BCBS North Dakota

Does BCBS North Dakota cover Ozempic?

Quick answer · Type 2 Diabetes

BCBS North Dakota 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 June 2, 2026. Policy effective May 11, 2026. Source: ND_GLP1_PAQL_ProgSum.pdf. How we verify this data →

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Ozempic for Type 2 Diabetes

What BCBS North Dakota 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
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Continuation of therapy (Ozempic as preferred agent)

All of:

  • Diagnosis of type 2 diabetes
  • A1C >= 6.5% confirmed by lab test or medical records
  • Patient is eligible for continuation of therapy: treated with a preferred agent within the past 90 days (starting on samples is not approvable), OR prescriber states patient has been treated with a preferred agent within the past 90 days and is at risk if therapy with a preferred agent is discontinued
  • Patient age is within FDA labeling for the requested indication, OR there is support for using the requested agent for the patient's age
  • Patient will NOT be using the requested agent in combination with a DPP-4 containing agent
  • Patient will NOT be using the requested agent in combination with another GLP-1 receptor agonist
  • Patient does NOT have any FDA labeled contraindications to the requested agent

New start as preferred agent

All of:

  • Diagnosis of type 2 diabetes
  • A1C >= 6.5% confirmed by lab test or medical records
  • Ozempic is a preferred agent
  • Patient age is within FDA labeling for the requested indication, OR there is support for using the requested agent for the patient's age
  • Patient will NOT be using the requested agent in combination with a DPP-4 containing agent
  • Patient will NOT be using the requested agent in combination with another GLP-1 receptor agonist
  • Patient does NOT have any FDA labeled contraindications to the requested agent

Documentation to bring

  • Documentation of type 2 diabetes diagnosis
  • Lab test results or medical records confirming A1C >= 6.5%
  • For continuation: documentation of treatment with preferred agent within past 90 days (samples do not qualify)
  • Confirmation patient is not using a DPP-4 inhibitor concurrently
  • Confirmation patient is not using another GLP-1 receptor agonist concurrently

Quantity limits

  • 2 MG/3ML, 4 MG/3ML, 8 MG/3ML — 1 pen

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months

Not covered when

  • Concurrent use with DPP-4 inhibitor
  • Concurrent use with another GLP-1 receptor agonist
  • FDA labeled contraindications (personal or family history of MTC or MEN 2; prior serious hypersensitivity reaction)

Policy note: Ozempic (injection) is listed as a preferred agent. Rybelsus (oral semaglutide tablet) shares the same PA criteria module and is also covered. Fill limit of one GLP-1 agent at one strength per 28 days applies across the class. The PA criteria module covers diabetes indication; CV risk reduction and CKD are FDA-labeled indications for Ozempic but the PA criteria module is structured around T2DM diagnosis without separate pathways for CV or CKD indications.

Policy effective May 11, 2026 · verified June 2, 2026 · source: ND_GLP1_PAQL_ProgSum.pdf

ACA Marketplace

Covered (preferred drug)

What you need to qualify

  • A1C of 6.5% or higher
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Continuation of therapy (Ozempic as preferred agent)

All of:

  • Diagnosis of type 2 diabetes
  • A1C >= 6.5% confirmed by lab test or medical records
  • Patient is eligible for continuation of therapy: treated with a preferred agent within the past 90 days (starting on samples is not approvable), OR prescriber states patient has been treated with a preferred agent within the past 90 days and is at risk if therapy with a preferred agent is discontinued
  • Patient age is within FDA labeling for the requested indication, OR there is support for using the requested agent for the patient's age
  • Patient will NOT be using the requested agent in combination with a DPP-4 containing agent
  • Patient will NOT be using the requested agent in combination with another GLP-1 receptor agonist
  • Patient does NOT have any FDA labeled contraindications to the requested agent

New start as preferred agent

All of:

  • Diagnosis of type 2 diabetes
  • A1C >= 6.5% confirmed by lab test or medical records
  • Ozempic is a preferred agent
  • Patient age is within FDA labeling for the requested indication, OR there is support for using the requested agent for the patient's age
  • Patient will NOT be using the requested agent in combination with a DPP-4 containing agent
  • Patient will NOT be using the requested agent in combination with another GLP-1 receptor agonist
  • Patient does NOT have any FDA labeled contraindications to the requested agent

Documentation to bring

  • Documentation of type 2 diabetes diagnosis
  • Lab test results or medical records confirming A1C >= 6.5%
  • For continuation: documentation of treatment with preferred agent within past 90 days (samples do not qualify)
  • Confirmation patient is not using a DPP-4 inhibitor concurrently
  • Confirmation patient is not using another GLP-1 receptor agonist concurrently

