BCBS Mississippi

Does BCBS Mississippi cover Ozempic?

Quick answer · Type 2 Diabetes

BCBS Mississippi covers Ozempic for type 2 diabetes with prior authorization on Employer / Commercial Insurance and ACA Marketplace.

  • Employer / Commercial Insurance: Covered (preferred drug). A1C of 6.5% or higher
  • ACA Marketplace: Covered (preferred drug). A1C of 6.5% or higher

Last verified July 26, 2026. Policy effective April 1, 2026. Source: policy-231.html. How we verify this data →

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Ozempic for Type 2 Diabetes

What BCBS Mississippi requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Covered (preferred drug)

What you need to qualify

  • A1C of 6.5% or higher
  • Diagnosis documented with a code (E11.10, E11.11, E11.9, E11.65, E11.69, E11.00, E11.01, E11.641, E11.21, E11.22, E11.29, E11.311, E11.319, E11.39, E11.36, E11.40, E11.49, E11.610, E11.51, E11.59, E11.618, E11.620, E11.628, E11.630, E11.638, E11.649, E11.8, E13.37X1, E13.37X2, E13.37X3, E13.37X4, E13.37X5, E13.37X6, E13.37X7, E13.37X8, E13.37X9, E13.10)
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Initial approval for T2DM

All of:

  • Individual is being treated as an adjunct to diet and exercise for a diagnosis of type 2 diabetes
  • Diagnosis confirmed by lab tests (e.g., A1C >= 6.5%)
  • Individual is new to therapy
  • Individual will NOT use the requested agent in combination with a DPP-4 containing agent
  • Individual will NOT use the requested agent in combination with another GLP-1 receptor agonist
  • Individual does NOT have any FDA labeled contraindications to the requested agent

Continuation of therapy

All of:

  • Individual is being treated as an adjunct to diet and exercise for a diagnosis of type 2 diabetes
  • Diagnosis confirmed by lab tests (e.g., A1C >= 6.5%)
  • Requested medication is eligible for continuation of therapy
  • Individual will NOT use the requested agent in combination with a DPP-4 containing agent
  • Individual will NOT use the requested agent in combination with another GLP-1 receptor agonist
  • Individual does NOT have any FDA labeled contraindications to the requested agent

Plus any one of:

  • Documentation that the individual has been treated with the requested medication within the past 90 days
  • Prescriber states the individual has been treated with the requested medication within the past 90 days and is at risk if therapy is discontinued

Documentation to bring

  • Lab test results confirming T2DM diagnosis (e.g., A1C >= 6.5%) or medical records
  • For continuation: documentation of treatment with requested medication within the past 90 days, OR prescriber attestation of same with clinical risk statement

Approval and renewal

  • To renew, the plan looks for For continuation, ONE of the following: documentation that the individual has been treated with the requested medication within the past 90 days, OR prescriber states the individual has been treated with the requested medication within the past 90 days and is at risk if therapy is discontinued.

Not covered when

  • Combination use with DPP-4 containing agents (e.g., Glyxambi, Januvia, Janumet, Jentadueto, Kazano, Kombiglyze, Nesina, Onglyza, Tradjenta)
  • Combination use with another GLP-1 receptor agonist
  • FDA labeled contraindications to the requested agent
  • Use of samples will not be considered current or stable therapy

Exceptions

  • State Health Plan (State and School Employees): Prescription drug may be covered under a prescription drug benefit plan administered by the State Health Plan's Pharmacy Benefit Manager. PA requests must be submitted to the Plan's PBM (CVS Caremark) at https://www.dfa.ms.gov/cvs-caremark
  • Structural Steel Self-Insured Group (FID#: 89805, Formulary: BCBSMS COMM-CUSTOM STEEL): Effective 06/16/2025, all GLP-1 agonist medications are covered without Prior Authorization.

Policy note: Effective 04/01/2026, review at the pharmacy is required for new start GLP-1 agonist prescriptions. Prior authorization is required for members with type 2 diabetes not treated with an oral antidiabetic agent. The metformin trial requirement was removed effective 04/01/2026. The policy covers Ozempic under the same criteria as Mounjaro, Rybelsus, and Trulicity. Although Ozempic has FDA labeling for CV risk reduction and CKD indications, this policy only establishes PA criteria under the T2DM indication context; those expanded indications are not separately addressed in the criteria section. BCBSMS determines medication trial and adherence by pharmacy claims data over the preceding 12 months.

