TRICARE Wegovy coverage remains available for TRICARE Prime and TRICARE Select enrollees when a TRICARE-authorized provider submits an approved prior authorization and the prescription is filled at a network pharmacy [1][3]. The form is not a quick checkbox. It asks for age 18 or older, BMI of 30 or higher, or BMI of 27 or higher with a listed comorbidity, at least 6 months of behavioral modification and dietary restriction, and a failed 3-month generic anorexiant trial unless contraindicated [4]. TRICARE For Life and direct-care-only beneficiaries are excluded as of August 31, 2025 [1][2].

Does your TRICARE plan still include Wegovy coverage?

The plan split comes first. TRICARE Prime and TRICARE Select enrollees keep weight loss medication coverage in certain circumstances, including Prime Remote and the Young Adult, Reserve Select, and Retired Reserve variants [2]. The coverage lane requires a prescription from a TRICARE-authorized provider, a network pharmacy, and a maintained prior authorization [1][3]. Wegovy is one of the weight loss medications listed for Prime and Select beneficiaries with an approved prior authorization [3].

TRICARE For Life is a different answer. As of August 31, 2025, TRICARE For Life and direct-care-only beneficiaries, along with NATO or Partnership for Peace members, lost weight loss drug coverage. Their approved prior authorizations are no longer valid [1][2]. Weight loss drug prescriptions cannot be filled at military pharmacies, and an excluded beneficiary pays 100% of the cost elsewhere, even with a previously approved prior authorization [1].

The August 2025 TRICARE change explains the plan split. If you have TFL, the TRICARE For Life weight loss coverage guide addresses that separate lane. The broader coverage hub keeps the program rules together.

What does the Wegovy prior authorization form require?

The Express Scripts TRICARE prior authorization request form covers semaglutide injection, Wegovy, and tirzepatide injection, Zepbound. Its adult pathway applies at age 18 and older [4]. For Wegovy, the form requires a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related comorbidity [4].

The listed comorbidities are diabetes, impaired glucose tolerance, dyslipidemia, hypertension, and sleep apnea [4]. Your provider needs the BMI and the relevant health history documented in the request. The form does not treat BMI as the only gate.

It also asks for at least 6 months of behavioral modification and dietary restriction that failed to reach the desired weight loss, with continued engagement through the course of therapy [4]. That means your history should show what you did, when you did it, and how your provider documents the result.

The form asks for a 3-month trial of a generic anorexiant, such as phentermine, benzphetamine, diethylpropion, or phendimetrazine, that failed to achieve a 5% reduction in baseline weight [4]. The form allows an exception when you have a contraindication or a prior adverse reaction to those drugs [4]. Do not assume the exception applies without documentation. Your provider must explain the relevant reason in the request.

What records should you gather before your provider submits?

Start with the artifacts that answer each question on the form. Your current height and weight support the BMI calculation. The medical record should identify diabetes, impaired glucose tolerance, dyslipidemia, hypertension, or sleep apnea when one of those is the reason you qualify at a BMI of 27 or higher [4].

For the behavioral modification and dietary restriction requirement, gather the history showing at least 6 months of participation and the result that did not reach the desired weight loss [4]. The form also asks whether you stayed engaged through the course of therapy [4]. A brief statement that you tried to lose weight may not answer those fields. Your provider needs the documented history that matches the form.

For the generic anorexiant requirement, gather the medication history for the 3-month trial and the baseline weight used to measure the 5% result [4]. If the trial was not appropriate because of a contraindication or a prior adverse reaction, gather the clinical documentation that explains that exception [4].

The request also has boundaries. Uses outside the FDA label, including diabetes, are not approved through the weight loss form [4]. Wegovy cannot be combined with another GLP-1 medication such as Trulicity, Ozempic, or Mounjaro under this request [4]. Those are form rules, not a suggestion to change any medication plan. Your provider and the official TRICARE source have the final word.

What is the full TRICARE Wegovy checklist?

Use this checklist in the same order as the prior authorization form. Give each item to your provider as a record, not as a conclusion you make on your own.

