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HealthRX.com · Printable coverage checklist

Humana Wegovy coverage-route worksheet

Identify which Humana coverage you have and why Wegovy is prescribed, then send the request to the program that actually decides it: the Humana Part D plan, the Medicare GLP-1 Bridge, or an employer's current administrator. Record each call and keep the rules that apply to your route.

Companion to “Does Humana Cover Wegovy? Prior Authorization, Formulary Tier, and Appeal Steps” · healthrx.com/wegovy/humana-coverage · Facts checked 2026-10-18

Your coverage and prescription

Coverage type on the ID cardMedicare Advantage with drugs, Part D, group Medicare or employer plan
Plan name and member ID
Purpose written on the prescriptioncardiovascular risk, MASH or weight
Diagnoses and codes the prescriber will use

Send the request to the right place

  • Cardiovascular risk reduction or MASH: coverage determination with the Humana Part D plan
  • Not on the formulary for that use: ask the plan for a formulary exception
  • Weight only, on Medicare drug coverage: prior authorization through the Medicare GLP-1 Bridge
  • Group Medicare plan: ask whether Wegovy is a supplemental drug and how disputes are handled
  • Employer plan: confirm who administers the drug benefit now

Rules for each route (CMS, Medicare.gov, Humana)

  • A Wegovy prescription to reduce cardiovascular event risk goes to the Part D plan, even when weight loss is also a goal.[1]
  • CMS monitors plans so they do not shift Part D coverage decisions onto the Bridge.[1]
  • Humana is CMS's central processor for the Bridge because it already administers LI NET.[1]
  • Bridge eligibility starts at BMI 35, or 30 with certain heart, blood pressure or kidney conditions, or 27 with prediabetes, a past heart attack or stroke, or symptomatic peripheral artery disease.[2]
  • The Bridge copayment does not count toward your Part D deductible or out-of-pocket limit.[2]
  • A Bridge prior authorization lasts through December 31, 2027 unless you change GLP-1s.[2]
  • Humana announced its exit from employer group commercial medical products on February 23, 2023.[3]

Calls and requests

DateHumana plan, Bridge or employerWhat you askedReference numberFollow-up

Questions for Humana or the prescriber

  1. Is Wegovy on my plan's formulary for cardiovascular risk reduction, and what does the coverage determination ask for?
  2. If it is not on the formulary, how do we request an exception?
  3. Has the prescriber written the purpose of the prescription on the request?
  4. For weight-only use, has the prior authorization gone to the Bridge central processor?
  5. Which pharmacy will fill it, and what will I pay?
Sources for the facts on this sheet
  1. Centers for Medicare & Medicaid Services. Information for Part D Plans | CMS (Medicare GLP-1 Bridge). Accessed 2026-10-18. https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-part-d-plans
  2. Centers for Medicare & Medicaid Services, Medicare.gov. Weight loss drugs | Medicare. Accessed 2026-10-18. https://www.medicare.gov/coverage/weight-loss-drugs
  3. Humana Inc.. Humana Reports First Quarter 2025 Financial Results; Affirms Full Year 2025 Adjusted Financial Guidance. Accessed 2026-10-18. https://news.humana.com/press-room/press-releases/2025/humana-reports-first-quarter-2025-financial-results--affirms-ful

This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.