This article is for providers prescribing GLP-1 medications for the treatment of type 2 diabetes
Coverage of Glucagon-like Peptide-1 (GLP-1) Receptor Agonists for the Treatment of Type 2 Diabetes pharmacy medical policy 056 changed from step therapy requirements to prior authorization on July 1, 2024.
This policy describes new coverage requirements for these medications. Now, we’re reaching out to members who were previously receiving these medications based on prior step therapy requirements on claims history only. Please read carefully.
What’s the policy?
This new policy went into effect on July 1, 2024 to require a covered diagnosis on authorization requests in order for Blue Cross to cover the following medications: Adlyxin, Bydureon, Byetta, Mounjaro, Ozempic, Rybelsus, Soliqua, Trulicity, Victoza, and Xultophy.
Who this affects
Members who have the Blue Cross Blue Shield of Massachusetts formulary and have received coverage of diabetic GLP-1 medications based only on medication claims look back history. Coverage for these members will end on December 31, 2024. An authorization will be required for continued use.
What to do
We’re contacting members who will be impacted by this change and will require an authorization after December 31. If your patient needs to continue with the medication, please request an authorization.
If we receive any new coverage requests for these members prior to the December 31, 2024 end date, we’ll review the request against the new criteria. We’ll deny coverage for any non-covered diagnoses and the member will be responsible for the full cost of the medication.
If you have previously submitted an authorization and received an approval for a member based on the new policy requirements that went into effect on July 1, 2024, you do not need to resubmit for authorization.Resources
News Alert: Medication coverage changes starting Jan 1. Log in and go to News. Sort by date to go to August 30 and look for the headline.
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