Blue Cross Blue Shield does cover Ozempic and in 2024 had Ozempic on its “balanced drug list,” however, Ozempic is not a drug that is prescribed for either weight loss or without prior condition on behalf of BCBS. Ozempic, on its own, is usually listed at its suggested drug price of $935.77, which is a fairly substantial out-of-pocket cost for most patients.
Key Takeaways
Insurers are more likely to prescribe drugs like Ozempic for Type 2 diabetes than they are for weight-loss. Weight-loss alternative medications, like Wegovy, are more likely to be given to patients who are not showing signs of weight-loss with proper diet, exercise, and healthy lifestyle habits.
Out-of-pocket costs when covered by Blue Cross Blue Shield is usually anywhere from $7 to $11, making it an extremely enticing prescription to get covered (since when not covered and prescribed, can cost over $1,000 or usually suggested drug price of $935.77).
Does Blue Cross Blue Shield Cover Ozempic?
Yes, Blue Cross Blue Shield (BCBS) does cover Ozempic. However, there are some circumstances that may make it more complicated to get a prescription covered by Blue Cross Blue Shield (BCBS).
Weight Loss and Ozempic Coverage
Much like with Medicare coverage and those over the age of 55, Ozempic is usually not prescribed as part of any type of weight loss treatment. The reason why weight-loss drugs are often avoidant of coverage of prescriptions can actually be tracked all the way back to the 1990s. When the safety and effectiveness of obesity treatments was put into question. Consequently, the Medicare Prescription Drug, Improvement, and Modernization Act was passed in 2003 and went into effect in 2006.
The result was that many insurers started to treat weight loss medications with more restrictions. More commonly, you’ll need to be treated for Type 2 diabetes in order to get coverage of Ozempic on behalf of Blue Cross Blue Shield.
Type 2 Diabetes
Ozempic falls into a restrictive category of medications. According to some physicians, “The insurer may also require information on the patient’s glycemic control, including HbA1c levels, and sometimes documentation of concurrent lifestyle interventions such as diet and exercise.”
This means that you may also need to provide proof that other medications were not effective in treating your Type 2 diabetes in order to get prescribed Ozempic.
Tier 2 Drugs Under Blue Cross Blue Shield
Ozempic is considered a “Tier 2” drug. According to Blue Cross Blue Shield the tiers and rules are as follows:
Tier 1: Preferred generic drugs. Generic drugs have the same active ingredients and work the same way as the brand-name drugs they copy.
Tier 2: Non-preferred generic drugs. You will pay more for these generic drugs than for preferred generic drugs.
Tier 3: Preferred brand drugs.
On average, once covered, you’ll pay out-of-pocket around $7 to $11 for Tier 2 drug prescriptions.
How to Check Whether Blue Cross Blue Shield Covers Ezempic
The Blue Cross Blue Shield (BCBS) formulary found here (2024 version) shows coverage for Ozempic. However, you may need to dig into your specific policy and determine whether Type 2 diabetes treatment is covered under your insurance.
Blue Cross Blue Shield (BCBS) has been known to have comprehensive diabetes coverage and treatment. Including a recent partnership with Livongo that offers even more comprehensive diabetes treatment.
If you’re unsure whether your insurance covers any current or preexisting conditions of Type 2 diabetes, use the Blue Cross Blue Shield location finder to determine the appropriate customer support line to call.
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