QUICK ANSWER
Coverage Overview
Short answer: Cigna coverage for Foundayo varies by plan. Some employer-sponsored plans cover it with prior authorization, while many marketplace plans exclude weight loss medications. On Medicare, Foundayo is covered through the Medicare GLP-1 Bridge for $50 per monthly fill, with conditions. Note: Evernorth's $200/month cap currently applies to Wegovy and Zepbound only — Foundayo is not yet included.
Is Foundayo covered by Cigna?
Most Cigna plans do not routinely cover Foundayo for weight loss. Coverage is most commonly available only when an employer has specifically opted into GLP-1 benefits. Some plans may offer coverage under specific conditions:
- Some employer-sponsored commercial plans cover Foundayo with prior authorization (the Evernorth $200/month cap does not yet include Foundayo)
- Individual / ACA marketplace plans rarely cover weight loss medications
- Basic Part D coverage in Cigna Medicare Advantage plans excludes Foundayo for weight loss (federal statute), but members with drug coverage can get it through the Medicare GLP-1 Bridge for $50 per monthly fill if they meet CMS's eligibility criteria
Who this guide is for
Cigna members exploring Foundayo coverage through employer-sponsored commercial plans, ACA marketplace plans, Cigna Medicare Advantage, or Express Scripts-administered pharmacy benefits.
Why Cigna Coverage Varies by Employer and Plan
Cigna coverage differences are driven by who controls your benefits (employer vs insurer), how the plan is funded (fully insured vs self-funded), and your medical indication. This is why two Cigna members can receive very different coverage decisions, even within the same company.
- Large employers often control their own formularies and may add GLP-1 coverage
- Evernorth's $200/month cap (currently Wegovy/Zepbound only) may expand to other GLP-1s
- Express Scripts administers the pharmacy benefits for most Cigna plans
To determine your exact coverage, check directly with Cigna. If you're denied, you still have options.
What to Know If You're Denied
Independent analyses suggest that 65% or more of properly documented appeals are overturned for commercial insurance[10]—yet only about 1 in 10 patients ever appeal. Whether you've already been denied or are preparing for prior authorization, you still have options.
Denied already? See your appeal options →
Your GLP-1 coverage,
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Coverage Outlook for 2026
Express Scripts’ 2026 National Preferred Formulary lists Foundayo as a preferred alternative, but whether your plan covers weight-loss drugs at all is up to your employer. The Evernorth $200/month cap (currently Wegovy and Zepbound only) may expand to include Foundayo. On Medicare, Foundayo is covered through the Medicare GLP-1 Bridge (July 1, 2026 – December 31, 2027), with conditions.
Last updated October 6, 2026 · Key facts verified October 5, 2026
Cigna Plans & Express Scripts
Unlike BCBS (which operates as 33 independent affiliates), Cigna operates nationally through Express Scripts, its pharmacy benefit manager (PBM).
Coverage is primarily determined by:
- Your Plan Type — large employer / small employer / individual / Medicare
- Express Scripts Formulary — whether your employer's plan includes GLP-1 coverage
Coverage varies by employer plan design, not by state. Call to check your coverage →
Pro tip: Calling can allow you to get more helpful information that isn't always available online.
Things to Keep in Mind
- Prior Auth is required — even when listed. Getting your full coverage details makes this a smoother process.
- If not covered — there are still different "exception" paths and options to consider.
- If denied, file an appeal — 65%+ of properly documented appeals succeed for commercial insurance.[10]
- Comorbidities can unlock coverage — BMI (Body Mass Index) 27+ with conditions like diabetes, hypertension, or cardiovascular disease may qualify.
If this feels overwhelming, you're not alone — most people first learn their true coverage only after being denied once.
But coverage isn't the full story. Express Scripts administers most Cigna pharmacy benefits, and your plan type matters more than you might think.
See how Express Scripts affects your coverage →CIGNA'S PHARMACY BENEFIT MANAGER
Does Express Scripts Cover Foundayo?
Express Scripts is Cigna's pharmacy benefit manager (PBM). It administers the prescription drug formulary, prior authorization rules, and pharmacy claims processing for most Cigna plans.
