Coverage Reminders for Glucagon-like Peptide-1 (GLP-1) Receptor Agonists
Due to a recent increase in media attention and drug shortages for some of the glucagon-like peptide-1 (GLP-1) receptor agonists, CareFirst BlueCross BlueShield, CareFirst BlueChoice, Inc. and all its subsidiaries and affiliates (collectively, “CareFirst”) wants to remind prescribers that OZEMPIC (semaglutide), TRULICITY (dulaglutide), RYBELSUS (semaglutide), and VICTOZA (liraglutide) are only covered for the treatment of type 2 diabetes mellitus.
To help ensure appropriate medication use and protect patient access, these medications may require prior authorization which includes provider attestation that the medication is being prescribed for type 2 diabetes. CareFirst reserves the right to request medical records or documentation to support attestations submitted as part of a prior authorization.
For members whose plan includes weight loss medications as a covered benefit, only GLP-1s that are FDA-approved to treat obesity are covered and must be obtained via specific prior authorization criteria that ensures appropriate use of those agents.
Additional information, including which medications require prior authorization, can be found online on our Pharmacy Prior Authorization page. For assistance with submitting a prior authorization, check out the Medication Prior Authorization interactive guide on the Learning and Engagement Center. You can find this training in the on-demand training section of the site. Select ‘CareFirst Essentials,’ followed by ‘Authorizations: Additional Information.’
For questions, please contact CareFirst Pharmacy Services at (800) 241-3371.