Weight Loss Coverage

Weight Loss Coverage

Obesity can lead to numerous chronic conditions, including Type 2 diabetes, high blood pressure, high cholesterol and cardiovascular disease. These conditions lead to an increased risk of heart attack and stroke. With such serious related issues, it is not surprising that many patients seek medical solutions when diet and exercise alone do not seem to help. While your health plan encourages you to live a healthy lifestyle and maintain a healthy weight, we want you to be aware that many medications prescribed for weight loss are typically not covered, although your individual plan may vary.

A number of medications used to treat Type 2 diabetes, called GLP-1s, are being prescribed by some doctors in an effort to aid weight loss in patients who do not have diabetes. Ozempic, Rybelsus, Trulicity, Victoza and Mounjaro are some of the GLP-1s that have been prescribed for weight loss. This has happened so frequently that shortages of these critical medications have occurred nationwide.

The U.S. Food and Drug Administration has not approved these medications for weight loss. Based on their policies, BlueChoice does not cover these for weight loss use, even if your specific plan covers weight loss medications.

To help ensure that GLP-1 products are being prescribed properly, our health plans require members to have a prior authorization (PA) before these medications will be covered under the pharmacy benefit.

PA Process Requirements
The PA process requires providers to submit documentation that the GLP-1 is being prescribed for someone with a diagnosis of Type 2 diabetes. The PA may also have other criteria to fulfill prior to the medication being approved.