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Prior authorization for Wegovy or Zepbound: what records does your doctor need?

A prior authorization is your plan's approval before it pays for a medicine. Answer a few questions and get a printable checklist of the records published criteria commonly ask for, matched to your use, plus the questions to ask your plan.

Takes about 2 minutes Nothing you type leaves your device Every item cites a published criteria document
This doesn't say whether you qualify. It shows what plans commonly ask for. Your plan has its own criteria and makes the decision; your prescriber decides whether the medicine suits you.Information only, not a promotion. Every medicine named here is prescription-only. Only a prescriber can decide whether one is right for you and prescribe it. We don't recommend, rank or favor any medicine. Where we list several, they're in alphabetical order. We don't sell medicines or take money from drug companies.
Step 1 of 6Coverage
What coverage will the request go to?

Different payers publish different criteria. Pick the closest.

Which medicine, and for what?

The use decides which criteria apply: weight, diabetes, heart, sleep apnea and liver uses each have their own.

Medicine
Use
What's your BMI, roughly?

Criteria are written in BMI bands. Don't know it? Work it out in pounds and inches (opens in a new tab).

Was it measured at a clinic in the last 3 months?
Do you have any of these conditions?

Tick any your doctor has diagnosed. Many criteria hinge on them.

Have you been in a weight program?

A program that covers diet, activity and behavior change, with follow-up: through a doctor, dietitian, employer, app or class.

Have you taken a weight-loss medicine before?
Which of these do you take or use now?

Some criteria ask about these: a medicine tried first, or one that can't be combined.

Next you'll see your checklist. Tick items as you gather them, then print it or save it as a PDF for your prescriber's office.

Private by design: the checklist is built in your browser. Nothing is sent or stored, and nothing goes in the link. Privacy notice

Your prior authorization checklist

What this means

What this doesn't mean

  • It isn't a yes or a no. Matching a line in one published document doesn't mean your plan will approve; missing one doesn't mean it won't. Your plan's own criteria decide.
  • It doesn't say the medicine is right for you. Your prescriber decides that, after checking your health, other medicines and risks.
  • Never change records to fit criteria. The request has to match your chart. If something doesn't fit, ask your prescriber about other options.

Why we say this

Each item on your checklist comes from one of these published documents. All checked Oct 14, 2026.

    Read next

    How this works

    Plans and the pharmacy benefit managers (PBMs) that run their drug lists publish the criteria they use. This tool holds the requirements from a handful of those documents, each dated, and picks the ones for your use and coverage:

    • Weight, heart and liver (employer and Marketplace plans): CVS Caremark's published criteria for Wegovy (4774-C) and tirzepatide (6947-C).1,2
    • Type 2 diabetes, heart, sleep apnea and MASH (Medicaid): Indiana Medicaid's GLP‑1 criteria from July 2026 and Maryland Medicaid's Wegovy and Zepbound form.3,4
    • Medicare, for weight: the CMS rules for the Medicare GLP‑1 Bridge.5,6

    Your answers don't decide anything. They only mark which records you said you have, and which you may still have to get. Each item names its source, so your prescriber's office can check it against your own plan's document.

    What this can't tell you

    • Your plan's exact criteria. Ask the plan for them; the questions on the checklist do that.
    • Whether your plan covers weight-loss medicines at all. Many employers don't: KFF found 43% of firms with 5,000 or more workers covered GLP‑1s for weight in 2025, and 16% of firms with 200 to 999.7
    • Whether a GLP‑1 suits you. That's for a prescriber.

    Questions people ask

    What does a prior authorization for Wegovy or Zepbound usually ask for?

    For weight, published criteria from one large pharmacy benefit manager ask for at least 6 months in a weight program that covers diet, activity and behavior change, and a starting BMI of 30, or 27 with a weight-related condition such as high blood pressure, type 2 diabetes or high cholesterol, each with documents.1,2 Heart, sleep apnea and liver uses have their own criteria, such as a past heart attack or stroke, a sleep study, or a liver scan.1,3

    Does this tell me whether I qualify?