Whether Express Scripts "covers" Foundayo depends entirely on your underlying Cigna plan:
| Your Plan Type | Express Scripts Shows | What It Means |
|---|---|---|
| Employer w/ GLP-1 coverage | "Covered with PA" | Your employer opted to cover it; PA required |
| Employer w/o GLP-1 coverage | "Not covered" | Your employer didn't add GLP-1 coverage |
| Individual / Marketplace | "Excluded" | Standard plans rarely cover weight loss drugs |
| Cigna Medicare (Part D) | Bridge: $50 per monthly fill (with conditions) | Federal statute excludes weight loss drugs from basic Part D coverage, but Foundayo is covered through the Medicare GLP-1 Bridge |
How to Check Your Express Scripts Coverage
- Log into Express Scripts at express-scripts.com or the Express Scripts app
- Search for "Foundayo" in the drug lookup tool
- Review the result: "covered with prior authorization," "not covered," or "excluded"
- For confirmation, call the Member Services number on your Cigna ID card
Key Point
Express Scripts does not set independent coverage rules. It simply applies the pharmacy benefits defined by your Cigna plan. All the coverage criteria, prior authorization rules, and appeal steps on this page apply both to Cigna and to Express Scripts as the PBM.
Evernorth's $200/Month Cap Program (Wegovy & Zepbound Only)
In May 2025, Cigna's Evernorth division announced a program that caps out-of-pocket costs for Wegovy and Zepbound at $200 per month on some employer-sponsored plans.[13][18] Foundayo is not currently included in this cap — it was approved April 1, 2026, after the program launched. As of early 2025, the EncircleRx program covers 9 million patients and has saved insurers $200 million.[19]
- $200/month maximum for Wegovy and Zepbound (not Foundayo)
- Foundayo not yet included — ask your employer if they plan to add it
- Available only if your employer opts in — not automatic for all Cigna plans
- EnGuide home delivery — convenient mail-order option[20]
- EnReachRx support (Q1 2025) — pharmacist support for dosing and side effects[19]
Questions to ask Cigna or HR:
- "Does my employer plan to add Foundayo to the $200/month cap program?"
- "What is my out-of-pocket cost for Foundayo without the cap?"
- "Do I have access to EnGuide home delivery or EnReachRx pharmacist support?"
Express Scripts answers depend on your plan type.
See how plan type affects coverage →PLAN + EMPLOYER RULESHow Plan Type Affects Your Coverage
How Plan Type Affects Your Coverage
Your Foundayo coverage is shaped by your plan type and employer decisions:
- Your Plan Type — who controls your benefits (your employer, Cigna, government)
- Employer Benefit Design — whether your employer added GLP-1 coverage
Think of it this way:
Cigna sets default formularies, but employers can customize them. Large employers often have more flexibility than small ones.
That's why two people with Cigna — even at the same company — can get different coverage if they chose different plan options.
Cigna Plan Types and Potential Coverage
| Your Plan Type | Chance of Coverage | Why |
|---|---|---|
| Large Employer (1,000+ employees) | Varies widely | ~36% of large employers cover GLP-1s for weight loss[21]; some have $200/mo cap (Wegovy/Zepbound only) |
| Small Employer (50–999 employees) | Usually excluded | Fully-insured plans less likely to include GLP-1s |
| Individual / ACA Marketplace | Rarely covered | Most individual plans exclude weight loss drugs |
| Cigna Medicare Advantage | Bridge: $50 per monthly fill (with conditions) | Federal law blocks weight-loss drugs in Part D, but Foundayo is covered through the Medicare GLP-1 Bridge |
Legend: Possible coverage · Usually excluded · Depends on employer plan design
More Details / Next Steps (Based on Plan Type)
Large Employer Plans — Often the Best Chance
Many large companies pay for healthcare themselves (this is called "self-funded"). Cigna just handles administration through Express Scripts.
That means your employer — not Cigna — decides whether drugs like Foundayo are covered.
Small Employer Plans — Usually No Coverage
Small employers usually buy standard Cigna plans with no customization. They must follow whatever Cigna's default formulary covers.