Policy effective April 1, 2026 · verified July 26, 2026 · source: policy-231.html

ACA Marketplace

Covered (preferred drug)

What you need to qualify

  • A1C of 6.5% or higher
  • Diagnosis documented with a code (E11.10, E11.11, E11.9, E11.65, E11.69, E11.00, E11.01, E11.641, E11.649, E11.21, E11.22, E11.29, E11.311, E11.319, E11.36, E11.39, E13.37X1, E13.37X2, E13.37X3, E13.37X4, E13.37X5, E13.37X6, E13.37X7, E13.37X8, E13.37X9, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.610, E11.618, E11.51, E11.52, E11.59, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.8)
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Initial therapy for T2DM

All of:

  • Adjunct to diet and exercise for type 2 diabetes diagnosis
  • A1C >= 6.5% confirmed by lab test
  • New to therapy OR continuation criteria met
  • Will NOT use in combination with a DPP-4 containing agent
  • Will NOT use in combination with another GLP-1 receptor agonist
  • Does NOT have any FDA labeled contraindications to the requested agent

Continuation of therapy

All of:

  • Requested medication is eligible for continuation of therapy
  • Will NOT use in combination with a DPP-4 containing agent
  • Will NOT use in combination with another GLP-1 receptor agonist
  • Does NOT have any FDA labeled contraindications to the requested agent

Plus any one of:

  • Documentation that the individual has been treated with the requested medication within the past 90 days
  • Prescriber states the individual has been treated with the requested medication within the past 90 days and is at risk if therapy is discontinued

Documentation to bring

  • Documentation of type 2 diabetes diagnosis (lab test result showing A1C >= 6.5% or other lab confirmation)
  • For continuation: documentation of treatment with requested medication within past 90 days OR prescriber attestation of recent use and risk if discontinued
  • Confirmation that DPP-4 agent will not be used concomitantly
  • Confirmation that no other GLP-1 receptor agonist will be used concomitantly
  • Confirmation of no FDA-labeled contraindications to requested agent
  • Note: Prior authorization required for members with T2DM not treated with an oral antidiabetic agent; pharmacy review required for new starts effective 04/01/2026

Approval and renewal

  • To renew, the plan looks for Documentation that the individual has been treated with the requested medication within the past 90 days, OR prescriber statement that the individual has been treated within the past 90 days and is at risk if therapy is discontinued.

Not covered when

  • Concurrent use with DPP-4 containing agents (e.g., Glyxambi, Januvia, Janumet, Jentadueto, Kazano, Kombiglyze, Nesina, Onglyza, Tradjenta)
  • Concurrent use with another GLP-1 receptor agonist
  • Any FDA labeled contraindications to the requested agent
  • Samples do not count as current or stable therapy for policy requirements

Exceptions

  • State Health Plan (State and School Employees): Prescription drug benefit may be covered under a prescription drug benefit plan administered by the State Health Plan's Pharmacy Benefit Manager (CVS Caremark). Perform formulary drug search at https://www.dfa.ms.gov/cvs-caremark and submit PA requests to the Plan's PBM.
  • Structural Steel Self-Insured Group (FID# 89805): Effective 06/16/2025, all GLP-1 agonist medications are covered without Prior Authorization.
  • Glenn Machine Works Self-Insured Group (FID# 89803): Effective 12/01/2025, Wegovy and Zepbound are covered without Prior Authorization.

Policy note: Effective 04/01/2026, pharmacy review is required for new start GLP-1 prescriptions. Prior authorization is required for members with T2DM not treated with an oral antidiabetic agent. Metformin trial requirement was removed as of 04/01/2026. BCBSMS determines medication trial and adherence via pharmacy claims data over the preceding 12 months. Ozempic is indicated for adults only per this policy.

Policy effective April 1, 2026 · verified June 2, 2026 · source: policy-231.html

Why Ozempic requests get denied by BCBS Mississippi

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Ozempic and Wegovy are the same molecule with different approved uses; a request for Ozempic under a diagnosis that matches Wegovy is routinely denied.
  2. Diagnosis code missing or wrong on the request.
  3. No recent A1C result on file.

Frequently asked questions

Does BCBS Mississippi cover Ozempic?
BCBS Mississippi covers Ozempic for type 2 diabetes with prior authorization on Employer / Commercial Insurance and ACA Marketplace.
What does BCBS Mississippi require to renew Ozempic?
For continuation, ONE of the following: documentation that the individual has been treated with the requested medication within the past 90 days, OR prescriber states the individual has been treated with the requested medication within the past 90 days and is at risk if therapy is discontinued.
How current is this information?
This page reflects BCBS Mississippi's written policy as of April 1, 2026, last verified against the source document on July 26, 2026.

Other medications under BCBS Mississippi

Ozempic coverage under other plans

All insurance plans · All medications

This page summarizes BCBS Mississippi's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.