Does Cigna cover Zepbound?
From published formulary and policy documents for the plan type below. Not a decision for your member ID.
Sources last checked October 24, 2026
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Coverage varies. Cigna policy IP0816 (effective 09/01/2026) requires prior authorization for Zepbound weight management: 8-month initial approval after at least 3 months of behavioral modification and diet, BMI 30 or higher (or 27 or higher with a comorbidity), and 1-year continuation with 5 percent weight loss. Evernorth's 2026 National Preferred Formulary change notice excludes Zepbound vials and lists Zepbound pens as the preferred alternative. Cigna's individual-market 3-tier list does not include Zepbound, and plan documents can exclude weight-loss drugs.
Applies to: Employer plans on Cigna coverage policies and Express Scripts NPF; chronic weight management (OSA is separate); plan documents may exclude weight-loss drugs
Source: Cigna Coverage Policy IP0816 Weight Loss Zepbound, 2026-09-01 (effective)
Policy details
Sources last checked October 11, 2026
Approval criteria
- Age 18 or older.
- At least 3 months of behavioral modification and dietary restriction.
- Baseline BMI of 30 or higher, or baseline BMI of 27 or higher with at least one weight-related condition.
- Conditions the policy names: high blood pressure, type 2 diabetes, abnormal cholesterol or triglycerides, obstructive sleep apnea, cardiovascular disease, knee osteoarthritis, asthma, COPD, fatty liver disease (MASLD/NAFLD), polycystic ovarian syndrome, and coronary artery disease.
- Baseline BMI is measured before starting any GLP-1 or GLP-1/GIP medicine.
- Used together with behavioral modification and a reduced-calorie diet.
Source: Cigna Coverage Policy IP0816, Zepbound for weight loss
Approval length
8 months
Source: Cigna Coverage Policy IP0816
Renewal criteria
- Same baseline BMI and weight-related condition criteria as the initial request.
- Lost at least 5 percent of baseline body weight.
- Used together with behavioral modification and a reduced-calorie diet.
- Continuation approval is for 1 year.
Source: Cigna Coverage Policy IP0816
Exclusions and limits
- Use together with another tirzepatide product or a GLP-1 receptor agonist is not covered.
- A separate section of the policy covers moderate-to-severe obstructive sleep apnea with its own criteria.
Source: Cigna Coverage Policy IP0816
Policy
IP0816, new policy, reviewed 07/09/2026, effective 09/01/2026
Source: Cigna Coverage Policy IP0816
Effective September 1, 2026
Source: Cigna Coverage Policy IP0816
What this means
The published policy lists approval criteria, an initial approval of 8 months, continuation criteria, and uses that are not covered.
This reflects the insurer's published formulary and policy for the plan type above. Your employer or plan may exclude weight-loss drugs or differ. Confirm with the number on your ID card.