HealthRX.com · Printable coverage checklist
VA Wegovy request checklist for veterans
Track a VA non-formulary request for Wegovy: who submitted it and under which criteria, the records the reviewer may need, the copay to expect for each days-of-supply, and what to record and whom to contact if the request is denied.
The request
Medicine and purposeWegovy injection or tablets, for weight management
Care-team member who submits the request
Date submitted
Who reviews it, and when to check back
Criteria document and date usedfor example, the April Criteria for Use
Records the reviewer may look for
- Lifestyle-program visit in the past year (MOVE! or another program), with the date
- Current BMI on record
- Weight-related conditions on record, such as high blood pressure, prediabetes or sleep apnea
- Earlier weight-management treatments: names, dates, response and why they stopped
- Pregnancy ruled out and contraception discussed, if this applies to you
- Recent diabetic eye exam, if you have diabetes
Criteria and copay facts to check against
- The criteria require documented participation in a lifestyle program covering diet, physical activity and behavior changes, plus a BMI of 27 or more with at least one weight-related condition.[1]
- At least one documented lifestyle-program visit in the past year makes a veteran eligible for consideration.[1]
- Exceptions to the criteria are decided at the local facility by its P&T committee and pharmacy service.[1]
- Tier 3 copays when a copay applies: $11 for a 1 to 30 day supply, $22 for 31 to 60 days and $33 for 61 to 90 days.[2]
- Priority group 1 pays no medication copay, and medication copays stop once $700 has been charged in a calendar year.[2]
- For concerns, start with your VA health care team, then the provider's supervisor or the medical center's chief of service, then the patient advocate.[3]
Ask your care team or VA pharmacy
- Has the request been submitted, and under which criteria?
- Is anything missing from my record that the reviewer needs?
- Does a local allocation policy affect this request?
- Once approved, how many days of supply come with each fill, and how are renewals handled?
- What will I pay for that supply, given my priority group and any exemptions?
If the request is denied
Reason given
Criteria cited
What could change the decisionmissing record, a clinical alternative, reconsideration
Supervisor or chief of service contactedname and date
Patient advocate contactedname and date
Request status log
| Date | Who you spoke to | What they said | Next step and date |
|---|---|---|---|
Sources for the facts on this sheet
- VA Pharmacy Benefits Management Services and National Formulary Committee. Semaglutide (WEGOVY) Subcutaneous Injection and Oral Tablet for Weight Management: Criteria for Use, April 2026. Accessed 2026-10-17. https://www.va.gov/formularyadvisor/DOC_PDF/CFU_Semaglutide_WEGOVY_for_weight_management_CFU_Rev_Apr_2026.pdf
- U.S. Department of Veterans Affairs. Current VA Health Care Copay Rates. Accessed 2026-10-17. https://www.va.gov/health-care/copay-rates/
- U.S. Department of Veterans Affairs. How To Get Help With Concerns At A VA Health Facility. Accessed 2026-10-17. https://www.va.gov/resources/how-to-get-help-with-concerns-at-a-va-health-facility/
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.