Prior Authorization Lookup by Payer & Drug
Top results25
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Wegovy (semaglutide) — Prior Authorization for Cardiovascular Risk Reduction and MASHDefines prior authorization criteria for coverage of Wegovy (semaglutide) injection and tablets for reduction of major adverse cardiovascular events in adults with established cardiovascular disease plus overweight/obesity, and for Wegovy injection for treatment of metabolic dysfunction-associated steatohepatitis (MASH). Affects UnitedHealthcare members subject to pharmacy clinical programs.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-01Wegovy (semaglutide) — Coverage for Cardiovascular Risk Reduction and MASHDefines prior authorization criteria for coverage of Wegovy (semaglutide) specifically for reduction of major adverse cardiovascular events in adults with established cardiovascular disease and for treatment of metabolic dysfunction‑associated steatohepatitis (MASH) with F2‑F3 fibrosis; applies to UnitedHealthcare pharmacy benefits.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyWegovy (semaglutide) prior authorization for MASH/NASHThis form governs pharmacy prior authorization and step-edit requests for Wegovy (semaglutide) when prescribed for metabolic dysfunction-associated steatohepatitis (MASH)/nonalcoholic steatohepatitis (NASH) for AvMed members.All AvMed updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-15Wegovy (semaglutide) — Supplemental Indications (cardiovascular risk reduction and MASH)Defines coverage, prior authorization documentation, prescriber specialty requirements, and medical necessity criteria for Wegovy (semaglutide) injection and tablet when used for cardiovascular risk reduction and metabolic dysfunction-associated steatohepatitis (MASH). Applies to Blue Cross Blue Shield - Iowa members where benefits exist.All Blue Cross Blue Shield - Iowa updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-15Wegovy Cardiovascular Risk ReductionDefines prior authorization, clinical criteria, documentation, prescriber specialty, dosing/quantity limits, and continuation requirements for Wegovy (semaglutide) injection and tablet for cardiovascular risk reduction in adults with established CVD and for Wegovy injection for metabolic dysfunction-associated steatohepatitis (MASH). Applies to members whose benefits include coverage for the drug.All Blue Cross Blue Shield - Iowa updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-10Wegovy (semaglutide) benefit application — coverage criteriaDefines covered indications, prior authorization requirements, prescriber specialties, dosing limits, and medical necessity criteria for Wegovy (semaglutide) for members of the payer product(s). Affects prescribers and pharmacists requesting coverage for Wegovy.All Blue Cross Blue Shield - Iowa updates
- Prior AuthClinical/Medical PolicyEff. 2025-10-30WEGOVY (semaglutide) — Prior Authorization Criteria for MASH (F2–F3)Prior authorization criteria for use of WEGOVY (semaglutide) to treat noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced fibrosis (F2–F3) in adults under Mississippi Division of Medicaid.All Mississippi Division of Medicaid updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-10Wegovy Prior Authorization (Kentucky Medicaid)Rules for prior authorization of Wegovy for Kentucky Medicaid members managed by MedImpact, including restriction to a single Wegovy formulation per member and procedures when switching formulations.All medimpact updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Wegovy (semaglutide) — Medi‑Cal Rx Code I diagnosis restriction and temporary continuation guidanceUpdates to Medi‑Cal Rx processing and prior authorization requirements for Wegovy (semaglutide) claims, describing temporary overrides for patients under 21 and honoring certain prior authorizations for adults; intended for pharmacy providers and prescribers serving Health Plan of San Joaquin members.All healthplanofsanjoaquin updates
- Prior AuthClinical/Medical PolicyPrior authorization form for GLP-1 agents (Wegovy, Zepbound) and related indicationsThis document is a prior authorization request form used by prescribers to request coverage of specific GLP-1 receptor agonists (Wegovy, Zepbound) for indications including cardioprotection, NASH/MASH, and obstructive sleep apnea; it applies to Medicaid beneficiaries and providers submitting pharmacy PA requests in North Carolina. It outlines required clinical information and continuation criteria.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Weight Loss - GLP-1 and GLP-1/GIP Agonists (Foundayo, Liraglutide/Saxenda, Wegovy, Zepbound)Defines Cigna coverage and prior authorization requirements for Foundayo, liraglutide (Saxenda, generic), Wegovy (tablet and injection), and Zepbound for weight loss and specified related indications, and explains documentation and prescriber requirements for certain indications.All Cigna updates
- Prior AuthClinical/Medical PolicyWeight Loss — GLP‑1 and GLP‑1/GIP Agonists (Saxenda, Wegovy, Zepbound) Coverage CriteriaCigna policy defining medical necessity and benefit-exclusion override criteria to authorize coverage of liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound) for weight loss and select FDA indications in adults and pediatric patients; affects providers prescribing or requesting prior authorization for these agents under Cigna-administered plans.All Cigna updates
