BCBS North Carolina coverage for Ozempic (Type 2

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

Age 18 and older
Diagnosis documented with a code

Qualification pathways

You can qualify through any one of these.

New patient - prior therapy requirement

All of:

Diagnosis of type 2 diabetes mellitus (medical record documentation required)
Requested product will not be taken concomitantly with a DPP-4 containing agent
Requested product will not be taken concomitantly with another GLP-1 agonist

Plus any one of:

Patient has tried and had an inadequate response, intolerance, or hypersensitivity to an agent containing metformin, sulfonylurea, or insulin
Patient has an FDA labeled contraindication to metformin
Patient has a diagnosis of, or is at high risk for, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, and/or MASH

Continuity of care - currently on therapy

All of:

Diagnosis of type 2 diabetes mellitus (medical record documentation required)
Prescriber states patient is currently being treated with the requested agent within the past 90 days and is at risk if therapy is changed
Requested product will not be taken concomitantly with a DPP-4 containing agent
Requested product will not be taken concomitantly with another GLP-1 agonist

Documentation to bring

Medical record documentation of type 2 diabetes mellitus diagnosis
Documentation of prior trial with inadequate response, intolerance, or hypersensitivity to metformin, sulfonylurea, or insulin OR FDA labeled contraindication to metformin OR diagnosis of/high risk for ASCVD, heart failure, CKD, or MASH (OR attestation that patient is currently on this agent within the past 90 days and at risk if changed)
Attestation that requested product will not be taken concomitantly with a DPP-4 containing agent
Attestation that requested product will not be taken concomitantly with another GLP-1 agonist

Quantity limits

0.25mg/dose (2mg/3mL pen), 0.5mg/dose (2mg/3mL pen) — 3 mL (1 pen)
1mg/dose (4mg/3mL pen) — 3 mL (1 pen)
2mg/dose (8mg/3mL pen) — 3 mL (1 pen)

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months

Not covered when

Concomitant use with DPP-4 containing agent
Concomitant use with another GLP-1 agonist

Policy note: Ozempic injection is approved for T2DM in adults only per FDA labeling cited in this policy. Ozempic tablets (new to market) were added to this policy in May 2026. The criteria for Ozempic injection and Ozempic tablets are the same in this document.

Policy effective May 1, 2026 · verified June 2, 2026 · source: glp1-agonists-nc-standard.pdf

BCBS North Carolina coverage for Ozempic (Type 2 Diabetes)