Foundayo - Weight Loss - Glucagon-Like Peptide-1 Agonists - Coverage Policy Number IP0206

Oct 13, 2026

Drug Coverage Policy defining Cigna health-benefit coverage guidance for Foundayo, a GLP-1 receptor agonist, used with a reduced-calorie diet and increased physical activity to reduce excess body weight and sustain weight reduction long term. Eligibility includes adults with overweight plus at least one weight-related comorbidity and adults with obesity; concomitant use with another GLP-1 agonist is not recommended. Coverage decisions rely on the member plan document terms, applicable laws, and the stated criteria, including covered diagnosis and procedure codes. Dosing starts at 0.8 mg once daily and is titrated through subsequent dose levels after at least 30 days, with a maximum of 17.2 mg once daily.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages12

Reading Time4 min

AccessFree to download

Overview

Dosing

Guidelines

Instructions for Use

Drug Coverage Policy Effective Date ..................09/01/20 26 Coverage Policy Number.......... IP0206 Policy Title…………………….….Foundayo Weight Loss – Glucagon-Like Peptide-1 Agonists – Foundayo • Foundayo ™ (orforglipron tablets – Eli Lilly) INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clientsand do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Policy. In the event of a conflict, a customer’s benefit plan document always supersedes the information in the Coverage Policies. In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including Coverage Policies and; 4) the specific facts of the particular situation. Each coverage request should be reviewed on its own merits. Medical directors are expected to exercise clinical judgment where appropriate and have discretion in making individual coverage determinations. Where coverage for care or services does not depend on specific circumstances, reimbursement will only be provided if a requested service(s) is submitted in accordance with the relevant criteria outlined in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s). Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this Coverage Policy (see “Coding Information” below). When billing, providers must use the most appropriate codes as of the effective date of the submission. Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered. Coverage Policies relate exclusively to the administration of health benefit plans. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. Overview Foundayo is a glucagon-like peptide-1 (GLP-1) receptor agonist indicated in combination with a reduced-calorie diet and increased physical activity to reduce excess body weight and maintain weight reduction long term in 1 : • Adults with overweight in the presence of at least one weight-related comorbid condition . • Adults with obesity. Concomitant use with another GLP-1 receptor agonist is not recommended.1 Dosing In the prescribing information for Foundayo, the recommended starting dose is 0.8 mg orally once daily (QD) .1 After ≥ 30 days on the 0.8 mg dose, increase the dose to 2.5 mg QD. After ≥ 30 days on the 2.5 mg dose, increase the dose to 5.5 mg QD. The dose may be increased to the next dose level (9 mg, 14.5 mg, or 17.2 mg QD) after ≥ 30 days on the current dose based on treatment response and tolerability. The maximum dose is 17.2 mg QD (reached on Day 151) . Guidelines Foundayo has not been addressed in guidelines . The American Ac

FAQs

What is Foundayo and what is it intended to do?

Foundayo is a GLP-1 receptor agonist indicated with a reduced-calorie diet and increased physical activity to reduce excess body weight and maintain weight reduction long term.

Who is eligible for coverage under this policy?

Coverage applies to adults with overweight with at least one weight-related comorbid condition and to adults with obesity. Concomitant use with another GLP-1 receptor agonist is not recommended.

How are coverage decisions made under this policy?

Coverage requests are reviewed based on the member benefit plan terms effective on the date of service, applicable laws/regulations, relevant collateral sources including Coverage Policies, and the specific facts of the situation, with reimbursement requiring submission aligned to covered diagnosis and/or procedure codes.

Oct 13, 2026

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