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Does Blue Cross Blue Shield cover Rybelsus?

Rybelsus is covered by some Blue Cross Blue Shield plans - here’s what you should know
Leandra Beabout
By | Apr. 18, 2025 Medically reviewed by Anne Jacobson, MD, MPH
Hand holding two white tablets: Does Blue Cross Blue Shield cover Rybelsus?

Key takeaways

  • Some BCBS enrollees get Rybelsus covered, but it depends on their specific insurance plan.

  • Whether BCBS covers Rybelsus depends on why it is prescribed, whether prior authorization requirements have been fulfilled, and, sometimes, whether a cheaper equivalent is available.

  • Without insurance or discounts, Rybelsus costs about $1,358 per month. With insurance coverage, out-of-pocket costs may be limited to a fixed copay.

  • Check your plan’s formulary (list of covered drugs) to determine if your BCBS plan covers Rybelsus.

In this article:

Rybelsus (semaglutide) is one of many drugs that are FDA-approved to lower blood sugar in people with Type 2 diabetes. It has the same active ingredient as popular injectable GLP-1 agonists such as Ozempic (also used for Type 2 diabetes) and Wegovy (used for weight loss). However, Rybelsus is the only GLP-1 agonist that comes in oral form. In all cases, semaglutide works by stimulating insulin production, thus lowering blood sugar and suppressing appetite. 

Like most brand-name medications, Rybelsus is expensive. Insurance coverage varies by provider, plan, and the reason for the prescription.

Does Blue Cross Blue Shield cover Rybelsus?

The short answer: Sometimes. Prescription drug benefits vary by health insurance plan, not insurance company. The Blue Cross Blue Shield (BCBS) system comprises 33 independent, locally operated BCBS companies with enrollees across all 50 states. Thus, it’s difficult to say whether a Blue Cross Blue Shield enrollee will get Rybelsus covered. 

Every health insurance plan includes a drug formulary. But even drugs listed on a plan’s formulary might be subject to coverage restrictions. There are a few factors that impact Rybelsus coverage, including the following:

  • The reason you’re taking it. Insurance plans typically only cover drugs when prescribed for their approved indication. The U.S. Food and Drug Administration has approved Rybelsus to improve glycemic control (blood sugar) in adults with Type 2 diabetes.
  • Whether you need prior authorization. Some BCBS plans will only cover Rybelsus after a prior authorization, or pre-authorization, process has been completed. Prior authorization involves communication between your healthcare provider and insurance provider about why Rybelsus is necessary for you. In most cases, your healthcare provider must initiate a prior authorization request.
  • Whether your prescription exceeds quantity limits. Some drug benefits are restricted by quantity limits. Talk to your prescriber if you are concerned that your prescription for Rybelsus exceeds the supply covered by your Blue Cross and Blue Shield Association plan (or plan provided by an independent licensee of Blue Cross).
  • Whether a generic or cheaper equivalent is available. Insurance plan formularies divide drugs into tiers of preferred and nonpreferred medications. Generic medicines are often preferred first, though brand-name medications without a generic equivalent might also be preferred. However, even preferred brand-name drugs often come with a higher out-of-pocket cost than generic drugs.

Does Blue Cross Blue Shield cover Rybelsus for weight loss?

Again, Rybelsus coverage varies by plan. However, in most cases, the criteria for insurance drug coverage is that the medication is being used for an FDA-approved purpose. 

“Rybelsus is only FDA-approved for diabetes, so insurance is unlikely to cover it for weight loss. However, if a patient has diabetes, then Rybelsus can be prescribed for both diabetes and weight loss,” explains Mir Ali, MD, a board-certified surgeon and the medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California.

When it comes to weight loss drugs, the only FDA-approved semaglutide product is Wegovy. Though they have the same active ingredient, Rybelsus and Wegovy are available in different forms. Rybelsus comes in oral tablets, but Wegovy is administered as a once-weekly injection. 

How much does Rybelsus cost?

Currently, the average retail price of a 30-day supply of 7-milligram (mg) tablets is $1,358. That means a person without insurance (including Medicare) or financial assistance could pay more than $16,000 annually for their Rybelsus prescription.

People with BCBS insurance plans typically pay a copay, a fixed out-of-pocket amount for prescription drugs. Copays vary across insurance companies and health plans. As with most insurance companies, BCBS plans have a higher copay for brand-name drugs than generic drugs. For instance, Blue Cross and Blue Shield’s Federal Employee Program Blue Basic Plan has a $15 copay for a 30-day supply of generics and $75 for preferred brand-name drugs.

How to check whether your Blue Cross Blue Shield plan covers Rybelsus 

Rybelsus prescription drug coverage depends on the specific BCBS insurance benefit plan. The best way to check for insurance coverage is to look at your plan’s drug list. The drug formulary also includes information about which tier Rybelsus is on and whether it requires prior authorization.

To find your formulary, log in to your BCBS plan online, then search for the drug formulary under “Benefits” or “Resources.” Scroll down the document to the “Antidiabetics” list, where you’ll find Rybelsus.

You can also call Blue Cross Blue Shield to ask about drug coverage. Call the phone number on the back of your member ID card, and be prepared to read your account and group numbers (also on the card) to the representative.

How to save on Rybelsus

There are ways to save on Rybelsus regardless of whether your BCBS insurance plan covers your prescription. For instance, cash payers can save hundreds of dollars by presenting a SingleCare discount card or SingleCare Rybelsus coupon at partner pharmacies. Insured patients who meet eligibility criteria might also qualify for financial assistance through nonprofit organizations or the drug manufacturer’s savings program.