- Prior AuthClinical/Medical PolicyPrior authorization form for GLP‑1 receptor agonists (Wegovy, Zepbound) — coverage criteria and submission requirementsThis document is a prior authorization request form used by providers to request initiation or continuation of GLP‑1 receptor agonists (notably Wegovy and Zepbound) for indications including cardioprotection, NASH/MASH, and obstructive sleep apnea; it governs submission requirements and clinical information needed for Medicaid pharmacy PA review. Affects prescribing providers and prior authorization reviewers.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2023-10-01Pharmacologic Weight Loss (Saxenda, Wegovy) — Coverage CriteriaDefines documentation, eligibility, prior authorization, continuation, dosage limits, and FDA dosing recommendations for liraglutide (Saxenda) and semaglutide (Wegovy) for commercial members of Neighborhood Health Plan of Rhode Island.All Neighborhood Health Plan of Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2023-10-01Clinical coverage criteria for GLP-1 / GIP agents (Saxenda, Wegovy, Zepbound) for weight management and Wegovy for MACE risk reductionClinical coverage criteria and prior authorization requirements for Saxenda (liraglutide), Wegovy (semaglutide), and Zepbound (tirzepatide) for weight reduction and for Wegovy for major adverse cardiovascular event (MACE) risk reduction. Applies to commercial members of Neighborhood Health Plan of Rhode Island.All Neighborhood Health Plan of Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2018-07-20Pharmacologic weight loss agents (Wegovy, Zepbound, Contrave) coverageMedical necessity and prior authorization criteria for Wegovy (semaglutide), Zepbound (tirzepatide), Contrave (naltrexone/bupropion) and related agents for weight reduction, MACE risk reduction, OSA, and MASH for Medicaid members.All Neighborhood Health Plan of Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2024-06-01Semaglutide (Wegovy)Defines medical necessity criteria, prior authorization requirements, and coverage limitations for Wegovy (semaglutide) injection and tablets for Centene lines of business (HIM, Medicaid). Applies to prescribers requesting coverage under Centene-affiliated health plans.All Centene updates
- Prior AuthClinical/Medical PolicyEff. 2024-06-01Clinical Policy: Semaglutide (Wegovy)Defines Centene coverage criteria for Wegovy (semaglutide) for cardiovascular event prevention and other indications, including documentation, dosing, exclusions, and prior authorization requirements for affected members and providers.All Centene updates
- Prior AuthClinical/Medical PolicyEff. 2021-09-24Semaglutide (Wegovy) — coverage for weight management, cardiovascular event prevention, and MASHDefines medical necessity criteria, prior authorization requirements, dosing limits, and renewal rules for Wegovy (semaglutide) for weight management, cardiovascular event prevention, and metabolic dysfunction-associated steatohepatitis for Health Net of California members.All mhn updates
- Prior AuthClinical/Medical PolicyPrior authorization criteria for Wegovy (semaglutide) — cardiovascular event risk reductionThis document governs prior authorization and step-edit requests for Wegovy (semaglutide) when prescribed for cardiovascular event risk reduction for AvMed members; it specifies required documentation, clinical criteria for initial and renewal approvals, and administrative submission instructions.All AvMed updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-07-01Weight Loss Medications: Contrave, Liraglutide (Saxenda), Wegovy (semaglutide) injection, Zepbound (tirzepatide)Pharmacy benefit prior authorization policy for weight management medications (Contrave, liraglutide/Saxenda, Wegovy/semaglutide, Zepbound/tirzepatide) including indications, coverage criteria, continuation, and limitations for Mass General Brigham Health Plan commercial/exchange members.All Mass General Brigham Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-01Weight Loss Medications: Contrave, Liraglutide (Saxenda), Wegovy (semaglutide) injection, Zepbound (tirzepatide)Prior authorization policy for pharmacy coverage of specified weight-loss medications for Mass General Brigham Health Plan commercial/exchange members; defines initial and continuation criteria, limitations, and documentation requirements.All Mass General Brigham Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Anti-obesity pharmacotherapy (Alli, Contrave, Qsymia, Saxenda, Wegovy, Zepbound) - Prior AuthorizationPrior authorization policy for pharmacy coverage of specified weight-management medications for commercial/exchange members of Mass General Brigham Health Plan, detailing initial and continuation criteria, age limits, quantity limits, and cardiac-risk indication for Wegovy.All Mass General Brigham Health Plan updates
- Prior AuthClinical/Medical PolicyEff. 2021-09-24Semaglutide (Wegovy) - Coverage CriteriaDefines Health Net coverage criteria, dosing limits, and renewal requirements for Wegovy (semaglutide) for weight management, cardiovascular event prevention, and metabolic dysfunction-associated steatohepatitis (MASH). Affects providers submitting prior authorization and continuations for Health Net members.All Health Net updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Prior authorization criteria for Wegovy (semaglutide) and Zepbound (tirzepatide)Prior authorization criteria for Wegovy and Zepbound for chronic weight management and related indications (pediatrics, MASH, secondary CV prevention, obstructive sleep apnea) applicable to CareOregon members.All careoregon updates
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Tool Description
Search payerprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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