Wegovy Prior Authorization Resources

Find the right PA form for your patient's payer, get the ICD-10 codes you need, and download appeal templates — all in one place.

Last verified: Apr 24, 2026

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated Apr 24, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated Apr 24, 2026
California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated Apr 24, 2026
Cigna - General Medication Prior Authorization FormCigna Corporation · Updated Apr 24, 2026
Colorado - Uniform Prior Authorization FormColorado · Updated Apr 16, 2026

ICD-10 codes for Wegovy Prior Authorizations

E66.9Obesity, unspecified
E66.0Obesity due to excess calories
E66.01Morbid (severe) obesity due to excess calories
K75.81Nonalcoholic steatohepatitis (NASH)
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