HealthRX.com · Printable coverage checklist
Kaiser Wegovy pathway and milestone record
Pick the Northwest pathway that matches the prescription, then date each milestone from the first visit to the decision, including the Ozempic trial most pathways require. The criteria to check against and the questions for Pharmacy Services are on the same sheet.
Region, plan and prescription
Kaiser region and plan name
Plan covers weight-loss medications?yes, no, or rider coverage
Pathwayadult weight management, ages 12 to 17, heart risk reduction or MASH
Kaiser prescriber and department
Milestones from first visit to decision
| Milestone | Date | What was documented |
|---|---|---|
| Primary care visit about weight | ||
| Referral to obesity medicine or endocrinology | ||
| Diet and exercise program started | ||
| First older weight-loss medicine: start and stop | ||
| Second older weight-loss medicine: start and stop | ||
| Ozempic trial: start, dose reached, stop | ||
| Wegovy request submitted | ||
| Decision received |
Criteria to check against
- Kaiser Northwest covers Wegovy for weight loss only for members whose plan covers weight-loss medications.[1]
- Adult weight management and MASH requests in the Northwest need a failed Ozempic trial first; for ages 12 to 17, a reason Ozempic cannot be used also counts.[1]
- The heart risk pathway is for people 55 to 74 without diabetes who had a STEMI or type 1 NSTEMI while on Ozempic 2 mg; the document says that Ozempic step does not apply to Medicare Part D patients.[1]
- Approvals last 12 months; weight-management renewal needs 5% or greater weight loss achieved and maintained.[1]
- Kaiser Permanente Washington covers Ozempic as its semaglutide product, including for members with weight-loss rider coverage.[2]
Ask Kaiser Pharmacy Services
- Which region's Wegovy criteria apply to my plan?
- Does my plan include weight-loss medication coverage or a weight-loss rider?
- Does my Ozempic history count as the required semaglutide trial?
- What is my cost share for Wegovy if it is approved?
- If it is denied, how do I file a grievance and request external review?
If the request is denied
Date and the criterion Kaiser cited
Grievance or appeal filed on, reference number
Peer-to-peer requested?date and outcome
External review: who handles it, date requested
Sources for the facts on this sheet
- Kaiser Foundation Health Plan of the Northwest. Kaiser Permanente Northwest Region Criteria for Coverage: semaglutide (Wegovy), commercial. Accessed 2026-10-18. https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/formularies/nw/kp-criteria-wegovy-nw-en-commercial.pdf
- Kaiser Foundation Health Plan of Washington. Provider E-News, January 2026. Accessed 2026-10-18. https://wa-provider.kaiserpermanente.org/static/pdf/provider/communications/e-news/january-2026.pdf
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.