Obesity and being overweight pose significant health risks, increasing the likelihood of developing chronic conditions such as diabetes, heart disease, osteoarthritis, musculoskeletal issues, and certain cancers. These conditions can negatively impact quality of life and reduce life span. Fortunately, advancements in weight management offer hope, and healthcare professionals play a vital role in guiding individuals toward safe and effective treatment. Cigna offers a range of programs and resources to support its members in their weight loss journeys. This article provides a detailed overview of Cigna's coverage for weight loss programs and medications, including Form Health, SafeGuardRx, and Omada, while emphasizing the importance of personalized approaches and lifestyle changes.
Cigna's Comprehensive Approach to Weight Management
Cigna recognizes that effective weight management requires a multifaceted approach. As a health care professional, you can help influence your patients’ health outcomes and encourage them to improve their health. Cigna Lifestyle Management programs can assist you by promoting early patient engagement, and providing support and coaching that can help your patients make lasting behavior changes. Cigna's programs aim to improve outcomes, increase retention, and enhance patient understanding of the guidance and support provided by healthcare professionals. Encourage your patients to learn what programs and benefits may be available to them through their Cigna medical plan.
Cigna offers various programs to address different aspects of healthy living:
Weight Management Program: This program employs a non-diet approach to weight loss, focusing on long-term lifestyle changes. It helps individuals build confidence, become more active, eat healthier, and change their habits.
Tobacco Cessation Program: This program helps patients gain the confidence and motivation they need to change their habits and stay tobacco free. The program helps your patients develop a personal plan that includes a realistic quit date and relapse prevention strategies. Over-the-counter nicotine replacement therapy is also provided.
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Stress Management Program: This program uses a flexible and motivational approach to help patients become aware of their sources of stress and how stress affects them mentally and physically, both on and off the job. Program options focus on changing behaviors through practical strategies that can help your patients cope better with their source of stress.
Patients can self-enroll in these programs as a telephone program that offers one-on-one coaching, or as an online program to learn at their own convenience. Encourage your patients to log in to myCigna.com (My Health > My Health Assistant) to learn more about these and other lifestyle management programs available to them through Cigna. They may also enroll by calling the toll-free number on the back of their ID card. For additional information, please call Cigna customer service at 1.800.88Cigna (882.4462).
Form Health: A Personalized Weight-Management Program
Recognizing that everyone's body is different, Form Health offers a personalized weight-management program tailored to individual medical history, lifestyle, and health goals. All SimplePay Health and Cigna plan members can use Form Health.
What to Expect from Form Health
Form Health pairs you with a physician and registered dietitian to help you meet your weight-management goals. If needed, weight-management medication is available through Form Health for those who qualify.
The program provides:
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- Doctors and dietitians who specialize in weight management.
- An achievable, sustainable plan developed collaboratively with your care team based on your unique needs.
- A strategy for eating habits, exercise, mindset changes, emotional support, and, when appropriate, FDA-approved medication.
- Convenient virtual care that works with your schedule, including regular video visits, text messaging, tracking tools, and educational resources-all within the Form Health app.
How Form Health Works and Eligibility
Body mass index (BMI) is a calculation of a person’s body fat based on their height and weight. It’s part of what Form Health uses to determine your eligibility for the program.
Eligibility requirements include:
- Current enrollment in a Cigna or SimplePay Health medical plan.
- A BMI that meets program requirements:
- Obesity program: Requires a BMI 30+ or a BMI 27+ with a weight-related medical condition (high blood pressure, diabetes, etc.).
- Overweight program (starting January 1, 2025): Requires a BMI of 25+.
You and your covered dependents age 18 and older all have access to Form Health. All Form Health medical services are billed through Cigna or SimplePay Health at no cost to you. Any prescribed medications are subject to cost sharing according to your plan’s prescription drug coverage.
Important Update: New Rules for Medication (Starting January 1, 2025)
As of January 1, 2025, any new GLP-1 weight-management medications must be prescribed by Form Health. Form Health only prescribes GLP-1 medications for weight management in accordance with FDA guidelines, including a careful consideration of your medical history. Even if you otherwise meet the criteria for weight-management treatment via a GLP-1 prescription, your medical history may mean that another treatment option is better for you.
To sign up, visit Form Health and select Sign up.
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Cigna's Coverage of GLP-1 Agonists and Other Weight-Loss Drugs
GLP-1 agonists are FDA-approved drugs for Type 2 diabetes or weight management. Injectable drugs called GLP-1 agonists have become popular lately, thanks to their high level of success in treating Type 2 diabetes (and their sometimes jaw-dropping side effect of extreme weight loss). These drugs work by stimulating the pancreas to produce more insulin, which helps lower blood glucose levels. They also tend to decrease appetite and slow digestion. Some of the most popular GLP-1 agonists available by prescription are Ozempic, Wegovy, Mounjaro, and Zepbound. Zepbound and Mounjaro contain the same active ingredient, tirzepatide, while Ozempic and Wegovy contain semaglutide. Each medication is approved by the Food and Drug Administration (FDA) for different health issues. Ozempic and Mounjaro are approved for the treatment of Type 2 diabetes, while Wegovy and Zepbound are approved for weight management in adults with obesity or who are overweight. In 2024, Wegovy received additional approval for lowering cardiovascular risk, and Zepbound was approved for treating moderate to severe obstructive sleep apnea in adults with obesity or who are overweight.
