{"id":634274,"date":"2025-11-10T21:37:16","date_gmt":"2025-11-11T02:37:16","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=634274"},"modified":"2025-11-10T21:37:16","modified_gmt":"2025-11-11T02:37:16","slug":"does-blue-cross-blue-shield-cover-metformin","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-blue-cross-blue-shield-cover-metformin\/","title":{"rendered":"Does Blue Cross Blue Shield cover metformin?"},"content":{"rendered":"

If you have Type 2 diabetes\u2014or you know someone who does\u2014chances are you\u2019ve heard of<\/span> metformin<\/span><\/a>. It\u2019s a popular <\/span>prescription drug<\/span>, and over 150 million people take it worldwide each year. Metformin is <\/span>FDA<\/span>-approved for people over 10 years of age who have Type 2 diabetes, and is a relatively affordable option for managing blood sugar. However, cutting out-of-pocket costs is always attractive, so you might wonder if your <\/span>Blue Cross<\/span> Blue Shield plan will cover it. Insurance plans often cover metformin, but there are some important factors to keep in mind.\u00a0<\/span><\/p>\n

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\n\t\t\t\t
\n\t\t\t\t\tMetformin 500 mg (60 Tablets)\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$5.32\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
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\n\t\t\t\t\t$5.32\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 Metformin prices at all pharmacies<\/a>\n\t\t<\/div>\n\n\t\t<\/span><\/p>\n

Does <\/span>Blue Cross<\/span> Blue Shield cover metformin?<\/span><\/h2>\n

For most people, <\/span>Blue Cross<\/span> Blue Shield <\/span>health insurance<\/span> will cover metformin. But ultimately, it depends on your specific plan. <\/span>Blue Cross<\/span> Blue Shield isn\u2019t one single company\u2014rather, it\u2019s a collection of<\/span> 33 locally operated companies<\/span><\/a>, each with its own plans and policies, so your coverage could be completely different from someone living in the next state. Even though many people who have Type 2 diabetes receive coverage, there are still a few variables to consider.<\/span><\/p>\n

Medical condition<\/span><\/h3>\n

Insurance companies are more likely to cover drugs prescribed for <\/span>FDA<\/span>-approved uses\u2014in this case, specifically for the treatment of Type 2 diabetes. However, \u201ceven though many prescriptions for metformin are technically off-label\u2014for things like prediabetes, PCOS, or weight management\u2014we still see good coverage because metformin is inexpensive,\u201d says<\/span> Dr. Rekha Kumar, MD<\/span><\/a>, Obesity Medicine Specialist at<\/span> Found<\/span><\/a>. \u201cThe one place I see more scrutiny is with <\/span>extended-release<\/span> versions, which sometimes require extra steps for approval.\u201d<\/span><\/p>\n

Prior authorization<\/span><\/h3>\n

Per Dr. Kumar, \u201cMetformin is usually straightforward\u2014<\/span>prior authorization<\/span> isn\u2019t common because it\u2019s generic and low-cost. The exceptions are when it\u2019s prescribed for something outside of type 2 diabetes, like PCOS, or if a specific formulation is requested, such as <\/span>extended-release<\/span>.\u201d<\/span><\/p>\n

Some plans might also require<\/span> prior authorization<\/span><\/a> before they approve coverage. This is essentially asking for proof that metformin is medically necessary. Sometimes, it\u2019s as simple as the <\/span>prescriber<\/span> sending documentation of certain symptoms, but other times it might require<\/span> step therapy<\/span><\/a>\u2014trying a diet plan, exercise regimen, or other drugs for a certain amount of time before progressing to metformin.<\/span><\/p>\n

Formulary<\/span> classification<\/span><\/h3>\n

Every insurance plan has a <\/span>drug list<\/span> that shows how it classifies various <\/span>covered medications<\/span>. This is called a <\/span>formulary<\/span>, and it typically ranks drugs into categories such as generic, <\/span>preferred brands<\/span>, non-<\/span>preferred brands<\/span>, and <\/span>specialty drugs<\/span>. Generics often receive the best coverage, and since metformin is a <\/span>generic drug<\/span>, it typically falls into this tier.<\/span><\/p>\n

How much does metformin cost?<\/span><\/h2>\n

Even without insurance coverage<\/span><\/a>, metformin is still more affordable than some antidiabetic drugs. People paying completely out of pocket often pay around $165 for 60, 500 mg tablets\u2014a <\/span>30-day supply<\/span>. That\u2019s nearly $2000 over an entire year, although there are plenty of ways to reduce that cost, whether you have insurance or not.<\/span><\/p>\n

How much does metformin cost with <\/span>Blue Cross<\/span> Blue Shield?<\/span><\/h2>\n

If BCBS covers metformin, you might still be responsible for <\/span>copays<\/span> until you meet your <\/span>deductible<\/span>. However, the <\/span>copay<\/span> amount will vary based on the plan. Some plans cover the entire amount, leaving a $0 <\/span>copay<\/span>, while others might cover a large percentage, leaving a small amount leftover for you to pay. Either way, if you have coverage, you likely won\u2019t end up paying an exorbitant amount for metformin.\u00a0<\/span><\/p>\n

How to check whether your <\/span>Blue Cross<\/span> Blue Shield <\/span>plan covers<\/span> metformin\u00a0<\/span><\/h2>\n

There are a few different ways to check your plan\u2019s metformin coverage:<\/span><\/p>\n