Express Scripts GLP-1 Coverage for Weight Loss (2026)

If your prescription card says Express Scripts, you have probably already run into the confusing part: Express Scripts is not your insurance company. It runs the prescription side of your benefits for whoever sponsors your plan. That distinction matters here, because whether a GLP-1 medication for weight loss is covered depends on choices made above Express Scripts.

Here is what Express Scripts’ and Evernorth’s own published documents say as of 2026-10-16, what your employer or health plan controls, and how to find out where your own plan stands.

Transformation Health is an independent guide, not a provider, and is not affiliated with Express Scripts, Evernorth, or the Cigna Group: we do not prescribe, sell medication, or work with insurance. This content is for general education and is not medical advice. Talk with a licensed provider about your situation.

First, what Express Scripts actually is

Express Scripts is a pharmacy benefit manager, or PBM, and part of Evernorth Health Services, the Cigna Group’s health services business.^[1] A PBM does not insure you. Express Scripts’ own formulary documents put it this way: it manages your prescription plan “for your employer, plan sponsor, health plan or benefit fund."^[2] It maintains the formulary, the list of covered medications, and runs coverage reviews when you fill a prescription.

This structure matters because a PBM can list a medication on its formulary while your plan still excludes it. The same Express Scripts documents say that not all listed medications are covered by all prescription plans, and tell members to check their benefit materials.^[2]

The short answer

Coverage depends on your plan, not on Express Scripts alone. As of 2026-10-16, the 2026 Express Scripts National Preferred Formulary lists Wegovy (pens, tablets, and HD), the Zepbound pen, Foundayo, and generic liraglutide as preferred weight loss medications, and lists Saxenda, Zepbound vials, and Zepbound KwikPens as excluded.^[2]

So on plans that include weight loss drug coverage and use this formulary, several GLP-1 options are listed. Whether your plan includes that coverage is your employer’s or plan’s decision. The real question is not “does Express Scripts cover GLP-1s,” it is “does my plan include weight loss medications.”

GLP-1 medications prescribed for type 2 diabetes are a separate coverage category, with their own criteria. This page is about coverage for weight management.

What the 2026 National Preferred Formulary lists

These rows come from the 2026 Express Scripts National Preferred Formulary (version dated October 1, 2026, effective January 1 through December 31, 2026) and Evernorth’s summary of exclusion changes for January 1, 2026.^[2][3] Your plan may use a different Express Scripts formulary or a customized version, so treat this as a starting point.

Express Scripts has also published its 2027 National Preferred Formulary exclusion list (dated August 1, 2026), which shows the same Weight Loss row.^[4] Lists can change, so confirm again at open enrollment.

Prior authorization criteria. Criteria are set for your plan, so ask member services which criteria document applies to you. For plans that use Evernorth’s EncircleRx program, Evernorth’s provider page lists Wegovy, Zepbound, Saxenda, and Foundayo as affected medications and two coverage requirements as of 2026-10-16: joining a lifestyle modification program, without which prior authorization cannot be completed, and a BMI of 32 or higher, or 27 or higher with two weight-related health issues.^[5] Cigna Healthcare, in the same corporate family, publishes its own weight loss GLP-1 policies with different thresholds; our Cigna page summarizes them.^[6][7][8] For reference, both Wegovy and Zepbound are FDA-approved, with a reduced-calorie diet and more physical activity, for adults with obesity, or with overweight and at least one weight-related condition.^[9][10]

Other FDA-approved uses. Wegovy is also FDA-approved to reduce the risk of major cardiovascular events in adults with established cardiovascular disease and either obesity or overweight, and Zepbound to treat moderate to severe obstructive sleep apnea in adults with obesity.^[9][10] Some plans review these uses separately from weight loss. Ask your plan whether that applies to you, and ask your prescriber whether either use fits your situation.

Cost programs your plan may offer. On May 21, 2025, Evernorth announced a pharmacy benefit option for employers and other plan sponsors that limits the member’s monthly copay for Wegovy and Zepbound for weight loss to a set maximum, with the copay counting toward the deductible. The same release lists EncircleRx separately, describing it as a financial model with more than 9 million enrolled lives.^[1] On July 10, 2025, Express Scripts announced it was adding weight loss GLP-1s to its Patient Assurance Program, which limits copays for participating medications.^[11] None of these applies unless your plan participates, so ask.

What changed in 2025 and 2026

May 21, 2025. Evernorth announced the monthly copay cap benefit option for Wegovy and Zepbound, for plan sponsors that adopt it.^[1]

July 10, 2025. Express Scripts announced it was adding weight loss GLP-1s to its Patient Assurance Program.^[11]

January 1, 2026. Zepbound vials became excluded on the National Preferred Formulary, with Wegovy and Zepbound pens named as preferred alternatives. Saxenda remained excluded.^[3]

October 1, 2026. The current version of the 2026 formulary lists Wegovy tablets, Wegovy HD, and Foundayo as preferred, and Zepbound KwikPens as excluded.^[2]

Employers also revisit their own plan decisions every plan year. A medication covered today can be excluded next year, and the reverse, so a benefit you have now is worth confirming again at open enrollment. For how other pharmacy benefit managers handle these drugs, see our pages on Optum Rx and CVS Caremark.

