Be Covered by Medicare and Medicaid in 2026
5
Applied Policy. CMS Finalizes CY 2026 Changes to Medicare Advantage and Part D
6
CMS. Medicare GLP-1 Bridge
7
Medicare Rights Center. GLP-1 Weight Loss Drug Demonstration Begins July 2026
8
SC Daily Gazette. SC Medicaid Program to Stop Covering Expensive Weight Loss Drugs for Obesity
9
Select Health of SC. Prescription Benefits
10
Utah DHHS. Pharmacy Program Slides
11
Intermountain Health. Weight Loss Treatment
12
HealthCare.gov. Appeals
13
Novo Nordisk. Denials and Appeals Guide
14
Obesity Action Coalition. Appealing a Denial
15
SelectHealth. Pharmacy Coverage
16
SelectHealth. Select Health Medicare Active Evidence of Coverage