Individual / ACA Marketplace Plans — Rarely Covered
If you bought your plan through Healthcare.gov or directly from Cigna, it's a standard, non-customized plan. Weight-loss drugs are almost always excluded.
- Coverage for type 2 diabetes (Mounjaro/Ozempic may be covered)
- Switching plans during open enrollment
- Self-pay options
Cigna Medicare Advantage — Medicare GLP-1 Bridge (with conditions)
Medicare and weight-loss GLP-1s: the Medicare GLP-1 Bridge
Through the Medicare GLP-1 Bridge (July 1, 2026 – December 31, 2027), a temporary CMS demonstration that runs outside the Part D benefit, people with eligible Part D coverage can get Wegovy, Foundayo or the Zepbound KwikPen for weight loss for $50 a month, if they meet CMS’s eligibility criteria and their prescriber gets prior authorization.
Source: CMS, Medicare GLP-1 Bridge · Facts in this box verified October 5, 2026
- Coverage for type 2 diabetes (Mounjaro)
- For OSA coverage, Zepbound (tirzepatide) has FDA approval for that indication (Foundayo does not)
Age 18+ and BMI ≥35; or BMI ≥30 with HFpEF, uncontrolled high blood pressure or CKD stage 3a+; or BMI ≥27 with prediabetes, a prior heart attack or stroke, or symptomatic PAD. Not eligible if you have type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic MASH with moderate-to-advanced liver fibrosis (F2–F3), or if your Part D plan paid for a GLP-1 for you at any time in 2026.
FIND YOUR PATHBased on Your Situation
Based on Your Situation
Now that you understand coverage patterns, here's what to do next:
PA Denied?
Your plan covers Foundayo, but your prior authorization was rejected.
- Appeal with documentation that addresses the denial reason
- You have 180 days to file an appeal
Plan Excludes It?
Foundayo isn't on your formulary (your plan's list of covered drugs) at all.
Exclusion options → Still Checking?
Haven't applied yet or want to understand your options first.
- Use our call script to verify with Cigna
- Check the 2026 outlook for coverage trends
Not Sure Which Applies? Check your denial letter.
- "Not medically necessary" or "step therapy required" = PA denial (you can appeal)
- "Excluded benefit" or "not covered" = plan exclusion (different strategy needed)
WHAT'S COMING
Cigna Coverage Outlook for 2026
2026 Coverage: Employer-Dependent
Express Scripts’ 2026 National Preferred Formulary lists Foundayo as a preferred alternative. Whether your plan covers weight-loss drugs at all is still your employer’s choice. The Evernorth $200/month cap (currently Wegovy and Zepbound only) may expand to include Foundayo — ask your employer about their plans.
What's Confirmed for 2026
- Foundayo not on standard formulary: The 2026 Express Scripts National Preferred Formulary does not yet list Foundayo — employer plans may add coverage independently[16]
- $200/month cap (Wegovy/Zepbound): The Evernorth cost-cap program does not currently include Foundayo — ask your employer if they plan to add it
- Medicare GLP-1 Bridge: Foundayo is covered for $50 per monthly fill (July 1, 2026 – December 31, 2027), if you meet CMS's eligibility criteria. Part D plans and pharmacies don’t opt in, and you don’t enroll separately; your prescriber must get prior authorization
What This Means for You
- Check your specific plan: Coverage depends on your employer's benefit design—don't assume
- During open enrollment: Ask HR if your employer is adding Foundayo coverage (note: the $200/month cap currently covers Wegovy and Zepbound only)
- Self-funded employers: Large employers can add or modify GLP-1 coverage at renewal
- Consider alternatives: If your plan covers GLP-1s for diabetes but not weight loss, ask about tirzepatide (Mounjaro/Zepbound) which has separate diabetes and weight loss indications
CALL YOUR INSURANCEVerify Your Specific Coverage
Verify Your Specific Coverage
Even though it takes a little more time, we recommend calling so you can speak with a person who may have more information than the online directory or PDF formulary listing.
