Key Takeaways
- Large commercial carriers list Wegovy with prior authorization: UnitedHealthcare's policy effective September 1, 2026 approves 5 months at a time for BMI 30 or higher (or 27 with a comorbidity) and renews for 12 months at 5 percent weight loss, and Wegovy has been the preferred GLP-1 obesity drug on CVS Caremark's Standard Control, Advanced Control and Value formularies and on Aetna since July 1, 2025 (NovoMedLink, MMIT data); whether your employer opted in is the real question
- Medicare changed on July 1, 2026: the Medicare GLP-1 Bridge covers the Wegovy pen and pill at a $50 monthly copay through December 31, 2027 for enrollees with a BMI of 35 or higher, or 30 or 27 with specific conditions, excluding people with type 2 diabetes, moderate to severe sleep apnea or MASH (CMS, August 6, 2026)
- State Medicaid programs vary and the list is shrinking: KFF counted 13 states covering GLP-1s for obesity as of January 2026, MassHealth ended coverage July 1, 2026, Rhode Island ends it in October 2026, and California, New Hampshire, Pennsylvania and South Carolina dropped it in 2025 and 2026
- Employer self-funded plans (covering 67 percent of workers with employer coverage per KFF's 2025 survey) make independent coverage decisions; only 16 percent of firms with 200 to 999 workers, 30 percent with 1,000 to 4,999 and 43 percent with 5,000 or more covered GLP-1s for weight loss in 2025
The short answer
As of September 5, 2026: the major commercial carriers (BlueCross BlueShield plans, UnitedHealthcare, Aetna and CVS Caremark, Cigna) list Wegovy for chronic weight management with prior authorization, but 67 percent of workers are in self-funded employer plans that choose whether to include it, and most smaller employers do not (KFF, October 2025). Medicare now covers the Wegovy pen and pill for $50 a month through the GLP-1 Bridge (July 1, 2026 to December 31, 2027) for enrollees meeting obesity criteria without diabetes. Medicaid covered GLP-1s for obesity in 13 states as of January 2026, fewer since. If none of that applies, Novo Nordisk sells the pen for $199 a month for the first two fills and the pill from $149.
Table of contents
- The coverage landscape most articles misunderstand
- Commercial insurance coverage by carrier (the big five)
- Why Medicare Part D cannot cover Wegovy (the federal exclusion)
- State-by-state Medicaid coverage map
- The employer self-funded plan variable
- Prior authorization requirements and denial rates
- What "coverage" actually means (formulary tiers and real costs)
- TRICARE, VA, and federal employee plans
- The FormBlends Coverage Decision Framework
- When coverage exists but access doesn't
- The compounded semaglutide pathway
- Carrier-by-carrier in 2026: the actual policy documents
- Medicare now covers Wegovy for $50 (GLP-1 Bridge)
- Medicaid map, September 2026
- Employer plans: who covers GLP-1s
- If coverage fails: 2026 cash options
- Marketplace (ACA) plans almost never cover it
- FAQ
The coverage landscape most articles misunderstand
Most online articles answer "Does insurance cover Wegovy?" with a simple yes or no. This is the wrong frame.
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Try the Cost Calculator →Insurance coverage for Wegovy operates on three independent layers:
Layer 1: The carrier's formulary decision. Does the insurance company include Wegovy on its drug list at all? This is a yes/no gate.
Layer 2: The plan design. Even if the carrier covers Wegovy, does your specific plan cover it? Employer plans, marketplace plans, and individual plans from the same carrier can have completely different formularies.
Layer 3: The prior authorization outcome. Even if your plan covers Wegovy, does your individual clinical situation meet the criteria? This is where documentation gaps turn into denials. No carrier publishes a Wegovy-specific denial rate, and the 40 to 60 percent range printed here earlier was unsourced and has been removed.
The error most articles make is treating Layer 1 as the whole answer. "UnitedHealthcare covers Wegovy" is technically true at Layer 1, but meaningless for the patient whose employer excluded it at Layer 2 or whose BMI doesn't meet the threshold at Layer 3.
The correct question is: "Does my specific plan, administered by my carrier, cover Wegovy for someone with my clinical profile?"
This article maps all three layers.
Commercial insurance coverage by carrier (the big five)
As of April 2026, the five largest commercial carriers cover Wegovy on their standard formularies with prior authorization. Coverage at the plan level varies.
BlueCross BlueShield (BCBS)
Formulary status: Covered on most plans, typically Tier 4 or specialty tier.
Prior authorization: Required for all plans. Criteria include BMI ≥30, or BMI ≥27 with one weight-related comorbidity (hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea). Some plans require documented failure of at least one other weight-loss intervention (behavioral program, metformin, orlistat).
Plan-level variation: BCBS operates as 35 independent companies. A BCBS plan in North Carolina may cover Wegovy while a BCBS plan in Illinois excludes it. Employer groups can request exclusion.
Denial rate: Not published. Correction, September 2026: the 45 percent figure and the Wilkinson et al. Health Affairs citation printed here earlier could not be located and have been removed. One dated data point: BCBS Massachusetts excluded Wegovy, Saxenda and Zepbound from plans renewing on or after January 1, 2026 (healthinsurance.org, August 20, 2026).
UnitedHealthcare (UHC)
Formulary status: Covered on standard commercial formularies, Tier 4 specialty.
Prior authorization: Required, and the policy is public. UnitedHealthcare's pharmacy PA notification for weight-loss drugs, effective September 1, 2026, approves Wegovy injection or tablet for patients 12 and older (over 16 for Wegovy HD) with a BMI of 30 or higher, or 27 or higher with a weight-related comorbidity such as dyslipidemia, hypertension, type 2 diabetes or sleep apnea, used alongside lifestyle modification. Separate routes exist for cardiovascular risk reduction in people with established cardiovascular disease and for MASH with F2 to F3 fibrosis (injection only). Initial authorization is 5 months; renewal requires at least 5 percent weight loss from baseline plus continued lifestyle modification and runs 12 months.
Plan-level variation: UHC administers both fully insured and self-funded employer plans. Self-funded plans (67 percent of covered workers nationally per KFF's 2025 survey) can exclude Wegovy entirely; UHC's policy points those plans to separate nonformulary Wegovy criteria. The UHC formulary is a recommendation, not a mandate, for self-funded groups.
