{"id":626975,"date":"2024-02-23T15:10:49","date_gmt":"2024-02-23T20:10:49","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=626975"},"modified":"2025-10-23T16:18:11","modified_gmt":"2025-10-23T20:18:11","slug":"wegovy-prior-authorization-criteria-blue-cross-blue-shield","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/wegovy-prior-authorization-criteria-blue-cross-blue-shield\/","title":{"rendered":"Wegovy prior authorization criteria: Blue Cross Blue Shield"},"content":{"rendered":"

Wegovy<\/span><\/a> is a brand-name medication approved by the Food and Drug Administration (FDA) for weight loss in certain patients, including children 12 years and older. It is <\/span>also approved to reduce cardiovascular risk<\/span><\/a> in adults with obesity or who are overweight. <\/span>Depending on your specific insurance plan, Blue Cross Blue Shield (BCBS) may cover Wegovy if you meet specific criteria. Some plans may require prior authorization before they cover Wegovy, meaning they\u2019ll request more information from the prescriber before agreeing to cover the medication. <\/span>Read on to learn more about why Wegovy prior authorization may be required and the Blue Cross Blue Shield Wegovy prior authorization criteria. <\/span><\/p>\n

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Blue Cross Blue Shield Wegovy coverage<\/span><\/h2>\n

BCBS is one of the largest healthcare insurance companies in the United States. It comprises 34 independent, locally operated companies within the country. And, as of December 2023, BCBS covers nearly <\/span>115 million people<\/span>, which is about 1 in 3 Americans.\u00a0<\/span><\/p>\n

Each BCBS insurance plan varies in what it covers, including medications. In some cases, insurance plans require <\/span>prior authorization<\/span><\/a>\u2014also known as pre-authorization\u2014before they approve medical services, procedures, or medicines. This ensures the treatment is medically necessary for the patient. Prescription <\/span>weight loss medications<\/span><\/a>, such as Wegovy, often require prior authorization before they\u2019re covered. So, there is a chance your BCBS plan will require prior authorization before it covers Wegovy. But, even with prior authorization, your plan isn\u2019t guaranteed to cover Wegovy.\u00a0<\/span><\/p>\n\t\t

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Save up to 80% on Wegovy with SingleCare<\/p>\n\t\t\t

Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.<\/p>\n\t\t\t

\n\t\t\t\t
\n\t\t\t\t\tWegovy 2.4 mg\/0.75 mL (4 Pens)\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t23666 - Hampton, VA\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t
\n\t\t\t\"Kroger\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$1170.27\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
\n\t\t\t
\n\t\t\t\"Harris\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$1170.27\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\tSee Wegovy prices at all pharmacies<\/a>\n\t\t<\/div>\n\n\t\t\n

Wegovy prior authorization criteria<\/span><\/h2>\n

A prior authorization ensures a drug is being prescribed safely and is of medical necessity. In most cases, your healthcare provider will initiate the prior authorization for Wegovy and will work with your BCBS plan to complete the request. If the prior authorization is approved, the medication will be covered. However, it may only be covered for a certain length of time. After that period ends, your coverage may need reapproval, which, in most cases, will be handled by your pharmacy, insurance company, and healthcare professional. This time period varies depending on your plan, so it\u2019s a good idea to check with your healthcare provider, pharmacist, or BCBS insurance plan about how long your Wegovy coverage will last.\u00a0\u00a0<\/span><\/p>\n

In order to meet the Wegovy pre-authorization criteria, patients will have to meet the eligibility requirements the FDA approved it for. These include one of the following:<\/span><\/p>\n