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Integrated HMO + provider system covering 8 states
Kaiser Permanente is a closed-network HMO with integrated provider system. Operates in CA, CO, GA, HI, MD, OR, VA, WA + DC. Restrictive GLP-1 coverage — typically covers diabetes indications only, with weight-loss requiring multiple PA appeals.
Kaiser is one of the more restrictive insurers for weight-loss GLP-1s. Most regions cover diabetes indications (Ozempic, Mounjaro) at tier 2. Wegovy and Zepbound for weight loss usually require multiple PA appeals or are denied. Kaiser providers cannot prescribe outside the formulary.
Sample copays based on a representative Kaiser Permanente plan. Your specific plan may differ.
| Product | Status | Sample copay |
|---|---|---|
| Hims & Hers Weight Loss | Not covered | — |
| Mounjaro T2D diagnosis | Covered | $45/mo |
| Ozempic T2D diagnosis | Covered | $45/mo |
| Zepbound OSA + obesity dual indication (covered) — weight-loss alone not covered | PA required | $75/mo |
| Wegovy Wegovy is not on Kaiser regional formularies — multiple appeals usually denied. | Not covered | — |
Look up your specific plan ID for plan-level accuracy. Open formulary tool
Coverage shown is a sample plan and not a guarantee for your specific Kaiser Permanente plan. Always verify with member services or your benefits administrator. We update this page when formulary changes are detected — last verified May 16, 2026.
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