Denial rate: Not published; the 52 percent figure printed here earlier could not be verified and has been removed.
Aetna (CVS Health)
Formulary status: Covered where the plan includes weight-loss drugs. Per NovoMedLink (MMIT data, May 1, 2025), Wegovy became the preferred GLP-1 obesity medicine on CVS Caremark's Standard Control, Advanced Control and Value formularies and on Aetna effective July 1, 2025; healthinsurance.org reports Caremark re-adds Zepbound to its template formulary on October 1, 2026.
Prior authorization: Required. Criteria include BMI threshold plus mandatory enrollment in Aetna's digital weight management program (a 12-week online behavioral intervention). Patients must complete at least 8 of 12 modules before PA approval.
Plan-level variation: Employer groups can opt out of the obesity program entirely, which removes Wegovy from the formulary.
Denial rate: Not published; the 38 percent figure printed here earlier could not be verified and has been removed.
Cigna
Formulary status: Covered on standard plans, Tier 4 specialty.
Prior authorization: Required. Cigna uses a step-therapy protocol: patients must try and fail phentermine or another older weight-loss medication before Wegovy approval. This adds 8-12 weeks to the approval timeline.
Plan-level variation: Employer plans can waive step therapy. About 30% of Cigna employer groups waive it as of 2026.
Denial rate: Not published; the 58 percent figure printed here earlier could not be verified and has been removed.
Humana
Formulary status: Limited. SingleCare (May 21, 2026) reports Humana covers Wegovy only for the cardiovascular and MASH indications, not for weight loss itself. Most Humana members are in Medicare Advantage plans, where the July 2026 Medicare GLP-1 Bridge, not Humana's formulary, now governs Wegovy for obesity.
Prior authorization: Required, standard BMI criteria.
Plan-level variation: Limited data due to small commercial footprint.
Denial rate: Not published; the 50 percent estimate printed here earlier was unsourced and has been removed.
Why Medicare Part D cannot cover Wegovy (the federal exclusion)
Correction, September 2026: this section's heading was true when written and is now half true. The statute still bars ordinary Part D coverage of drugs used for weight loss, but on July 1, 2026 CMS began covering Wegovy for obesity anyway through the Medicare GLP-1 Bridge, a demonstration that sits outside the normal Part D benefit (Medicare.gov; CMS provider page updated August 6, 2026). Details are in the new Medicare section below.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 explicitly excludes coverage for drugs used for weight loss or weight gain. The statute reads: "Such term does not include... agents when used for... weight loss or weight gain" (42 U.S.C. § 1395w-102(e)(2)(A)).
Wegovy's obesity indication is what the statute excludes from ordinary Part D. What Medicare now offers instead is the Bridge: a $50 copay per 30-day supply for the Wegovy pen or pill, July 1, 2026 through December 31, 2027, for enrollees with a BMI of 35 or higher, or 30 or higher with heart failure with preserved ejection fraction, uncontrolled hypertension or stage 3a or worse kidney disease, or 27 or higher with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease. People with type 2 diabetes, moderate to severe sleep apnea or MASH are excluded and use regular Part D routes.
The Ozempic loophole (and why it's closing).
Some Medicare patients have accessed semaglutide by getting Ozempic prescribed off-label for weight loss. Ozempic is FDA-approved for type 2 diabetes, which Medicare covers. If a provider writes "type 2 diabetes" on the prescription, Medicare pays.
Two things have changed. Part D plans now apply prior authorization to nearly all GLP-1 fills, up from 5 percent or fewer of beneficiaries through 2024 (Klebanoff et al., JAMA, September 25, 2025, via Penn LDI), so a diabetes diagnosis is checked before Ozempic is covered. And the Bridge removes much of the reason for the workaround. The 2024 CMS guidance and 23 percent audit figure printed here earlier could not be verified and have been removed.
Medicare Advantage plans.
Medicare Advantage (Part C) plans with drug coverage follow Part D rules, so they never covered Wegovy for weight loss on their own. The Bridge applies to Part D enrollees whether their coverage comes from a standalone drug plan or a Medicare Advantage plan; the pharmacy submits the Bridge claim, and CMS says decisions come back within 72 hours with no appeal path, only resubmission.
The 2027 legislative outlook.
The Treat and Reduce Obesity Act has not passed as of September 5, 2026, and we no longer print a cosponsor count. The policy that did move is administrative: the Bridge (July 2026 to December 2027) and the BALANCE model, whose Medicaid phase runs May 1, 2026 to December 31, 2031 at a negotiated $245 per monthly supply, while its Part D phase has been delayed indefinitely (KFF, May 11, 2026).
State-by-state Medicaid coverage map
Medicaid is a state-federal partnership. Each state designs its own formulary within federal guidelines. Coverage for Wegovy varies dramatically.
KFF counted 13 state Medicaid programs covering GLP-1s for obesity as of January 2026. Since then MassHealth ended coverage on July 1, 2026 and Rhode Island announced an October 2026 end, so the working number on September 5, 2026 is 11 to 12 depending on the day you read this. The 12-state list with per-state criteria printed here earlier did not match KFF's list and has been replaced below.
States that cover Wegovy (with restrictions)
| Medicaid GLP-1 obesity coverage | Status as of September 5, 2026 | Source |
|---|---|---|
| Covered as of January 2026 (13 states) | Delaware, Kansas, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Rhode Island, Tennessee, Utah, Virginia, Wisconsin | KFF, January 2026; state list per SingleCare, May 21, 2026 |
| Dropped coverage in 2025 or 2026 | California, New Hampshire, Pennsylvania, South Carolina | KFF, January 2026 |
| Ended July 1, 2026 | Massachusetts (MassHealth) | healthinsurance.org, August 20, 2026 |
| Ending October 2026 | Rhode Island | healthinsurance.org, August 20, 2026 |
| Tightened | Michigan now requires BMI 40 or higher | healthinsurance.org, August 20, 2026 |
| Dropped then reinstated | North Carolina (dropped October 2025, reinstated December 2025) | KFF, January 2026 |
Per-state BMI thresholds and renewal rules are set in each state's preferred drug list and change often; the one documented tightening is Michigan's move to BMI 40 or higher. Confirm with your state's Medicaid pharmacy program before assuming coverage.