Quantity limits

  • 2 MG/3ML, 4 MG/3ML, 8 MG/3ML — 1 pen

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months

Not covered when

  • Concurrent use with DPP-4 inhibitor
  • Concurrent use with another GLP-1 receptor agonist
  • FDA labeled contraindications (personal or family history of MTC or MEN 2; prior serious hypersensitivity reaction)

Policy note: Ozempic (injection) is listed as a preferred agent. Rybelsus (oral semaglutide tablet) shares the same PA criteria module and is also covered. Fill limit of one GLP-1 agent at one strength per 28 days applies across the class. The PA criteria module covers diabetes indication; CV risk reduction and CKD are FDA-labeled indications for Ozempic but the PA criteria module is structured around T2DM diagnosis without separate pathways for CV or CKD indications.

Policy effective May 11, 2026 · verified June 2, 2026 · source: ND_GLP1_PAQL_ProgSum.pdf

Ozempic for Heart Disease Risk Reduction

What BCBS North Dakota 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
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

CV risk reduction via T2DM diagnosis pathway

All of:

  • Diagnosis of type 2 diabetes
  • A1C >= 6.5% confirmed by lab test or medical records
  • FDA labeled indication for CV risk reduction applies (established cardiovascular disease with T2DM)
  • Patient age is within FDA labeling for the requested indication, OR there is support for using the requested agent for the patient's age
  • Patient will NOT be using the requested agent in combination with a DPP-4 containing agent
  • Patient will NOT be using the requested agent in combination with another GLP-1 receptor agonist
  • Patient does NOT have any FDA labeled contraindications to the requested agent

Documentation to bring

  • Documentation of type 2 diabetes diagnosis
  • Lab test results or medical records confirming A1C >= 6.5%
  • Documentation of established cardiovascular disease
  • Confirmation patient is not using a DPP-4 inhibitor concurrently
  • Confirmation patient is not using another GLP-1 receptor agonist concurrently

Quantity limits

  • 2 MG/3ML, 4 MG/3ML, 8 MG/3ML — 1 pen

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months

Not covered when

  • Concurrent use with DPP-4 inhibitor
  • Concurrent use with another GLP-1 receptor agonist
  • FDA labeled contraindications (personal or family history of MTC or MEN 2; prior serious hypersensitivity reaction)

Policy note: The PA criteria module does not create a separate pathway specifically for the CV risk reduction indication. The policy covers Ozempic under the T2DM diagnosis criteria module; the FDA-labeled CV risk reduction indication is acknowledged in the FDA indication table. CV risk reduction is covered under the same PA criteria as diabetes (T2DM diagnosis + A1C >= 6.5%). The policy references FDA labeling compliance as part of criteria (criterion 3.B.2). Specific CV risk reduction criteria (e.g., established CVD requirement, GDMT) are not separately enumerated in this PA module.

Policy effective May 11, 2026 · verified June 2, 2026 · source: ND_GLP1_PAQL_ProgSum.pdf

ACA Marketplace

Covered (preferred drug)

What you need to qualify

  • A1C of 6.5% or higher
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

CV risk reduction via T2DM diagnosis pathway

All of:

  • Diagnosis of type 2 diabetes
  • A1C >= 6.5% confirmed by lab test or medical records
  • FDA labeled indication for CV risk reduction applies (established cardiovascular disease with T2DM)
  • Patient age is within FDA labeling for the requested indication, OR there is support for using the requested agent for the patient's age
  • Patient will NOT be using the requested agent in combination with a DPP-4 containing agent
  • Patient will NOT be using the requested agent in combination with another GLP-1 receptor agonist
  • Patient does NOT have any FDA labeled contraindications to the requested agent

Documentation to bring

  • Documentation of type 2 diabetes diagnosis
  • Lab test results or medical records confirming A1C >= 6.5%
  • Documentation of established cardiovascular disease
  • Confirmation patient is not using a DPP-4 inhibitor concurrently
  • Confirmation patient is not using another GLP-1 receptor agonist concurrently

Quantity limits

  • 2 MG/3ML, 4 MG/3ML, 8 MG/3ML — 1 pen

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months

Not covered when

  • Concurrent use with DPP-4 inhibitor
  • Concurrent use with another GLP-1 receptor agonist
  • FDA labeled contraindications (personal or family history of MTC or MEN 2; prior serious hypersensitivity reaction)

Policy note: The PA criteria module does not create a separate pathway specifically for the CV risk reduction indication. The policy covers Ozempic under the T2DM diagnosis criteria module; the FDA-labeled CV risk reduction indication is acknowledged in the FDA indication table. CV risk reduction is covered under the same PA criteria as diabetes (T2DM diagnosis + A1C >= 6.5%). The policy references FDA labeling compliance as part of criteria (criterion 3.B.2). Specific CV risk reduction criteria (e.g., established CVD requirement, GDMT) are not separately enumerated in this PA module.