Call Script for Cigna
"Hi, I'm calling to check coverage for a prescription medication. My member ID is [NUMBER]. I need to know:
- Is Foundayo (orforglipron) covered on my plan's formulary for weight management?
- What tier is it on?
- Is prior authorization required?
- What are the coverage criteria—BMI, comorbidities, step therapy?
- Does my plan have the Evernorth cost cap, and does it apply to Foundayo? (Note: The cap currently covers Wegovy and Zepbound only)
- Can you send me the coverage policy in writing?"
Pro tip: Always request coverage criteria in writing. Verbal confirmations aren't binding, and having documentation helps if you need to appeal later.
Cigna Contact Information
| Department | Phone Number | Use For |
|---|---|---|
| Member Services | Number on ID card | Coverage questions, benefits |
| Pharmacy Customer Service | 1-800-244-6224 | Prior authorization status, appeals[9] |
COMMON CRITERIA FOR FOUNDAYOPrior Authorization Requirements
Prior Authorization Requirements
When Cigna does cover Foundayo, prior authorization is always required. Cigna’s Foundayo policy (IP0206, effective September 1, 2026) requires:[15]
- BMI ≥30 (or ≥27 with hypertension, type 2 diabetes, sleep apnea, cardiovascular disease)
- 3 months documented lifestyle efforts (diet and exercise in your medical record)
- No concurrent GLP-1 use — can't take Foundayo with Ozempic/Wegovy
- Renewal: at least 5% weight loss from your starting weight; renewals last 1 year[15]
Cigna Decision Timelines
- Standard review: for most employer plans, federal claims rules allow up to 15 days
- Expedited review: up to 72 hours (if medically urgent)
Quantity Limits (Updated 2026)
Cigna typically enforces quantity limits for GLP-1 oral tablets (based on standard patterns):[6]
- All doses (0.8mg to 17.2mg): Typically 30-day supply limits
- Maintenance doses: Standard 30-day refills once stable on 5.5mg+
Renewal Requirement — Don't Miss This
Cigna’s Foundayo policy requires at least 5% weight loss from your starting weight to renew coverage after the first 8 months approval; renewals last 1 year.[15] If you don't meet these thresholds, your renewal may be denied — even if the medication is working for you in other ways.
For complete documentation checklists and PA preparation: Foundayo Prior Authorization Guide →
YOUR PLAN COVERS ITIf Your PA Was Denied
If Your PA Was Denied
Your plan covers Foundayo, but the prior authorization was rejected. This is actually good news — 65%+ of properly documented appeals succeed for commercial insurance.[10]
Why Fight for Coverage?
Win your appeal → pay as little as $25/month with Lilly's savings card. Without coverage, you'd pay $149–$299/month self-pay. That's real monthly savings — worth the fight.
Common PA Denial Reasons
- Medical necessity not met → Medical Necessity Guide
- Step therapy required → Step Therapy Guide
- BMI criteria not met → BMI Criteria Guide
- Missing lifestyle documentation → Lifestyle Documentation Guide
Cigna Appeal Basics
- Deadline: 180 days from denial to file internal appeal
- Contact: Pharmacy Customer Service: 1-800-244-6224
- Tip: Submit via fax to get instant confirmation of receipt
For complete appeal strategies: Foundayo Appeals Guide → | External Review Process
Need help with your Cigna appeal? Start your free appeal review →
DIFFERENT STRATEGY NEEDEDIf Your Plan Excludes Foundayo
If Your Plan Excludes Foundayo
Foundayo isn't on your plan's drug list at all. Standard appeals won't work for a plan exclusion, but you have other options.
Your Options
- Request a formulary exception — your doctor can argue medical necessity → If Foundayo is not covered by your insurance
- Check your plan benefits — BMI 27+ with comorbidities (diabetes, hypertension, etc.) may qualify you even if weight loss only is excluded
→ Cost & Coverage Guide - Talk to HR — if you have employer insurance, ask if they can add GLP-1 coverage at renewal
- Switch plans during open enrollment — verify GLP-1 coverage in writing before switching
- Explore self-pay options — savings cards, LillyDirect, and patient assistance may reduce costs → Foundayo Cost Guide
Alternative Coverage May Be Different
Foundayo vs. Zepbound: Understanding FDA Indications
Important clarification: Foundayo (orforglipron) is FDA-approved only for chronic weight management—NOT for obstructive sleep apnea (OSA).[1]
If you have sleep apnea and want GLP-1 coverage specifically for that condition, ask your doctor about Zepbound (tirzepatide), which received FDA approval for OSA in December 2024.