States that explicitly exclude Wegovy
The remaining states and D.C. do not cover GLP-1s for obesity under Medicaid, though every state covers Ozempic and Mounjaro for type 2 diabetes. Note that Michigan, listed here earlier as excluding, is on KFF's covering list with a BMI 40 threshold, and Pennsylvania and California dropped coverage rather than never having it.
Why the split?
State Medicaid budgets are the constraint. KFF puts gross Medicaid spending on GLP-1s near $9 billion in 2024, before rebates. Wegovy's retail price without an offer is about $1,639 a month (GoodRx, September 4, 2026), and even at negotiated net prices a state covering 100,000 adults faces a nine-figure annual bill for one drug class.
The direction of travel is toward fewer covering states, not more: California, New Hampshire, Pennsylvania and South Carolina dropped coverage in 2025 and 2026, Massachusetts ended it July 1, 2026, and Rhode Island ends it in October 2026. The BALANCE model's Medicaid phase (May 1, 2026 to December 31, 2031) offers states a $245 negotiated monthly price, which may slow the exits (KFF, May 11, 2026).
The employer self-funded plan variable
67 percent of covered workers are in self-funded plans (KFF 2025 Employer Health Benefits Survey, October 22, 2025; 27 percent at firms with 10 to 199 workers, 80 percent at larger firms). This is the coverage variable most patients don't understand.
Fully insured vs self-funded.
In a fully insured plan, the employer pays premiums to an insurance carrier (UnitedHealthcare, Aetna, etc.), and the carrier assumes the financial risk. The carrier's formulary applies.
In a self-funded plan, the employer assumes the financial risk and pays claims directly. The carrier (UnitedHealthcare, Aetna, etc.) is hired as a third-party administrator (TPA) to process claims, but the employer decides what's covered.
A self-funded employer can take the UnitedHealthcare standard formulary and remove Wegovy. The patient still has a UnitedHealthcare insurance card, but Wegovy isn't covered.
Real-world employer decisions.
Correction, September 2026: an earlier version cited a 2025 Business Group on Health survey of 800 employers with 28, 41 and 31 percent splits. We could not match those figures to a published release and have replaced them with two dated surveys:
- KFF 2025 Employer Health Benefits Survey (October 22, 2025): among firms offering benefits, 16 percent of those with 200 to 999 workers, 30 percent with 1,000 to 4,999 and 43 percent with 5,000 or more cover GLP-1s for weight loss
- 2026 survey of 307 employers reported by healthinsurance.org (August 20, 2026): 60 percent cover GLP-1s for diabetes, 36 percent for weight loss
- Same survey: 5 to 10 percent of employers that cover weight-loss GLP-1s plan to drop them in 2027
Among covering firms, KFF found about one-third require a dietitian, case manager or lifestyle program as a condition of coverage, and only 1 percent of non-covering firms said they were very likely to add coverage within 12 months. The 73, 52 and 38 percent figures printed here earlier were unsourced and have been removed.
How to find out if your employer plan covers Wegovy.
Call the member services number on your insurance card and ask: "Is Wegovy on my plan's formulary?" Do not ask "Does UnitedHealthcare cover Wegovy?" The answer to the second question is yes, but it may not apply to your specific plan.
Prior authorization requirements and denial rates
Even when a plan covers Wegovy, most patients face prior authorization.
Standard PA criteria across commercial plans (2026):
- BMI ≥30 kg/m², or BMI ≥27 kg/m² with at least one weight-related comorbidity (hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cardiovascular disease)
- Age 12 or older for Wegovy injection under UnitedHealthcare's September 1, 2026 policy (over 16 for Wegovy HD); other plans may set 18
- Documented weight-loss attempt in the past 12 months (behavioral program, commercial weight-loss program, or prescription weight-loss medication)
- No contraindications (personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2, pregnancy, breastfeeding)
- Prescription from a licensed provider (MD, DO, NP, PA in most states)
Why PA requests are denied initially.
Correction, September 2026: the percentages in this list were attributed to a 12,000-request analysis (Hendricks et al., Obesity 2025) that we could not locate; the percentages have been removed and the reasons are kept as the ones plan criteria documents actually test for:
- Lifestyle modification not documented. UnitedHealthcare's policy requires use as an adjunct to lifestyle modification (diet, exercise, behavioral support or a community program); if the chart does not say so, the request fails.
- BMI doesn't meet threshold. Patient has BMI 26.8 without a documented comorbidity, or the comorbidity isn't one the plan accepts.
- Prescription written by an out-of-network provider. Some plans require the prescriber to be in-network.
- Plan excludes Wegovy entirely. The PA is submitted to a self-funded employer plan that removed weight-loss drugs; UnitedHealthcare routes these to separate nonformulary criteria.
- Missing labs or clinical notes. Plan requires recent A1C, lipid panel, or blood pressure readings to document the comorbidity.
Appeals work.
No published Wegovy appeal success rate survives verification; the 62 percent figure printed here earlier has been removed. The appeal process requires the provider to submit additional documentation, often the missing piece from the initial request, and NovoCare's coverage page says an initial PA decision can take up to 10 business days.
What "coverage" actually means (formulary tiers and real costs)
A plan can "cover" Wegovy and still leave the patient with a $500 monthly copay.
Formulary tiers determine out-of-pocket cost.
Most plans use a 4- or 5-tier formulary:
- Tier 1: Generic drugs, $5 to $15 copay
- Tier 2: Preferred brand drugs, $30 to $75 copay
- Tier 3: Non-preferred brand drugs, $75 to $150 copay
- Tier 4: Specialty drugs, 20% to 40% coinsurance (you pay a percentage of the negotiated price)
- Tier 5: Specialty tier with higher coinsurance, sometimes 40% to 50%
Wegovy typically lands on Tier 4 or Tier 5. The negotiated price between the plan and the pharmacy is usually $1,100 to $1,200 per month. A patient with 30% coinsurance pays $330 to $360 per fill.
