This article is for prescribers of GLP-1 medications caring for our members
As previously communicated, starting on January 1, 2026 and as members renew their benefits throughout 2026, GLP-1 medications will only be covered for type 2 diabetes.
This exclusion from our pharmacy benefit means the member will no longer have coverage for GLP-1s for obesity1—even if we’ve covered the medication in the past or it’s been authorized. The only exception will be for members whose employer purchases a rider to continue coverage.
While many employers have yet to make a decision about their coverage, we wanted to let you know how we’re addressing GLP-1s in the short-term. We’d also like to answer questions we’ve received about this benefit exclusion. Please refer to our Frequently Asked Questions below.
July 1, 2025 formulary updates
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Name of formulary |
July 1 change |
|---|---|
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Blue Cross formulary |
Adding a dispensing limit of 30 days to GLP-1s listed in the medical policy 572 Drugs for Weight Loss and Cardiovascular Risk Reduction in Overweight and Obesity . Approximately 4,000 members were notified the week of May 19. The pharmacy will reduce the medication to a 30-day supply. No action is needed from prescribers, unless the member is out of refills or the prescription has expired. |
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Removing Zepbound from the formulary. Covered alternatives are: Orlistat, Qsymia, Saxenda, and Wegovy. New prescriptions for the covered alternative will not require a new authorization. The member’s existing authorization will be transferred to the covered alternative until the original expiration date. Approximately 2,000 members and their prescribers were notified in late May. |
Frequently asked questions: GLP-1 for obesity benefit exclusion
Below, you'll find answers to frequently asked questions about our plans to exclude GLP-1 medications for obesity from our pharmacy benefits starting on January 1, 2026 and upon health plan renewal throughout 2026.
Q: Which medications will be excluded from coverage?
A: GLP-1s used for obesity, such as Saxenda, Wegovy, and Zepbound.
Q: Which formularies will this coverage change (benefit exclusion) apply to?
A: It will apply to these formularies:
- Our Blue Cross formulary (used by commercial members with our pharmacy benefits and group Medex®’ members with a 3-tier pharmacy benefit)
- Standard Control with Advanced Control Specialty Formulary (managed by CVS Caremark and used by members in certain self-insured accounts)
Q: Can I request an exception or submit an appeal to have my patient covered for a GLP-1 for obesity?
A: No, we are not making exceptions, and coverage cannot be appealed because these medications will be benefit excluded. This means that GLP-1 medications used for obesity will not be part of our pharmacy benefits for members who use our Blue Cross formulary or the Standard Control with Advanced Control Specialty Formulary.
We’ll only cover GLP-1s for obesity if the member’s employer purchases a rider to continue this coverage.
Q: My patient is using Wegovy due to a cardiovascular condition. Will they continue to be covered?
A: No. Because we are excluding all GLP-1s for obesity (Saxenda, Wegovy, Zepbound) from our pharmacy benefits, this medication would no longer be covered for our member unless their employer purchased a rider to maintain coverage.
Q: My patient has an approved authorization for [Saxenda, Wegovy, Zepbound] that goes beyond their health plan renewal date. Do they have a grace period?
A: No. Once their health plan renews without coverage for a GLP-1 for obesity, any existing authorizations will also expire. For example, if the member has an authorization currently in place until April 1, 2026, but their health plan renews on January 1, 2026, their authorization for the medication will expire on January 1, 2026.
Q: When will my patients experience this change (benefit exclusion)?
A: That will depend on when their health plan benefits renew. If their health plan renews on January 1, 2026 (the majority of our members’ benefits renew on January 1), they will no longer have coverage for a GLP-1 for obesity (Saxenda, Wegovy, Zepbound) as of that date. Any authorizations they may have had for the medication will expire on their plan renewal date (in this example, on December 31, 2025), and the medication will be excluded from their benefits.
Q: Is Blue Cross continuing to cover GLP-1 medications used for type 2 diabetes, such as Ozempic?
A: Yes, we will continue to cover GLP-1 medications for type 2 diabetes, such as Liraglutide, Mounjaro, Ozempic, Rybelsus, and Trulicity. Authorization is required. Please refer to Glucagon-like Peptide-1 (GLP-1) Receptor Agonists and Related Drugs for the Treatment of Type 2 Diabetes pharmacy medical policy 056.
Q: What will members know about this benefit exclusion and when?
A: We expect to notify members approximately 60 days before their health plan benefits renew. We’ll provide more details on our member notification later this summer.
Q: Will I get a list of my patients who are affected by this change?
A: Lists of affected members will be shared with providers that are part of a large organized system or group.
Q: What happens if an employer purchases a rider to continue covering GLP-1s for obesity (Saxenda, Wegovy, Zepbound)?
A: Members who will continue to have coverage for GLP-1s for obesity will still need to meet medical policy and formulary requirements for coverage, such as BMI requirements, prior authorization, etc.
Questions?
If you have questions about this change, contact your network representative. If you have a question about a current medication authorization, you may call Pharmacy Operations at 1-800-366-7778.
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- We’re also benefit excluding the GLP-1s for obesity (Saxenda, Wegovy, Zepbound) for other clinical indications, such as heart disease prevention.