Comorbidity pathway: If you have sleep apnea with BMI 27+, you may qualify for Foundayo under the weight management indication since sleep apnea counts as a qualifying comorbidity—but Foundayo itself is not approved to treat OSA.
Have an Employer Plan? Talk to HR
If you have insurance through your employer, your HR/Benefits department may be able to help:
- Self-funded employers (typically larger companies) can modify coverage—they're not bound by standard Cigna rules
- Ask HR to advocate for adding GLP-1 coverage at the next plan renewal
- Ask if the Evernorth cap (currently Wegovy/Zepbound only) can be expanded to include Foundayo
CIGNA FOUNDAYO COVERAGE
Frequently Asked Questions
It depends on your Cigna plan. Express Scripts is Cigna's pharmacy benefit manager (PBM)—it administers pharmacy benefits but doesn't set independent coverage rules. Whether Express Scripts shows Foundayo as "covered" depends entirely on your Cigna plan design. Employer plans with GLP-1 coverage will show it as covered with prior authorization; plans without GLP-1 coverage will show "not covered."
Some Cigna plans do, but many do not. Coverage depends on your specific plan type. Employer-sponsored commercial plans are most likely to include coverage, especially large self-funded employers. Individual marketplace plans typically exclude weight loss medications; Medicare members can get Foundayo through the Medicare GLP-1 Bridge ($50 per monthly fill, with conditions). Note: The Evernorth $200/month cap currently applies to Wegovy and Zepbound only — Foundayo is not yet included.
Cigna’s Foundayo policy (IP0206, effective September 1, 2026) requires: BMI ≥30, or ≥27 with a weight-related condition (for example high blood pressure, type 2 diabetes, sleep apnea or heart disease), at least 3 months of behavioral modification and dietary restriction, and no other GLP-1 at the same time. The first approval lasts 8 months; renewals last 1 year and need at least 5% weight loss.
When covered, Foundayo is typically placed on Tier 4 (non-preferred specialty), which means higher out-of-pocket costs. Note: The Evernorth $200/month cap currently applies to Wegovy and Zepbound only — ask your employer if they plan to add Foundayo. Prior authorization is always required regardless of tier.
You have 180 days to file an internal appeal. Request the denial in writing with the specific reason, then submit an appeal through the Cigna member portal (myCigna.com), by fax, or by mail. Include supporting documentation like a Letter of Medical Necessity and clinical evidence. Your doctor can also request a peer-to-peer review. If the internal appeal fails, you can request a binding external review within 4 months.
Not through the plan itself, but through the Medicare GLP-1 Bridge. Basic Medicare Part D coverage excludes drugs used for weight loss, but Foundayo is covered through CMS's Medicare GLP-1 Bridge (July 1, 2026 – December 31, 2027) for $50 per monthly fill, if you meet CMS's eligibility criteria. Cigna Medicare Advantage plans with drug coverage are eligible plan types. Part D plans and pharmacies don’t opt in, and you don’t enroll separately; your prescriber must get prior authorization. Note: Foundayo (orforglipron) is FDA-approved only for chronic weight management, not OSA. For OSA coverage, ask about Zepbound (tirzepatide) instead.
Not currently. In May 2025, Cigna's Evernorth division launched a program that caps patient out-of-pocket costs at $200/month for Wegovy and Zepbound only. Foundayo was approved April 1, 2026 — after the program launched — and is not yet included. As of early 2025, the EncircleRx program covers 9 million patients. Complementary programs include EnGuide (home delivery) and EnReachRx (pharmacist support). Ask your HR department if your employer plans to add Foundayo to the cap program.