Deductibles apply first.
If your plan has a $3,000 deductible and you haven't met it, you pay the full negotiated price ($1,100 to $1,200) until the deductible is met. After that, the coinsurance applies.
For a patient on a high-deductible health plan, "coverage" means paying full price for the first 2-3 months, then paying 30% coinsurance for the rest of the year.
Out-of-pocket maximums cap total spending.
Once you've spent your plan's out-of-pocket maximum ($5,000 to $9,000 for individual coverage in most plans), the plan pays 100%. For patients on Wegovy year-round, this usually happens by mid-year.
The Wegovy savings card exists, and it is live.
Correction, September 2026: an earlier version said the Wegovy savings card had been discontinued. It is active. Commercially insured patients whose plan covers Wegovy pay as little as $25 a month, with maximum savings of $100 per month (NovoCare eligibility page, seen September 4, 2026). It cannot be used with Medicare, Medicaid or other government coverage. For patients without coverage, Novo Nordisk's self-pay prices through NovoCare Pharmacy are $199 a month for a new patient's first two pen fills (through December 31, 2026) then $349, $399 for Wegovy HD 7.2 mg, and $149, $199 or $299 for the pill by strength; NovoCare adds that no insurance coverage is yet available for the 7.2 mg dose.
TRICARE, VA, and federal employee plans
TRICARE (military health coverage).
TRICARE covers Wegovy for active-duty service members and beneficiaries with prior authorization. Criteria include BMI ≥30 or BMI ≥27 with comorbidity. TRICARE's formulary is managed by Express Scripts. Copay for Wegovy is $29 per month for network pharmacies, $68 for non-network.
TRICARE is one of the most generous payers for Wegovy relative to copay cost.
Veterans Affairs (VA).
The VA covers Wegovy for veterans enrolled in VA healthcare. The VA added Wegovy to its national formulary in 2024. Prior authorization is required. Copay is $0 to $11 depending on the veteran's priority group and disability rating.
Federal Employee Health Benefits (FEHB) plans.
FEHB plans are administered by private carriers (BlueCross, Aetna, UnitedHealthcare) but follow OPM guidance. Most FEHB plans cover Wegovy with prior authorization. The Federal Employees Health Benefits Program issued guidance in 2024 encouraging coverage for obesity medications, and most carriers complied.
Copays vary by plan but are typically Tier 4 specialty, meaning 20-30% coinsurance.
The FormBlends Coverage Decision Framework
We built a decision framework for patients trying to determine whether pursuing insurance coverage for Wegovy makes sense compared to paying out-of-pocket for compounded semaglutide.
The 4-Gate Coverage Decision Model.
Gate 1: Does your plan's formulary include Wegovy?
Call your insurance member services or check your plan's online formulary. Search for "semaglutide" and "Wegovy." If it's not listed, stop here. Your plan doesn't cover it. Move to the compounded pathway.
Gate 2: Can you meet the prior authorization criteria?
Review your plan's PA criteria (available on the insurance website or by calling). Do you have the required BMI? Do you have documented comorbidities? Have you tried another weight-loss intervention in the past 12 months? If no to any of these, PA will likely be denied. Consider whether appealing is worth the 4-8 week delay.
Gate 3: Is your out-of-pocket cost sustainable?
Even if PA is approved, calculate your actual cost. If your plan has a $3,000 deductible and 30% coinsurance, your first fill costs $1,200, and subsequent fills cost $360. Over 12 months, that's $5,160. Compare this to Novo Nordisk's own $199 then $349 self-pay pen price, or to compounded semaglutide, which had a $197 month-one and $224 month-four median across 14 providers in the Compounded GLP-1 Price Index on September 3, 2026.
Gate 4: Is the approval timeline acceptable?
PA approval takes 5 to 14 business days on average. If denied, the appeal takes another 14 to 30 days. If you need to start treatment within 2 weeks, insurance coverage may not be the fastest path.
Decision output:
- All 4 gates pass: Pursue insurance coverage.
- Gate 1 or 2 fails: Move to compounded semaglutide or pay cash.
- Gate 3 fails (cost too high): Compare total annual cost of insurance pathway vs compounded. Often compounded is cheaper.
- Gate 4 fails (timeline too long): Start with compounded, then transition to Wegovy if PA is later approved.
[Diagram suggestion: Flowchart with 4 decision diamonds, each gate labeled, with "pursue insurance" and "consider compounded" endpoints]
When coverage exists but access doesn't
A pattern we see consistently in FormBlends intake data: patients whose insurance "covers" Wegovy but who cannot access it.
The prior authorization denial loop.
Patient submits PA. Denied for insufficient documentation. Provider resubmits with additional notes. Denied for missing lab work. Provider orders labs, resubmits. Denied because the lab is older than 90 days. Provider orders new labs, resubmits. Approved, but 12 weeks have passed.
By the time approval comes through, some patients have either paid out-of-pocket for compounded semaglutide or given up entirely.
The pharmacy stock-out problem.
This was a real problem through 2024. The FDA declared the semaglutide shortage resolved on February 21, 2025, Wegovy is now also sold as a daily pill, and NovoCare's coverage page (September 5, 2026) shows no stock warnings; the one access gap it does flag is that no insurance coverage is yet available for the Wegovy HD 7.2 mg injection.
The Q4 2025 shortage-database claim printed here earlier could not be verified against FDA's records and has been removed.
The reauthorization burden.
Most plans require PA reauthorization every 6 to 12 months. The patient must prove ongoing medical necessity, often including documented weight loss. If the patient hasn't lost at least 5% of baseline body weight, some plans deny reauthorization.
This creates a perverse incentive: patients who respond slowly to Wegovy (a known phenomenon, with some patients taking 6-9 months to see significant results) lose coverage before the medication has had time to work.
When you should NOT pursue insurance coverage for Wegovy
The strongest argument against pursuing insurance coverage, even when it exists:
Time cost exceeds financial savings.
If your plan requires 3 PA submissions, 2 appeals, and 16 weeks of back-and-forth, and your out-of-pocket cost after approval is $300 per month, you've spent 4 months without treatment to save about $75 per month compared to starting compounded semaglutide immediately at $224 a month (the month-four index median, September 3, 2026) or Wegovy self-pay at $199 for two months then $349.
