Commercial coverage
Does Humana cover Saxenda?
Saxenda (liraglutide) for weight loss / obesity — the Humana prior-authorization rule, source-cited.
Humana Saxenda PA criteria
Coverage splits by line of business; PA required wherever covered.
MEDICARE ADVANTAGE/Part D (dominant book): Part D statutorily EXCLUDES drugs for weight loss, so Wegovy/Zepbound/Saxenda are NOT covered for obesity alone.
Wegovy covered only via CV indication (established CVD - prior MI, ischemic stroke, or symptomatic PAD - with BMI >=27); Zepbound covered only via OSA indication (moderate-to-severe OSA, AHI >=15 on PSG or REI >=15 on home test, AND BMI >=27, per policy eff. 1/20/2025).
Separate Medicare GLP-1 Bridge (CMS demonstration, 7/1/2026 through 12/31/2027): Foundayo/Wegovy (all formulations) or Zepbound KwikPen for $50/30-day supply (not counting toward Part D deductible or $2,100 OOP cap); three-tier eligibility - BMI >=35 (any comorbidity); OR BMI >=30 with HFpEF, uncontrolled hypertension, or CKD stage 3a+; OR BMI >=27 with pre-diabetes, prior MI, prior stroke, or symptomatic PAD; provider attests lifestyle counseling given (not a member participation condition).
COMMERCIAL: ~Tier 3 with PA, subject to employer design (many exclude AOMs); per aggregators typically BMI >=30 OR 27-29.9 with comorbidity, ~3-6 month structured weight-management trial, age >=18, possible step therapy.
Source: CMS Medicare GLP-1 Bridge demonstration & KFF BALANCE/Bridge explainer; Humana pharmacy policies (PBM: Humana Pharmacy Solutions, in-house). View cited GLP-1 policy reference →
Frequently asked
- Does Humana cover Saxenda for weight loss / obesity?
- Varies by plan — PA required where covered. Coverage splits by line of business; PA required wherever covered. See the full source-cited criteria above. Per CMS Medicare GLP-1 Bridge demonstration & KFF BALANCE/Bridge explainer; Humana pharmacy policies (PBM: Humana Pharmacy Solutions, in-house), as of 2025-2026 (Zepbound OSA policy eff. 1/20/2025; Bridge 7/1/2026-12/31/2027; verified 2026-06-15) — confirm the member's current plan policy.
d3rx does not hold plan-specific pharmacy formularies or PBM prior-auth grids, so it cannot confirm a particular plan's GLP-1 coverage, tier, or PA criteria. The guidance below is the general, source-cited rule; confirm the specific plan's pharmacy formulary / PA policy for a binding answer.
Check Saxenda for another payer — or draft the PA
Run Saxenda + any payer in the GLP-1 PA lookup, or have Ask D3 draft a Humana-ready prior-authorization request with the right criteria and codes — free, no signup.