OSP News

The Blues Will Have Changes Coming for Select Weight Loss Drugs for Some Commercial Members

Posted: 06/28/2024

Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) are changing how they approach coverage of glucagon-like peptide-1 receptor agonist, known as GLP-1, drugs indicated for weight loss for their fully insured large group commercial members. These drugs include:

  • Saxenda® (liraglutide)
  • Wegovy® (semaglutide) 
  • Zepbound® (tirzepatide) 

Here’s what will change:

  • August 1, 2024 – Current prior authorizations for these drugs will end at midnight July 31. New prior authorization requests will be required, and new prior authorization criteria will be applied for these members for dates of service from August 1 through December 31, 2024. Some members will require new prescriptions to align with the new prior authorization criteria, if the original prescriber didn’t have an established relationship with the member or hasn’t seen the member in person. For members with a plan renewal date other than January 1, their new prior authorizations will end before their renewal dates, instead of December 31.
  • January 1, 2025 – Coverage for GLP-1 weight loss drugs for fully insured large group commercial members will end January 1, 2025. For members with a plan renewal date other than January 1, the coverage will end on the renewal date.

BCBSM and BCN are notifying members affected by these changes and their prescribers.

Click here to read the full article in the July 2024 Edition of BCBSM’s The Record.

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