Skip to content
myglp1coverage.com

BCBS North Dakota · Kidney Disease (CKD)

BCBS North Dakota coverage for Ozempic (Kidney Disease (CKD))

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

All Ozempic policies under BCBS North Dakota · Check your card