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[1] GLP-1s remain covered for: BMI 40 (Class III/morbid obesity) Type 2 Diabetes (Mounjaro, not Wegovy) Major Adverse Cardiac Events history Employers who opt-in to add weight loss drug coverage WHAT KAISER REQUIRES FIRST Kaiser Wegovy Step Therapy Requirements Even in regions where Kaiser covers Wegovy, you must typically "fail" multiple other treatments first: Kaiser Northwest Example (Most Documented) To qualify for Wegovy coverage in Kaiser Northwest, you must demonstrate: [3] Kaiser Wegovy Coverage Criteria BMI 30 (obesity) OR BMI 27 with a comorbidity (a related health condition like hypertension, diabetes, or high cholesterol) Age 18+ Following a structured diet and exercise program (documented, not just attested) Failed at least 2 prior weight loss medications [8] : Phentermine Diethylpropion Qsymia (phentermine/topiramate) Contrave (naltrexone/bupropion) Tried semaglutide (Wegovy or Ozempic) for minimum 6 months and either: It was ineffective (didn't achieve target weight loss) Cannot tolerate due to allergy, serious side effects, or contraindication Continuation Requirements (To Keep Coverage) Initial approval typically for 12 months Must document at least 5% weight loss after starting semaglutide to continue coverage Bariatric medicine chart review required before switching from semaglutide to Wegovy Kaiser's Internal "Medical Weight Management" Program Kaiser often requires patients to enroll in their internal weight management program before approving GLP-1s