The FDA approval of a GLP-1 agonist often affects whether and how your insurance will cover the drug when it’s prescribed to you. If you have a Cigna health insurance plan, for example, it may cover Ozempic-but only when it’s prescribed for Type 2 diabetes since Ozempic isn’t FDA approved for weight loss. As for the GLP-1 agonists, Cigna coverage is a little trickier to parse through.
In general, yes, Cigna covers Ozempic as long as it’s prescribed for Type 2 diabetes. You may need to obtain prior authorization first, though, depending on your medical history. Ozempic is considered a first-line treatment for Type 2 diabetes only if you have cardiovascular disease (CV disease) or are at high risk for CV disease. However, you should always check that your specific plan benefits include potential coverage for GLP-1 agonists since all plans are different. Many Cigna plans will allow for coverage of Wegovy when prescribed for chronic weight management, though prior authorization and proof of medical necessity are required. Many Cigna plans would cover Mounjaro when it was prescribed for Type 2 diabetes only; coverage wouldn’t be approved for weight loss, Type 1 diabetes, diabetes prevention, or metabolic syndrome. Any Cigna coverage for Zepbound is evaluated using the same criteria as Wegovy, and just like Wegovy, prior authorization is required. Cigna may cover Zepbound for obstructive sleep apnea with prior authorization if other treatment methods have been ineffective. Coverage varies by plan, however.
Receiving any type of coverage is contingent upon your specific plan. Cigna is providing employers with some flexibility in choosing to cover GLP-1s for their employees, potentially offering cost-protection measures to employers to help mitigate their expenses. In 2025, Cigna announced that it would cap monthly out-of-pocket costs at $200 for Wegovy and Zepbound in an effort to convince more employer-sponsored health insurance plans to cover the drugs. Even if designated as excluded or not covered, these drugs are still included in Cigna’s formulary-the list of medications it will cover in some circumstances.
Alternative Weight-Loss Medications
If you don’t qualify for coverage of any of these GLP-1 agonists, there are other types of drugs and weight management tools specifically approved by the FDA for weight loss, like Alli, Contrave, Xenical, and Plenity. As we noted, these drugs are typically not covered by Cigna, but you may obtain coverage if you meet certain criteria. These policies change frequently.
Saving Money on Weight-Loss Medications
Without GLP-1 insurance coverage, there are other ways to save money on your medication. Many drug manufacturers have copay cards that allow qualifying patients to receive the drug at little or no cost (especially if the list price of the drug is costly), and most manufacturers also have patient assistance programs to help people find ways to cut down on their out-of-pocket expenses. Of course, you can also use a SingleCare prescription discount card to save money on weight-loss drugs like Mounjaro, Zepbound, Ozempic, and Wegovy.
SafeGuardRx for Cigna Weight Management Program
SafeGuardRx for Cigna is a program designed to drive down costs and improve health outcomes for people living with chronic conditions like asthma, diabetes and cardiovascular disease. The program provides one-on-one counseling and support for customers living with diabetes or pulmonary conditions. As part of an expansion to the SafeGuardRx program, Cigna is now offering clients the SafeGuardRx for Cigna Weight Management Program. This new program is designed to help customers develop personalized approach to their weight loss journey and avoid long-term health costs attributed to obesity. Patients get 24/7 access to online, live physician counseling (up to six free consultations) and prescriptions if appropriate through MDLIVE.
Omada for Cigna Customers
Medications for weight loss, however, are only one component of an effective comprehensive weight-loss plan. Long-term lifestyle shifts are a key part of a good treatment regimen. Omada for Cigna customers, for example, is an online program that inspires healthy, long-term habits for weight management. Omada’s approach combines science with personalized support and digital technology to help participants build healthy habits around eating, activity, sleep, and stress.
The Role of Healthcare Professionals in Weight Management
Health care professionals like physicians, nurses, health coaches, dieticians, and more, are key partners to the safe and effective treatment of obesity. These professionals are trained to provide medical assessment, management, counseling, and coordination of treatment. For example, health coaches can help patients determine diet, the right exercise plan, and more. Additionally, a health care professional can assess behavioral health risks factors associated with and possibly impacting a person’s weight management outcomes. “The people who are most successful in their weight-loss journeys are those who are working with a trained professional to learn how to make better food choices, dispel common food myths, track their macro and micronutrient intake, learn how to add meaningful exercise into their daily lives, and most importantly, work to create new, healthier habits that stick,”