  • Age 18 or older, supported by the patient record for the adult pathway [4]
  • BMI of 30 or higher, supported by the current height and weight record, or BMI of 27 or higher with at least one listed comorbidity [4]
  • Diabetes, impaired glucose tolerance, dyslipidemia, hypertension, or sleep apnea documented when the BMI is 27 or higher [4]
  • At least 6 months of behavioral modification and dietary restriction documented, with the desired weight loss not reached [4]
  • Continued engagement through the behavioral modification and dietary restriction course documented [4]
  • A 3-month trial of a generic anorexiant documented, with failure to achieve a 5% reduction in baseline weight [4]
  • A contraindication or prior adverse reaction documented when the generic anorexiant trial does not apply [4]
  • The request identifies Wegovy under the weight management pathway rather than an outside-the-FDA-label use [4]
  • The medication record shows Wegovy will not be combined with Trulicity, Ozempic, or Mounjaro [4]
  • The prescription comes from a TRICARE-authorized provider and will be filled at a network pharmacy [1][3]
  • The prior authorization request is submitted to the pharmacy contractor for review [4]

This checklist can show you where a request is incomplete before it reaches the review stage. It cannot predict the result. The form is the controlling document for the request, and the official TRICARE source decides what the plan covers.

How long does Wegovy coverage last after approval?

The TRICARE form states that initial therapy approves for 12 months [4]. That is the initial period described on the form, not a permanent authorization. Annual renewal is required [4].

The renewal request asks for documented weight loss since starting the medication [4]. Keep the records your provider will need to show that result. The form does not turn renewal into an automatic continuation. It asks for documentation and sends the request through review again.

The form also limits what this weight management pathway can cover. Uses outside the FDA label, including diabetes, are not approved through the weight loss form [4]. TRICARE separately covers Ozempic, Mounjaro, Trulicity, and Victoza for all patients to treat diabetes when medically necessary [1]. That is a different coverage question from Wegovy under the weight management pathway. Do not combine those rules into one GLP-1 answer.

If your plan is Prime or Select, your provider should use the current TRICARE prior authorization form and confirm the network pharmacy requirement [1][3]. If you are TFL or direct-care only, the August 31, 2025 exclusion applies instead. The official plan source has the final word, and a prior authorization that existed before the change does not restore coverage for an excluded beneficiary [1][2].

What to do next

Written for a TRICARE Select enrollee starting the paperwork this week:

  1. Confirm that your enrollment is TRICARE Select, not TRICARE For Life or direct-care-only access.
  2. Ask your provider to use the current Express Scripts TRICARE prior authorization request form for Wegovy and Zepbound [4].
  3. Gather the current height and weight record needed for the BMI field.
  4. Mark the listed comorbidity in your medical history if your BMI is 27 or higher, diabetes, impaired glucose tolerance, dyslipidemia, hypertension, or sleep apnea [4].
  5. Gather records showing at least 6 months of behavioral modification and dietary restriction, including the result that did not reach the desired weight loss [4].
  6. Gather the 3-month generic anorexiant trial and the baseline weight used to assess the 5% result, or the documentation of a contraindication or prior adverse reaction [4].
  7. Ask your provider to document that the request is for the weight management pathway and not an outside-the-FDA-label use [4].
  8. Confirm that your medication history does not combine Wegovy with Trulicity, Ozempic, or Mounjaro under this request [4].
  9. Confirm that the prescription will come from a TRICARE-authorized provider and go to a network pharmacy [1][3].
  10. Keep the submitted form, supporting records, and any denial letter with your plan documents for the annual renewal.

Sources

  1. TRICARE, Weight Loss Products coverage page, plan eligibility, military pharmacy rules, and medically necessary diabetes coverage, accessed 2026-08-01, https://tricare.mil/weightlossproducts
  2. myAirForceBenefits, TRICARE coverage of weight loss medications, the August 31, 2025 coverage change, accessed 2026-08-01, https://myairforcebenefits.us.af.mil/TRICARE-Coverage-of-Weight-Loss-Medications-What-To-Know
  3. Express Scripts TRICARE pharmacy FAQ, GLP-1 and weight loss coverage, covered plans and network pharmacy requirements, accessed 2026-08-01, https://militaryrx.express-scripts.com/faq/are-glucagon-peptide-1-glp-1-and-weight-loss-medications-covered-through-tricare-pharmacy
  4. Express Scripts, TRICARE prior authorization request form for Wegovy and Zepbound, eligibility criteria, documentation, approval period, and renewal requirements, accessed 2026-08-01, https://www.express-scripts.com/interaction/member-proxinator/1/member/v1/drugpricing/prelogin/fst/drug/forms/content?repository=EIS_P8_DC%3AesiCPS&documentId=%7BE0E89991-0000-CF1F-9F1E-DF770B00E0D2%7D