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Medicare Part D will cover Wegovy for obesity starting July 1, 2026 — but with strict prior auth. We obtained the draft PA criteria and walked our medical board through every line.
CMS finalized its rule expanding Wegovy coverage to obesity (BMI ≥30, or ≥27 with comorbidity) effective July 1, 2026. PA criteria include 12-month diet/exercise documentation, prior failure of phentermine or orlistat, and quarterly weight check-ins. We walked our medical board through the draft and built an appeal template for the inevitable denials.