Employer / Commercial Insurance
Covered with requirementsNo additional clinical requirements are listed beyond the diagnosis.
Qualification pathways
You can qualify through any one of these.
Type 2 Diabetes with or without step therapy
All of:
- Diagnosis of Type 2 Diabetes OR trial of one generic or preferred medication for the treatment of Type 2 Diabetes
- Cannot be used in combination with other GLP-1 agonist-containing products
Documentation to bring
- Documentation of Type 2 Diabetes diagnosis OR documentation of trial of one generic or preferred medication for Type 2 Diabetes
- Confirmation that Ozempic will not be used in combination with other GLP-1 agonist-containing products
Approval and renewal
- Initial approval: 12 months
- Renewal: every 12 months
- To renew, the plan looks for Renewal requires that current criteria are met, medication is providing clinical benefit, and member is not experiencing serious adverse events.
Not covered when
- Combination use with other GLP-1 agonist-containing products is not permitted
Policy note: The document lists both 'Ozempic' (injectable) and 'Ozempic tablets' as separate line items with identical criteria. 'Ozempic tablets' likely refers to Rybelsus (oral semaglutide), but is labeled as 'Ozempic tablets' in this document. Step therapy requires a trial of one generic or preferred medication for T2DM, but does not specify metformin specifically. The document is dated March 2019 with a revision date of 06-01-2026 noted in the footer.
Policy effective March 1, 2019 · verified June 2, 2026 · source: prior-authorization-and-step-therapy-guidelines.pdf