The 16 weeks of delay represent 16 weeks of continued obesity-related health risk, 16 weeks without the cardiovascular benefits demonstrated in SELECT, and 16 weeks of diminished quality of life.
For some patients, paying $199 to $224 per month starting today is the better clinical decision than fighting for $300 per month starting in 4 months.
When your plan's coverage is unstable.
Self-funded employer plans can change formularies mid-year. If your employer is considering removing Wegovy from the formulary (5 to 10 percent of employers that cover weight-loss GLP-1s told a 2026 survey of 307 employers they plan to drop them in 2027, per healthinsurance.org; BCBS Massachusetts excluded Wegovy, Saxenda and Zepbound from January 1, 2026 renewals), starting treatment on insurance means risking a mid-treatment formulary change that forces you to either stop or switch to out-of-pocket payment.
Starting on compounded semaglutide from day one eliminates this risk.
When you value medication consistency.
Brand-name Wegovy and compounded semaglutide are not interchangeable. Switching between them mid-treatment requires re-titration in some cases. If you start on Wegovy through insurance, lose coverage 6 months later, and switch to compounded, you may experience a temporary efficacy gap during the transition.
Patients who prioritize treatment consistency sometimes choose compounded from the start to avoid forced switches.
The compounded semaglutide pathway
For patients whose insurance doesn't cover Wegovy, whose PA is denied, or whose out-of-pocket cost is unsustainable, compounded semaglutide is the most common alternative.
Pricing comparison (September 2026):
| Option | Monthly cost | Annual cost |
|---|---|---|
| Wegovy with insurance (average copay) | $150 to $400 | $1,800 to $4,800 |
| Wegovy self-pay through NovoCare Pharmacy (September 4, 2026) | $199 for the first two pen fills, then $349; pill $149 to $299; retail with no offer about $1,639 | About $3,888 for a year of pens |
| FormBlends compounded semaglutide (our own row) | Current price on the product page and in our price index | See the price index |
| Compounded semaglutide, 14-provider median (price index, September 3, 2026) | $197 month one (range $88 to $299); $224 month four | About $2,600 to $2,700 at the medians |
Key differences:
- Compounded semaglutide is not FDA-approved
- It's prepared by a state-licensed 503A or 503B compounding pharmacy
- It's typically drawn from a vial with a syringe rather than delivered by a pre-filled pen
- It's chemically identical to the semaglutide in Wegovy but hasn't undergone the same manufacturing and stability testing
When compounded makes sense:
- Your insurance doesn't cover Wegovy
- Your PA was denied and appeals failed
- Your copay exceeds $250 per month
- You want predictable pricing without annual formulary risk
- You're comfortable with compounded medications
When brand-name Wegovy makes sense:
- Your copay is under $100 per month
- You strongly prefer FDA-approved medications
- You want the convenience of a pre-filled pen
- Your insurance coverage is stable (large employer, not at risk of formulary change)
The decision is patient-specific and should be made with a licensed provider who understands your clinical situation and financial constraints.
Carrier-by-carrier in 2026: what the actual policy documents say
The carrier section above kept its structure; this table replaces the unverified denial percentages with what each payer has put in writing.
| Carrier or PBM | What the document says (checked September 5, 2026) | Source and date |
|---|---|---|
| UnitedHealthcare (commercial) | Wegovy injection and tablet covered with PA: age 12 or older (over 16 for HD), BMI 30 or higher or 27 with dyslipidemia, hypertension, type 2 diabetes or sleep apnea, adjunct to lifestyle modification; also covered for cardiovascular risk reduction with established cardiovascular disease and for MASH F2 to F3 (injection). Initial 5 months; renewal at 5 percent weight loss for 12 months. Separate nonformulary criteria for plans that exclude weight-loss drugs. | UHC PA notification, effective September 1, 2026 |
| CVS Caremark and Aetna | Wegovy is the preferred GLP-1 obesity medicine on Standard Control, Advanced Control and Value formularies and on Aetna, effective July 1, 2025. Caremark re-adds Zepbound to its template formulary October 1, 2026. | NovoMedLink (MMIT data May 1, 2025); healthinsurance.org, August 20, 2026 |
| BlueCross BlueShield plans | Independent BCBS companies decide separately. BCBS Massachusetts excluded Wegovy, Saxenda and Zepbound from plans renewing on or after January 1, 2026. | healthinsurance.org, August 20, 2026 |
| Humana | Covers Wegovy for the cardiovascular and MASH indications only, not weight loss. | SingleCare, May 21, 2026 |
| Cigna | Lists Wegovy with PA on standard commercial formularies; we could not fetch Cigna's current coverage policy PDF, so no criteria are quoted. | Not verified September 2026 |
The one payer whose full criteria are public and dated is UnitedHealthcare, which is why it is quoted at length. The pattern across payers is consistent: BMI 30, or 27 with a named comorbidity, lifestyle modification, an initial approval of a few months, and renewal tied to 5 percent weight loss.
Medicare now covers Wegovy for $50 a month (GLP-1 Bridge, July 1, 2026 to December 31, 2027)
This is the largest change to Wegovy coverage since the drug launched, and it happened by demonstration rather than legislation.
| Bridge rule (CMS, last updated August 6, 2026) | Detail |
|---|---|
| Dates | July 1, 2026 through December 31, 2027 |
| Copay | $50 per 30-day supply; the copay does not count toward the Part D deductible or the $2,100 out-of-pocket cap |
| Drugs | Wegovy pen and pill, Zepbound KwikPen only (not single-dose pens or vials), Foundayo |
| Who qualifies | BMI 35 or higher; or BMI 30 or higher with heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or worse; or BMI 27 or higher with prediabetes, prior heart attack, prior stroke, or symptomatic peripheral artery disease |
| Who is excluded | People with type 2 diabetes, moderate to severe obstructive sleep apnea, or MASH use regular Part D coverage instead |
| Prior authorization | Pharmacy transmits the request within 24 to 72 hours; decision within 72 hours; no appeals, but a corrected request can be resubmitted; approval is valid through December 31, 2027 for refills and dose changes |
Novo Nordisk's NovoCare page confirms the $50 Bridge copay is available nationwide from July 1, 2026 through the end of 2027. KFF (May 11, 2026) notes the negotiated Bridge price is $245 per monthly supply and that the broader BALANCE model's Part D phase, which was supposed to make this permanent, has been delayed indefinitely. If you have Medicare and type 2 diabetes, you are excluded from the Bridge; Ozempic for diabetes through regular Part D is the route.
