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Missing Medical Necessity The diagnosis should clearly justify the injection

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[9] To get Wegovy approved, you must meet all of: A 6-month weight-management program first documented behavioral modification, reduced-calorie diet, and increased physical activity with continuing follow-up (this is the real hurdle, not another drug) BMI 30 , or 27 with a weight-related condition (hypertension, type 2 diabetes, or dyslipidemia) Age 18+ (ages 1217 require the injection plus the comprehensive program) No drug step therapy: CVS Caremark's standard Wegovy policy does not require trying and failing another weight-loss drug first (some individual employer plans add it check yours) Wegovy also has separate coverage pathways for cardiovascular risk reduction (established heart disease + BMI 27, if you don't have type 2 diabetes) and MASH liver disease