Policy effective May 11, 2026 · verified June 2, 2026 · source: ND_GLP1_PAQL_ProgSum.pdf

Ozempic for Kidney Disease (CKD)

What BCBS North Dakota 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
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

CKD indication via T2DM diagnosis pathway

All of:

  • Diagnosis of type 2 diabetes
  • A1C >= 6.5% confirmed by lab test or medical records
  • FDA labeled indication for CKD applies (T2DM with chronic kidney disease)
  • Patient age is within FDA labeling for the requested indication, OR there is support for using the requested agent for the patient's age
  • Patient will NOT be using the requested agent in combination with a DPP-4 containing agent
  • Patient will NOT be using the requested agent in combination with another GLP-1 receptor agonist
  • Patient does NOT have any FDA labeled contraindications to the requested agent

Documentation to bring

  • Documentation of type 2 diabetes diagnosis
  • Lab test results or medical records confirming A1C >= 6.5%
  • Documentation of chronic kidney disease diagnosis
  • Confirmation patient is not using a DPP-4 inhibitor concurrently
  • Confirmation patient is not using another GLP-1 receptor agonist concurrently

Quantity limits

  • 2 MG/3ML, 4 MG/3ML, 8 MG/3ML — 1 pen

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months

Not covered when

  • Concurrent use with DPP-4 inhibitor
  • Concurrent use with another GLP-1 receptor agonist
  • FDA labeled contraindications (personal or family history of MTC or MEN 2; prior serious hypersensitivity reaction)

Policy note: Ozempic's CKD indication (reduce risk of sustained eGFR decline, end-stage kidney disease, and cardiovascular death in adults with T2DM and CKD) is listed in the FDA indication table. The PA criteria module does not create a separate CKD-specific pathway; coverage flows through the T2DM diagnosis module. No specific eGFR or UACR thresholds are defined in this PA policy. CKD indication covered under the same PA criteria as diabetes.

Policy effective May 11, 2026 · verified June 2, 2026 · source: ND_GLP1_PAQL_ProgSum.pdf

ACA Marketplace

Covered (preferred drug)

What you need to qualify

  • A1C of 6.5% or higher
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

CKD indication via T2DM diagnosis pathway

All of:

  • Diagnosis of type 2 diabetes
  • A1C >= 6.5% confirmed by lab test or medical records
  • FDA labeled indication for CKD applies (T2DM with chronic kidney disease)
  • Patient age is within FDA labeling for the requested indication, OR there is support for using the requested agent for the patient's age
  • Patient will NOT be using the requested agent in combination with a DPP-4 containing agent
  • Patient will NOT be using the requested agent in combination with another GLP-1 receptor agonist
  • Patient does NOT have any FDA labeled contraindications to the requested agent

Documentation to bring

  • Documentation of type 2 diabetes diagnosis
  • Lab test results or medical records confirming A1C >= 6.5%
  • Documentation of chronic kidney disease diagnosis
  • Confirmation patient is not using a DPP-4 inhibitor concurrently
  • Confirmation patient is not using another GLP-1 receptor agonist concurrently

Quantity limits

  • 2 MG/3ML, 4 MG/3ML, 8 MG/3ML — 1 pen

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months

Not covered when

  • Concurrent use with DPP-4 inhibitor
  • Concurrent use with another GLP-1 receptor agonist
  • FDA labeled contraindications (personal or family history of MTC or MEN 2; prior serious hypersensitivity reaction)

Policy note: Ozempic's CKD indication (reduce risk of sustained eGFR decline, end-stage kidney disease, and cardiovascular death in adults with T2DM and CKD) is listed in the FDA indication table. The PA criteria module does not create a separate CKD-specific pathway; coverage flows through the T2DM diagnosis module. No specific eGFR or UACR thresholds are defined in this PA policy. CKD indication covered under the same PA criteria as diabetes.

Policy effective May 11, 2026 · verified June 2, 2026 · source: ND_GLP1_PAQL_ProgSum.pdf

Why Ozempic requests get denied by BCBS North Dakota

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. No recent A1C result on file.

Frequently asked questions

Does BCBS North Dakota cover Ozempic?
BCBS North Dakota covers Ozempic for type 2 diabetes with prior authorization on Employer / Commercial Insurance and ACA Marketplace.
How long does a Ozempic approval last with BCBS North Dakota?
Initial approvals last 12 months, and renewals are granted in 12-month periods.
How current is this information?
This page reflects BCBS North Dakota's written policy as of May 11, 2026, last verified against the source document on June 2, 2026.

Other medications under BCBS North Dakota

Ozempic coverage under other plans

All insurance plans · All medications

This page summarizes BCBS North Dakota'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.