TRICARE, Medicare, and other plans

TRICARE. TRICARE says Express Scripts administers the TRICARE Pharmacy Program, but TRICARE sets its own rules for weight loss medications, and the formulary above does not apply.^[12] See our page on TRICARE GLP-1 coverage.

Medicare Part D. Plans with Medicare drug coverage follow federal Part D rules, whichever company manages the pharmacy benefit. The law lets Part D exclude “agents when used for anorexia, weight loss, or weight gain,” so a GLP-1 prescribed for weight loss alone is generally not covered under basic Part D coverage.^[13] Part D plans may cover a GLP-1 for another FDA-approved use, such as type 2 diabetes, and federal rules let plans offering enhanced alternative coverage add supplemental drug benefits.^[14] Separately, CMS is running the Medicare GLP-1 Bridge, a demonstration from July 1, 2026 through December 31, 2027 that gives eligible Part D enrollees access to certain GLP-1 drugs for weight management outside the regular Part D benefit.^[15] Ask your plan, and ask CMS or 1-800-MEDICARE whether the Bridge applies to you. Our pages on Medicare Part D and GLP-1 coverage and the Medicare GLP-1 Bridge cover the details.

Medicaid and individual plans. If your coverage is through Medicaid, the state sets the rules; our page on the BALANCE model and state Medicaid explains how state coverage works. For individual and marketplace plans, the plan documents, not the PBM name on the card, decide whether weight loss drugs are included.

How to check your own plan in ten minutes

You do not need to guess, and you do not need to wait for a denial letter. Three routes, fastest first:

Ask your HR benefits team. If you have an employer plan, the single decisive fact is whether your plan includes weight loss medication coverage. HR or your benefits portal can answer that directly. Also ask whether the plan participates in EncircleRx or an Evernorth copay cap.

Call the number on your prescription ID card. Express Scripts’ formulary documents direct members to that number for specific coverage questions.^[2] Ask three questions. Does my plan include coverage for weight loss medications? If so, which GLP-1 medications are on my formulary for weight management? And which prior authorization criteria apply to my plan?

Check your plan’s drug list. Log in to your Express Scripts account and search for semaglutide or tirzepatide. Read the indication notes carefully; a listing under diabetes coverage does not mean weight management is covered.

If the benefit exists on your plan, your next step is the paperwork. Our guide to GLP-1 prior authorization walks through the documentation these requests usually need, including BMI records, weight-related conditions, and lifestyle history.

If your plan says no

Plenty of people with Express Scripts cards land here, through no fault of their own. What you do next depends on why the answer was no.

The denial was about criteria or documentation. This is often fixable. A documented BMI, weight-related conditions noted explicitly in your chart, and recorded lifestyle efforts address the usual criteria. HealthCare.gov says you generally have 180 days from a denial notice to file an internal appeal, and if that appeal is denied, you can in many cases ask for an independent external review.^[16][17] Start with our guide on what to do when insurance denies your GLP-1.

The medication you want is excluded from your formulary. Express Scripts’ exclusion lists say that if there is a clinical reason you need an excluded medication, your prescriber can request a coverage review through the Express Scripts prior authorization portal.^[3][4] Your prescriber’s documentation of why the preferred alternative is not appropriate for you is what carries the request. For individual and small-group plans that must cover essential health benefits, federal rules require an exception process, with a decision due within 72 hours on a standard request and within 24 hours when circumstances are urgent.^[18] Employer plans follow different federal claim rules, and your plan documents state the exact limits that apply to you.

Your plan does not include the benefit. An appeal generally cannot override a plan exclusion, because the medication is not a covered benefit on your plan. You can ask HR whether weight loss coverage or an Evernorth copay cap is under consideration for the next plan year, check whether another plan at open enrollment includes it, and ask your prescriber whether any other covered use applies to you. Beyond that, the options are outside insurance:

• Manufacturer savings and self-pay options. Novo Nordisk and Eli Lilly each publish savings and self-pay terms, and the terms change. Our page on GLP-1 savings programs compares them.
• Cash-pay telehealth programs. Some prescribe brand-name medications and some prescribe compounded medications. Compounded medications are not FDA-approved. The FDA does not review them for safety, effectiveness, or quality, and they are not the same as brand-name products.^[19] Our page on compounded GLP-1 without insurance explains how that route works.

Prices vary by program, medication, and dose. Compare the total cost: medication, dose increases, visits, labs, shipping, membership fees, and cancellation terms. At most telehealth programs, a licensed provider reviews your health history and decides whether a prescription is appropriate. The full insurance coverage overview can help you weigh the options side by side.

