Understanding BCBS GLP-1 Coverage and Cost Options

If you have Blue Cross Blue Shield (BCBS) insurance, you may be eligible for coverage of GLP-1 medications, which can help manage type 2 diabetes.

BCBS coverage of GLP-1 medications varies by state and plan, with some plans covering certain medications and others not. For example, BCBS of Michigan covers medications like Victoza and Trulicity, but BCBS of California may have different coverage options.

To find out what GLP-1 medications are covered by your BCBS plan, you can check your plan's website or contact your insurance provider directly. This will give you a clear understanding of what medications are covered and what out-of-pocket costs you may incur.

BCBS plans often have a copayment or coinsurance for GLP-1 medications, which can range from $10 to $50 per prescription, depending on your plan and the medication prescribed.

To check if your BCBS plan covers weight loss medication, start by contacting your plan administrator. You can usually find their number on the back of your insurance card. If you're unsure about coverage, consider using NovoCare, a free insurance concierge offered by Novo Nordisk, the maker of Wegovy.

Some BCBS plans may classify weight loss medications as "non-formulary drugs", which means your healthcare provider will need to submit paperwork requesting coverage. This can include a "Coverage Request Letter" that your healthcare provider can use.

If your BCBS plan doesn't cover weight loss medication, there are still ways to save on the medication. For example, the Wegovy Savings Offer can cut the cost of Wegovy in half for eligible patients. You can also use prescription discount cards from sites like GoodRx, SingleCare, or Optum Perks.

To ensure approval for weight loss medication coverage, it's essential to maintain complete compliance with the standards outlined in the medical policy. This includes spacing diets under medical supervision for about 30 days and frequently needing to occur for several months. Failure to follow visits in consecutive calendar months can lead to denial or delay treatment.

Here are some questions to ask your BCBS plan administrator:

If your BCBS plan doesn't cover weight loss medication, you may want to consider alternative medications that are covered, such as Mounjaro (tirzepatide), Trulicity (dulaglutide), or metformin.

To understand Wegovy coverage details, it's essential to know that BCBS plans may cover Wegovy, but the specifics can vary. You can contact your plan directly or use NovoCare, a free insurance concierge offered by Novo Nordisk, to get the details on your insurance coverage for Wegovy.

To check if BCBS covers Wegovy, you can usually find their number on the back of your insurance card. You may also want to review your plan's drug formulary to see how BCBS categorizes Wegovy.

Wegovy is typically categorized as a Non-Preferred Brand drug by BCBS plans, which may result in a higher copay. For example, BlueCross BlueShield of Texas and Blue Cross Blue Shield of Michigan both categorize Wegovy as a Non-Preferred Brand drug.

Prior authorization is often required for Wegovy coverage, even if your BCBS plan covers the medication. This means your healthcare provider will need to fill out a document and submit it to your BCBS health plan to request coverage.

Here's a summary of the coverage details for Wegovy:

Keep in mind that coverage limits and copays can vary depending on your specific BCBS plan. It's essential to review your plan's details and ask questions about coverage limits, copays, and any other requirements.

To verify your BCBS coverage for GLP-1 medications like Wegovy and Ozempic, contact your plan directly or use NovoCare, a free insurance concierge offered by Novo Nordisk.

You can also review your plan's drug formulary, but be aware that these get updated regularly. Check the date on the formulary to ensure you're looking at the most recent version.

If your BCBS plan doesn't cover Wegovy, you may still be able to save on the medication through the Wegovy Savings Offer, which cuts the cost in half for eligible patients.

Here are some options to consider if your BCBS insurance won't cover Ozempic:

Your price for GLP-1 medications can depend on your insurance coverage, the pharmacy you use, and whether you are eligible for any savings programs or pharmacy discounts. For example, the list price for Wegovy is $1,349.02 for a month's supply, while Ozempic costs $968.52 for a 30-day supply.

To be eligible for Wegovy, your healthcare provider will measure your body mass index (BMI) to determine if you have obesity or overweight. Obesity is defined as a BMI of 30 or greater, while overweight is defined as a BMI of 27 or greater.

The US Food & Drug Administration (FDA) has approved Wegovy for two indications: to reduce excess body weight and maintain weight reduction long term in people ages 12 and older with obesity or overweight, and to reduce the risk of heart attack, stroke, or cardiovascular death in adults with existing heart disease and obesity/overweight.

To meet the eligibility criteria, you must have a BMI that falls within one of these two categories. Your healthcare provider will use this information to determine if you're a good fit for Wegovy.

Here are the specific BMI categories that qualify for Wegovy eligibility:

If your BCBS insurance won't cover Wegovy, there are still ways to save on the medication.

You can take advantage of the Wegovy Savings Offer, which cuts the cost of Wegovy in half for eligible patients. You can learn more about this offer online.

Sites like GoodRx, SingleCare, and Optum Perks offer prescription discount cards for various pharmacies.

Enrolling in a clinical trial may give you free access to Wegovy, but depending on the trial terms, you may not know if you are getting Wegovy or a placebo.

Compounded semaglutide may be an option during a drug shortage. Though they are not approved by the FDA, compounded medications are allowed under federal law. Companies such as Ro offer compounded semaglutide if you qualify.

If your BCBS plan doesn't cover Wegovy, it might cover a cheaper alternative for weight loss. Talk to your plan administrator and your healthcare provider about your options.

Here are some ways to save on Wegovy without insurance coverage:

Your best next steps are to talk to your healthcare provider and plan administrator about your options and to explore these alternative ways to save on Wegovy.

The cost of BCBS GLP-1 coverage can vary significantly, with Wegovy's list price being $1,349.02 for a month's supply, while Ozempic's list price is $968.52 for a 30-day supply.

Prior authorization is often required for Wegovy coverage, which means your healthcare provider will need to fill out a document on your behalf and submit it to your BCBS health plan.

If your BCBS insurance doesn't cover Wegovy, there are still ways to save on the medication, including the Wegovy Savings Offer, which cuts the cost in half for eligible individuals.

You can also use prescription discount cards from sites like GoodRx, SingleCare, and Optum Perks to reduce the cost of Wegovy.

If your BCBS plan doesn't cover Wegovy, it might cover a cheaper alternative for weight loss, so it's worth talking to your plan administrator and healthcare provider about your options.

Here are some potential costs to consider:

If you're unable to afford weight loss medication, working with a healthcare professional to develop a personalized weight-loss strategy can be a more affordable and effective option in the long run.