Medicaid map, September 2026 edition
The Medicaid table earlier in this article was rebuilt from KFF's January 2026 count and two later sources. Here is the same information as a timeline of changes, because the direction matters more than any single snapshot.
| Date | Change | Source |
|---|---|---|
| October 2025 | North Carolina dropped coverage | KFF, January 2026 |
| December 2025 | North Carolina reinstated coverage | KFF, January 2026 |
| 2025 to early 2026 | California, New Hampshire, Pennsylvania, South Carolina dropped coverage | KFF, January 2026 |
| January 2026 | 13 states covering (DE, KS, MA, MI, MN, MS, MO, NC, RI, TN, UT, VA, WI) | KFF; SingleCare, May 21, 2026 |
| May 1, 2026 | BALANCE model Medicaid phase begins ($245 negotiated monthly price, through December 31, 2031) | KFF, May 11, 2026 |
| July 1, 2026 | MassHealth ended coverage | healthinsurance.org, August 20, 2026 |
| 2026 | Michigan tightened to BMI 40 or higher | healthinsurance.org, August 20, 2026 |
| October 2026 | Rhode Island scheduled to end coverage | healthinsurance.org, August 20, 2026 |
Every state Medicaid program covers semaglutide as Ozempic for type 2 diabetes. The exits above concern the obesity indication only.
Employer plans: 67 percent of workers are self-funded, and here is who covers GLP-1s
| Survey | Finding |
|---|---|
| KFF Employer Health Benefits Survey (October 22, 2025) | 67 percent of covered workers are in self-funded plans. GLP-1 weight-loss coverage among firms offering benefits: 16 percent (200 to 999 workers), 30 percent (1,000 to 4,999), 43 percent (5,000 or more). About one-third of covering firms require a lifestyle program, dietitian or case manager. 1 percent of non-covering firms very likely to add coverage within 12 months. |
| 2026 survey of 307 employers (healthinsurance.org, August 20, 2026) | 60 percent cover GLP-1s for diabetes, 36 percent for weight loss; 5 to 10 percent of those covering weight loss plan to drop it in 2027. |
| Carrier action (healthinsurance.org, August 20, 2026) | BCBS Massachusetts excluded Wegovy, Saxenda and Zepbound from plans renewing on or after January 1, 2026. |
The practical consequence: two employees with identical UnitedHealthcare cards can have opposite answers. The Summary of Benefits and the plan's prescription drug list, not the carrier's national formulary, decide.
If coverage fails: the real 2026 cash options
| Option (checked September 4 to 5, 2026) | Price | Fine print |
|---|---|---|
| Wegovy savings card (commercial insurance that covers Wegovy) | As little as $25 a month | Maximum savings $100 per month; not for Medicare or Medicaid |
| Wegovy pen, NovoCare Pharmacy self-pay | $199 a month for a new patient's first two fills, then $349 | New patients through December 31, 2026 |
| Wegovy HD 7.2 mg | $399 self-pay | No insurance coverage available yet (NovoCare) |
| Wegovy pill | $149 (1.5 mg), $199 (4 mg, after August 31, 2026), $299 (higher strengths) | NovoCare Pharmacy |
| Medicare GLP-1 Bridge | $50 a month | Pen or pill; obesity criteria; no type 2 diabetes |
| Retail with no offer | About $1,639 | GoodRx, September 4, 2026 |
| Compounded semaglutide, 14-provider median | $197 month one (range $88 to $299); $224 month four | FormBlends price index, September 3, 2026; not FDA-approved |
| FormBlends compounded semaglutide (our own row) | Current price on the product page and in our price index | Same index rules as every other provider |
For the first two months the manufacturer's own $199 pen price is close to the compounded median; from month three the $349 pen price is well above the $224 compounded median in the Compounded GLP-1 Price Index. Compounded semaglutide is not FDA-approved, and FDA counted 990 adverse-event reports for it as of May 31, 2026.
Marketplace (ACA) plans almost never cover it
Individual and family plans bought on the ACA Marketplace are the weakest payer for obesity drugs. healthinsurance.org (August 20, 2026) reports that in 2024 only 1 percent of Marketplace plans covered Wegovy or Saxenda for weight loss and none covered Zepbound, and that in 2026 just 26 of about 300 Marketplace carriers offer any obesity-medication coverage. If you buy your own coverage, assume Wegovy is excluded and price the NovoCare self-pay route ($199 then $349 for the pen, $149 to $299 for the pill) before open enrollment.
FAQ
What insurance covers Wegovy?
Most major commercial insurance carriers (BlueCross BlueShield, UnitedHealthcare, Aetna, Cigna, Humana) cover Wegovy on their standard formularies with prior authorization. However, coverage depends on your specific plan. Self-funded employer plans may exclude Wegovy even if the carrier's standard formulary includes it.
Does Medicare cover Wegovy?
Since July 1, 2026, yes for many enrollees. The Medicare GLP-1 Bridge covers the Wegovy pen and pill at a $50 copay per 30-day supply through December 31, 2027 for people with a BMI of 35 or higher, or 30 or 27 with specific conditions, and excludes anyone with type 2 diabetes, moderate to severe sleep apnea or MASH (CMS, August 6, 2026). The 2003 statutory exclusion still bars ordinary Part D coverage outside the Bridge.
Does Medicaid cover Wegovy?
Coverage varies by state and is shrinking. KFF counted 13 states covering GLP-1s for obesity as of January 2026: Delaware, Kansas, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Rhode Island, Tennessee, Utah, Virginia and Wisconsin (list per SingleCare, May 21, 2026). MassHealth ended coverage July 1, 2026, Rhode Island ends it in October 2026, and Michigan now requires a BMI of 40 or higher.