YOUR PATH FORWARD
What's Next
Foundayo Coverage: Other Major Insurers
See how other insurers compare on Foundayo coverage:
- UnitedHealthcare — Coverage policies still forming; 2026 formularies predate Foundayo's approval
- Blue Cross Blue Shield — Coverage varies across 33+ independent companies; no affiliate has announced Foundayo coverage yet
- Aetna — CVS Caremark ended its new-to-market block on Foundayo on June 1, 2026; coverage depends on your plan
- Anthem Blue Cross — Separate policies from other BCBS affiliates; check your plan’s Foundayo coverage
- Humana — Humana no longer sells employer-group commercial medical plans (exit completed in 2025); Humana Medicare Advantage members with drug coverage can use the Medicare GLP-1 Bridge for Foundayo
Other GLP-1 Medications at Cigna
Cigna's coverage varies by medication. Compare your options:
References
- FDA. (2026). "FDA Approves First New Molecular Entity Under National Priority Voucher Program." April 1, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-first-new-molecular-entity-under-national-priority-voucher-program
- Eli Lilly PR Newswire. (2026). "FDA Approves Lilly's Foundayo (orforglipron), the Only GLP-1 Pill for Weight Loss That Can Be Taken Any Time of Day Without Food or Water Restrictions." April 1, 2026. https://www.prnewswire.com/news-releases/fda-approves-lillys-foundayo-orforglipron-the-only-glp-1-pill-for-weight-loss-that-can-be-taken-any-time-of-day-without-food-or-water-restrictions-302731485.html
- STAT News. (2026). "Eli Lilly obesity pill approved — orforglipron (Foundayo)." April 1, 2026. https://www.statnews.com/2026/04/01/eli-lilly-obesity-pill-approved-orforglipron-foundayo/
- BioSpace. (2026). "Eli Lilly's Oral Obesity Pill Approved, Kicking Off Renewed Novo Rivalry." April 1, 2026. https://www.biospace.com/fda/eli-lillys-oral-obesity-pill-approved-kicking-off-renewed-novo-rivalry
- Cigna Healthcare. (2025). "Weight Loss – Glucagon-Like Peptide-1 Agonists Prior Authorization Criteria." Earlier combined Cigna policy, since replaced by drug-specific policies (Foundayo: IP0206). https://static.cigna.com/assets/chcp/pdf/coveragePolicies/cnf/cnf_684_coveragepositioncriteria_weight_loss_glp1_agonists_pa.pdf
- Cigna Healthcare. (2026). "General GLP-1 Quantity Limit Guidelines." Note: Foundayo-specific quantity limits are not confirmed in Cigna’s Foundayo policy (IP0206); check your plan’s drug list.
- Cigna Healthcare. (2026). "2026 IFP Prescription Drug List Changes." Note: Foundayo-specific quantity limits are not yet published in this document. https://www.cigna.com/static/www-cigna-com/docs/ifp/m-26-rx-all-989894-2026-ifp-prescription-drug-list-changes.pdf
- Cigna Healthcare. (2025). "2025 Cigna Healthcare Formulary Assurance." https://www.cigna.com/static/www-cigna-com/docs/medicare/plans-services/2025/formulary-assurance.pdf
- Cigna Healthcare. (2025). "Prescription Drug Lists and Coverage." https://www.cigna.com/individuals-families/member-guide/prescription-drug-lists/
- American Medical Association / KFF Analysis. (2024). "Over 80% of Prior Auth Appeals Succeed—Why Aren't There More?" Note: The 80%+ figure reflects Medicare Advantage data; commercial insurance appeal success rates are typically 65%+ based on industry analyses. https://www.ama-assn.org/practice-management/prior-authorization/over-80-prior-auth-appeals-succeed-why-aren-t-there-more
- Wharton S, et al. (2025). "Orforglipron Once Daily for the Treatment of Obesity." N Engl J Med. ATTAIN-1 trial. DOI: 10.1056/NEJMoa2511774. https://www.nejm.org/doi/full/10.1056/NEJMoa2511774
- U.S. Government Accountability Office. (2011). "Private Health Insurance: Data on Application and Coverage Denials." GAO-11-268. https://www.gao.gov/assets/gao-11-268.pdf