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Citations

[1] Evernorth. “Evernorth launches new benefit option that drives lower net cost for weight loss medicines” (news release; quotes the President of Evernorth Care Management and Express Scripts), May 21, 2025. Accessed 2026-10-16. https://www.evernorth.com/articles/evernorth-launches-new-benefit-option-drives-lower-net-cost-weight-loss-medicines

[2] Express Scripts. “2026 Express Scripts National Preferred Formulary,” effective January 1, 2026 through December 31, 2026 (document version dated 10/01/2026; includes the Formulary Exclusions table, Weight Loss class). Accessed 2026-10-16. https://www.express-scripts.com/pdf/formulary/NPE1702_204612.pdf

[3] Evernorth Health Services. “2026 National Preferred Formulary: Exclusion List Changes Coming January 1, 2026” (Weight Loss row). August 2025. Accessed 2026-10-16. https://my.comms.evernorth.com/rs/190-RZO-340/images/2026%20NPF%20Changes.250806.pdf?version=0

[4] Express Scripts Pharmacy Benefit Services. “2027 National Preferred Formulary Exclusions” (document dated 08/01/2026). Accessed 2026-10-16. https://www.express-scripts.com/art/open_enrollment/DrugListExclusionsAndAlternatives.pdf

[5] Evernorth. “Provider information on our GLP-1 program” (EncircleRx coverage requirements). Accessed 2026-10-16. https://www.evernorth.com/encirclerx-provider

[6] Cigna National Formulary Coverage. “Weight Loss - Glucagon-Like Peptide-1 Agonists - Wegovy Injection Prior Authorization Policy.” Review date 06/17/2026. Accessed 2026-10-16. https://static.cigna.com/assets/chcp/pdf/coveragePolicies/cnf/cnf_1010_coveragepositioncriteria_weight_loss_glp1_agonists_wegovy_injection_pa.pdf

[7] Cigna. Drug Coverage Policy IP0816, “Weight Loss - Glucagon-Like Peptide-1 Agonists - Zepbound.” Effective 09/01/2026. Accessed 2026-10-16. https://static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/ip_0816_coveragepositioncriteria_weight_loss_zepbound.pdf

[8] Cigna. Drug Coverage Policy IP0739, “Weight Loss - Glucagon-Like Peptide-1 Agonists BMI >= 35.” Effective 04/30/2026. Accessed 2026-10-16. https://static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/ip_0739_coveragepositioncriteria_weight_loss_glp1_bmi_35.pdf

[9] U.S. Food and Drug Administration. WEGOVY (semaglutide) injection and tablets, prescribing information. Novo Nordisk. Revised 06/2026. Accessed 2026-10-16. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215256s025lbl.pdf

[10] U.S. Food and Drug Administration. ZEPBOUND (tirzepatide) injection, prescribing information. Eli Lilly and Company. Highlights revised 08/2026. Accessed 2026-10-16. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/217806Orig1s041correctedlbl.pdf

[11] Evernorth. “Express Scripts expands Patient Assurance Program to drive affordability and access to GLP-1s” (news release), July 10, 2025. Accessed 2026-10-16. https://www.evernorth.com/articles/express-scripts-expands-patient-assurance-program-drive-affordability-and-access-glp-1s

[12] TRICARE (Defense Health Agency). “Pharmacy.” Accessed 2026-10-16. https://www.tricare.mil/CoveredServices/Pharmacy

[13] 42 U.S.C. 1395w-102(e)(2)(A) (definition of covered Part D drug; exclusions). Accessed 2026-10-16. https://www.law.cornell.edu/uscode/text/42/1395w-102

[14] 42 CFR 423.104(f)(1) (enhanced alternative coverage; supplemental benefits). Accessed 2026-10-16. https://www.law.cornell.edu/cfr/text/42/423.104

[15] Centers for Medicare and Medicaid Services. “Medicare GLP-1 Bridge.” Accessed 2026-10-16. https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge

[16] HealthCare.gov (Centers for Medicare and Medicaid Services). “Internal appeals.” Accessed 2026-10-16. https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/

[17] HealthCare.gov (Centers for Medicare and Medicaid Services). “External review.” Accessed 2026-10-16. https://www.healthcare.gov/appeal-insurance-company-decision/external-review/

[18] 45 CFR 156.122(c) (prescription drug benefits: standard and expedited exception requests). Accessed 2026-10-16. https://www.law.cornell.edu/cfr/text/45/156.122

[19] U.S. Food and Drug Administration. “Compounding and the FDA: Questions and Answers.” Accessed 2026-10-16. https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers

Important disclosures

Coverage information on this page is current as of 2026-10-16, is general and educational, and changes frequently. It does not represent the terms of your specific plan and is not legal advice. Confirm current benefits, formulary status, and prior authorization requirements directly with your insurance company: call the member services number on your insurance or prescription ID card, or ask your HR benefits team if you have an employer plan.