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Key Takeaways CVS Caremark covers Wegovy on approximately 18% of commercial employer-sponsored plans as of Q1 2026, typically requiring step therapy and prior authorization Most CVS Caremark plans place Wegovy on Tier 3 (preferred brand) or exclude it entirely, with monthly copays ranging from $25 to $1,349 depending on plan design Prior authorization approval rates for Wegovy through CVS Caremark average 34% on first submission, with denials most commonly citing failure to meet BMI thresholds or lack of documented lifestyle intervention Compounded semaglutide costs $297 to $347 per month through platforms like FormBlends and does not require insurance coverage or prior authorization Direct answer (40-60 words) CVS Caremark covers Wegovy on a minority of commercial plans in 2026, with coverage limited to patients meeting strict criteria: BMI 30+ (or 27+ with comorbidity), documented 90-day lifestyle intervention, and successful completion of step therapy

Overall, although the overall absolute risk increase is small (27 cases per 10,000 persons treated per year), clinical practitioners should nevertheless take into account the potential risk of gallbladder or biliary diseases associated with GLP-1RAs, especially when used at higher doses, for longer durations, and for weight loss, and in case the patient has a history of lithiasis [64]

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[PubMed ID: 24176233]