- Drug Topics. (2025). "Evernorth Benefit Option Will Cap Wegovy, Zepbound Monthly Cost at $200." May 22, 2025. Note: The $200 cap covers Wegovy and Zepbound; Foundayo is not yet included. https://www.drugtopics.com/view/evernorth-benefit-option-will-cap-wegovy-zepbound-monthly-cost-at-200
- HealthCare.gov. "External Review." https://www.healthcare.gov/appeal-insurance-company-decision/external-review/
- Cigna Healthcare. (2026). "Weight Loss – Glucagon-Like Peptide-1 Agonists – Foundayo." Drug Coverage Policy IP0206, effective 09/01/2026. static.cigna.com (IP0206)
- Kaiser Family Foundation. (2024). "Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Requests in 2023." https://www.kff.org/medicare/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/
- American Hospital Association. (2024). "Payer Denial Tactics—How to Confront a $20 Billion Problem." https://www.aha.org/aha-center-health-innovation-market-scan/2024-04-02-payer-denial-tactics-how-confront-20-billion-problem
- Evernorth Health Services. (2025). "Evernorth Launches New Benefit Option That Drives Lower Net Cost for Weight Loss Medicines and Limits Patient Cost to No More Than $200 Per Month." May 21, 2025. https://www.evernorth.com/articles/evernorth-launches-new-benefit-option-drives-lower-net-cost-weight-loss-medicines
- Healthcare Dive. (2025). "Cigna doubles down on GLP-1 support programs with 2 new launches." May 2, 2025. EncircleRx covers 9 million patients, has saved insurers $200 million. EnReachRx launched Q1 2025. https://www.healthcaredive.com/news/cigna-evernorth-glp1-support-programs-enreachrx-enguide-q1-2025/746967/
- Fierce Healthcare. (2025). "New Evernorth program to cap out-of-pocket costs for Wegovy, Zepbound at $200." May 21, 2025. Note: The cap covers Wegovy and Zepbound; Foundayo is not yet included. Includes EnGuide home delivery option. https://www.fiercehealthcare.com/payers/new-evernorth-program-cap-out-pocket-costs-wegovy-zepbound-200
- International Foundation of Employee Benefit Plans (IFEBP). (2025). "Employee Benefits Survey 2025." Per IFEBP data, approximately 36% of large employers cover GLP-1 medications for weight loss. https://www.ifebp.org/resources/surveys/employee-benefits-survey
- McDermott+Consulting. (2025). "CY 2026 MA and Part D Final Reg: Policies Under Consideration." March 13, 2025. CMS proposed permitting coverage of anti-obesity medications. https://www.mcdermottplus.com/blog/regs-eggs/cy-2026-ma-and-part-d-final-reg-policies-under-consideration/; Ritter Insurance Marketing. (2025). "Medicare and Medicaid to Start Covering GLP-1 Drugs for Beneficiaries." November 12, 2025. https://ritterim.com/blog/medicare-and-medicaid-to-start-covering-glp1-drugs-for-beneficiaries/
- Express Scripts. (2026). "2026 Express Scripts National Preferred Formulary." Note: Foundayo is not yet listed on the standard formulary; employer plans may add coverage independently. https://www.express-scripts.com/art/open_enrollment/Preferred_Members_FormularyRxGuide.pdf
- Honest Care. (2025). "GLP-1 Patient Access Report — Q3/Q4 2025." https://www.findhonestcare.com/insights/glp1-coverage-2025/
Last updated October 6, 2026 · Key facts verified October 5, 2026
Disclaimer
The information on this page is for educational and informational purposes only and is not intended as medical advice. Honest Care does not provide medical diagnosis, treatment, or individualized recommendations. Always seek the advice of your physician or other qualified healthcare professional regarding any medical condition or treatment.
While this content has been reviewed for accuracy and balance, new evidence may emerge after publication. Drug availability, indications, and insurance coverage can change over time. Honest Care makes no warranties as to completeness or currentness of the information and is not responsible for decisions made based on this content.