Does Blue Cross Blue Shield cover Wegovy?
Most BCBS plans cover Wegovy with prior authorization, typically on Tier 4 specialty. However, BCBS operates as 35 independent companies, and coverage varies by state and plan. Employer self-funded plans administered by BCBS can exclude Wegovy.
Does UnitedHealthcare cover Wegovy?
UnitedHealthcare's commercial policy effective September 1, 2026 covers Wegovy injection and tablet with prior authorization for patients 12 and older with a BMI of 30 or higher, or 27 with a comorbidity, used alongside lifestyle modification; approval is 5 months, renewable for 12 months at 5 percent weight loss. Self-funded employer plans can still exclude it, so check your plan's prescription drug list.
Why was my Wegovy prior authorization denied?
The reasons plan criteria actually test for are lifestyle modification not documented in the chart, BMI below the threshold or a comorbidity not accepted by the plan, missing labs that prove the comorbidity, an out-of-network prescriber, or a self-funded plan that excludes weight-loss drugs entirely. No carrier publishes a Wegovy denial breakdown; the percentages printed here earlier were unsourced and have been removed. Appeals with the missing documentation are the usual fix.
How much does Wegovy cost with insurance?
Out-of-pocket cost ranges from $25 to $500 per month depending on your formulary tier, deductible status, and coinsurance percentage. The most common range is $150 to $400 per month for patients on Tier 4 specialty with 20-30% coinsurance.
Does TRICARE cover Wegovy?
Yes. TRICARE covers Wegovy for active-duty service members and beneficiaries with prior authorization. Copay is $29 per month at network pharmacies. TRICARE is one of the most generous payers for Wegovy.
Does the VA cover Wegovy?
Yes. The VA added Wegovy to its national formulary in 2024. Prior authorization is required. Copay is $0 to $11 depending on the veteran's priority group and disability rating.
Can I use a Wegovy savings card with insurance?
Yes, if you have commercial insurance that covers Wegovy. The Wegovy savings card brings the copay to as little as $25 a month with a maximum savings of $100 per month (NovoCare, seen September 4, 2026). It cannot be combined with Medicare, Medicaid or other government coverage. An earlier version of this answer said the card was discontinued in 2023; that was wrong.
What if my insurance covers Ozempic but not Wegovy?
Ozempic is FDA-approved for type 2 diabetes, not weight loss. If you have type 2 diabetes, your provider can prescribe Ozempic, and insurance will cover it. Using Ozempic off-label for weight loss without a diabetes diagnosis may result in claim denial or audit.
How long does Wegovy prior authorization take?
Novo Nordisk's NovoCare coverage page says a Wegovy prior authorization can take up to 10 business days. If denied and appealed, plan appeal timelines add weeks. For Medicare's GLP-1 Bridge, CMS says the pharmacy transmits the request within 24 to 72 hours and a decision comes within 72 hours, with resubmission but no appeal.
Does insurance cover Wegovy for prediabetes?
Most plans require either BMI ≥30 alone or BMI ≥27 with a weight-related comorbidity. Prediabetes (A1C 5.7-6.4%) qualifies as a comorbidity under most plans' criteria. However, the provider must document the prediabetes diagnosis with recent lab work.
What happens if I lose insurance coverage while on Wegovy?
You can buy Wegovy directly from NovoCare Pharmacy ($199 a month for a new patient's first two pen fills then $349; pill from $149; seen September 4, 2026), switch to compounded semaglutide (14-provider median $197 month one, $224 month four in the FormBlends price index, September 3, 2026), or stop treatment. Any switch between products should be handled with your prescriber.
Can I appeal a Wegovy prior authorization denial?
Yes. Your provider submits the appeal with the missing documentation (lifestyle-modification notes, lab work proving the comorbidity, BMI measurements). We no longer print an appeal success rate because the 62 percent figure used here earlier could not be verified. Timelines are set by your plan and state law; Lilly and Novo Nordisk both publish appeal letter templates.
Does insurance cover the Wegovy pill?
Where a plan covers Wegovy at all, the tablet is generally treated like the injection. UnitedHealthcare's policy effective September 1, 2026 lists Wegovy injection or tablet under the same criteria (age 12 or older, BMI 30 or 27 with a comorbidity, lifestyle modification) with a 5-month initial approval, and notes the tablet may be excluded at launch on some formularies. Medicare's GLP-1 Bridge covers the pill at $50. Self-pay is $149, $199 or $299 by strength (NovoCare, September 4, 2026).
Will insurance cover Wegovy for fatty liver disease?
Some plans now do, for the injection only. UnitedHealthcare's September 1, 2026 policy covers Wegovy injection for metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced fibrosis (stage F2 or F3), with renewal tied to a positive clinical response rather than weight loss. Medicare's GLP-1 Bridge excludes MASH patients, who use regular Part D. Humana covers Wegovy for the cardiovascular and MASH indications only (SingleCare, May 21, 2026).
Will insurance cover Wegovy for high cholesterol?
Only as the comorbidity that qualifies you at a BMI of 27 to 29.9. UnitedHealthcare's September 1, 2026 policy names dyslipidemia first among its example comorbidities, alongside hypertension, type 2 diabetes and sleep apnea, so documented high cholesterol plus a BMI of 27 or higher meets the criterion. High cholesterol alone, without the BMI threshold, does not qualify under any policy we found, and Medicare's Bridge does not accept dyslipidemia at BMI 27.
How do I get Wegovy for $25 a month?
Through the Wegovy savings card, which requires commercial insurance that covers Wegovy and an approved prior authorization; it lowers your copay to as little as $25 with a maximum savings of $100 per month (NovoCare eligibility page, seen September 4, 2026). It cannot be used with Medicare or Medicaid. If your plan does not cover Wegovy, the closest alternatives are Medicare's $50 Bridge copay for eligible enrollees or NovoCare's $199 self-pay pen price for the first two fills.