    No. It lists what published criteria commonly ask for, and what to gather. Your plan has its own criteria, and the plan decides. Your prescriber decides whether the medicine is right for you.

    Why does the BMI have to be recent?

    Some criteria ask for a BMI measured within a set time: Indiana Medicaid's criteria ask for one from the past 3 months for heart and sleep apnea uses, and Maryland Medicaid's form for one within the last 90 days.3,4 A weight measured in the clinic, with the date, is what plans look for.

    What does the Medicare GLP‑1 Bridge need?

    CMS's criteria cover people with Part D aged 18 or older with a BMI of 35 or more; 30 or more with heart failure with preserved ejection fraction, uncontrolled high blood pressure or chronic kidney disease stage 3a or worse; or 27 or more with prediabetes, a past heart attack or stroke, or symptomatic artery disease. People with type 2 diabetes, moderate-to-severe sleep apnea or MASH go through their Part D plan instead. The prescriber completes the prior authorization.5,6 More in who qualifies for the Bridge.

    What happens when the approval runs out?

    Plans ask for a renewal. One large pharmacy benefit manager's criteria for weight ask for at least 3 months on a steady maintenance dose and at least 5% of starting weight lost, or kept off.1,2 Diabetes criteria may ask for a new HbA1c.3 Put the renewal date in your calendar.

    Is anything I enter saved or sent?

    No. The checklist is built in your browser. Nothing is sent or stored, and nothing goes in the link.

    Sources

    1. CVS Caremark. Wegovy prior authorization with quantity limit, reference 4774-C (P08-2025 v5): weight (6-month program, BMI 30 or 27 with a condition; renewal at 5%), heart risk and MASH criteria. PDF. Checked Oct 14, 2026.
    2. CVS Caremark. Tirzepatide prior authorization with quantity limit, reference 6947-C (P08-2025 v4): weight and obstructive sleep apnea (AHI of 15 or more, BMI 30 or more) criteria; approval 8 months for weight, 6 months for sleep apnea, then 12. PDF. Checked Oct 14, 2026.
    3. Indiana Medicaid (prepared by OptumRx). GLP-1 receptor agonists and combinations: prior authorization criteria, July 1, 2026. PDF. Checked Oct 14, 2026.
    4. Maryland Department of Health, Medicaid Office of Pharmacy Services. Wegovy and Zepbound prior authorization form (MDH 12/2025). PDF. Checked Oct 14, 2026.
    5. CMS. Medicare GLP-1 Bridge: information for prescribers (criteria, covered drugs, "SEND TO BRIDGE FOR WEIGHT MANAGEMENT", decision within 72 hours). Product No. 12235, June 2026. PDF. Checked Oct 14, 2026.
    6. Medicare.gov. Medicare GLP-1 Bridge: who qualifies, covered drugs, $50 monthly copayment. medicare.gov. Checked Oct 14, 2026.
    7. KFF. 2025 Employer Health Benefits Survey: GLP-1 coverage for weight loss by firm size; 34% of covering firms require a dietitian, case manager or lifestyle program. October 22, 2025. kff.org. Checked Oct 14, 2026.
    8. Express Scripts for TRICARE. GLP-1 and weight loss medication coverage (Prime and Select with prior authorization; others not covered from Aug 31, 2025). militaryrx.express-scripts.com. Checked Oct 14, 2026.
    9. US prescribing information (FDA labels): Wegovy injection and tablets (June 2026), Zepbound and Mounjaro (August 2026), Ozempic (May 2026). Wegovy · Zepbound · Mounjaro · Ozempic. Checked Oct 14, 2026.
    10. Social Security Act § 1927(d)(2)(A): drugs used for weight loss may be excluded, applied to Medicare Part D. law.cornell.edu. Checked Oct 14, 2026.

    Last checked Oct 14, 2026 · Next review due Jan 14, 2027

    How this tool was made. Written by the GLP Guidebook team from the published documents above. Plans and PBMs are named only to cite their published criteria; we don't recommend or rank any. It's general information, not medical advice. Talk to your doctor or another licensed prescriber before starting, stopping or changing any medicine. In an emergency, call 911. How we write