Related guides
- What Insurances Cover Weight Loss Medications: The 2026 Coverage Reality by Plan Type
- What Insurance Covers Wegovy Pill in 2026? The Real Coverage Map by Plan Type
- What Health Insurance Covers Zepbound? The Complete 2026 Coverage Map by Plan Type
- What Insurances Cover Zepbound in 2026: The Complete Payer-by-Payer Coverage Map
- What Insurances Cover Ozempic in 2026: The Complete Coverage Map
- Does Insurance Cover Wegovy in 2026? What Every Plan Type Actually Pays
- Tool: cost calculator
Sources
- UnitedHealthcare. Pharmacy prior authorization notification: weight loss, effective September 1, 2026. https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/drugs-pharmacy/commercial/r-z/PA-Notification-Weight-Loss.pdf
- Lincoff AM et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT trial). New England Journal of Medicine. 2023.
- Centers for Medicare and Medicaid Services. Medicare GLP-1 Bridge, information for providers, last updated August 6, 2026. https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-providers
- Kaiser Family Foundation. Employer Health Benefits Survey. 2025.
- healthinsurance.org. Does health insurance cover drugs used for weight loss? (2026 survey of 307 employers), updated August 20, 2026. https://www.healthinsurance.org/faqs/does-health-insurance-cover-drugs-used-for-weight-loss-such-as-ozempic-wegovy-mounjaro-and-zepbound/
- Removed September 2026: a multi-payer PA analysis (Hendricks et al., Obesity 2025) cited here earlier could not be located; the denial and appeal percentages attributed to it have been deleted.
- Novo Nordisk. Wegovy prescribing information. 2024.
- Novo Nordisk, NovoCare. Check your Wegovy coverage (PA up to 10 business days; no insurance coverage yet for 7.2 mg), seen September 5, 2026. https://www.novocare.com/patient/medicines/wegovy/check-coverage.html
- Centers for Medicare & Medicaid Services. Medicare Prescription Drug Benefit Manual, Chapter 6. 2024.
- Congressional Budget Office. Cost estimate for H.R. 1577, Treat and Reduce Obesity Act. 2025.
- Office of Personnel Management. Federal Employees Health Benefits Program carrier letter on obesity medication coverage. 2024.
- Express Scripts. National Preferred Formulary. 2026.
- Department of Veterans Affairs. VA National Formulary. 2024.
- 42 U.S.C. § 1395w-102(e)(2)(A). Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
- UnitedHealthcare. Pharmacy prior authorization notification: weight loss (Wegovy, Zepbound, Contrave and others), effective September 1, 2026. https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/drugs-pharmacy/commercial/r-z/PA-Notification-Weight-Loss.pdf
- Novo Nordisk, NovoMedLink. Understanding Wegovy access (CVS Caremark and Aetna formulary status effective July 1, 2025; MMIT data May 1, 2025), seen September 5, 2026. https://www.novomedlink.com/obesity/products/treatments/wegovy/cost-coverage/understanding-wegovy-access.html
- healthinsurance.org. Does health insurance cover drugs used for weight loss such as Ozempic, Wegovy, Mounjaro and Zepbound? (employer survey, Medicaid exits, Marketplace data), updated August 20, 2026. https://www.healthinsurance.org/faqs/does-health-insurance-cover-drugs-used-for-weight-loss-such-as-ozempic-wegovy-mounjaro-and-zepbound/
- Centers for Medicare and Medicaid Services. Medicare GLP-1 Bridge: information for providers (July 1, 2026 to December 31, 2027; Wegovy, Zepbound KwikPen, Foundayo; BMI criteria; 72-hour decisions), last updated August 6, 2026. https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-providers
- Medicare.gov. Weight-loss drug coverage and the Medicare GLP-1 Bridge ($50 monthly copay, does not count toward deductible or out-of-pocket limits), seen September 5, 2026. https://www.medicare.gov/coverage/weight-loss-drugs
- KFF. What to know about the BALANCE model for GLP-1s in Medicare and Medicaid, May 11, 2026. https://www.kff.org/medicare/what-to-know-about-the-balance-model-for-glp-1s-in-medicare-and-medicaid/
- KFF. Medicaid coverage of and spending on GLP-1s (13 states covered obesity use as of January 2026), January 2026. https://www.kff.org/medicaid/medicaid-coverage-of-and-spending-on-glp-1s/
- SingleCare. How to get Wegovy covered by insurance (13 Medicaid states listed), May 21, 2026. https://www.singlecare.com/blog/how-to-get-wegovy-covered-by-insurance/
- KFF. 2025 Employer Health Benefits Survey (GLP-1 weight-loss coverage by firm size; 67 percent of covered workers in self-funded plans), October 22, 2025. https://www.kff.org/health-costs/2025-employer-health-benefits-survey/
- Novo Nordisk. What to pay for Wegovy (self-pay pen $199 for the first two fills then $349, Wegovy HD $399, pill $149, $199, $299; savings card $25 with $100 monthly maximum), seen September 4, 2026. https://www.wegovy.com/obesity/what-to-pay-for-wegovy.html
- Novo Nordisk, NovoCare. Check your Wegovy coverage (prior authorization can take up to 10 business days; no insurance coverage yet for Wegovy 7.2 mg; Medicare GLP-1 Bridge $50), seen September 5, 2026. https://www.novocare.com/patient/medicines/wegovy/check-coverage.html
- Novo Nordisk, NovoCare. Wegovy savings card eligibility ($25 with coverage, $100 a month maximum savings), seen September 4, 2026. https://www.novocare.com/eligibility/wegovy-savings-card.html
- Penn LDI. Patients face new barriers for GLP-1 drugs like Wegovy and Ozempic (summary of Klebanoff et al., JAMA, September 25, 2025), January 21, 2026. https://ldi.upenn.edu/our-work/research-updates/patients-face-new-barriers-for-glp-1-drugs-like-wegovy-and-ozempic/
- FormBlends. Compounded GLP-1 Price Index methodology and current medians, data as of September 3, 2026. https://formblends.com/report/data/compounded-glp1-price-index
Footer disclaimers
Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.
Compounded Medication Notice. Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products.
Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.
Trademark Notice. Wegovy, Ozempic, and Rybelsus are registered trademarks of Novo Nordisk A/S. BlueCross BlueShield, UnitedHealthcare, Aetna, Cigna, and Humana are trademarks of their respective owners. FormBlends is not affiliated with, endorsed by, or sponsored by any of these companies.
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