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BCBS North Dakota · Heart Disease Risk Reduction

BCBS North Dakota coverage for Wegovy (Heart Disease Risk Reduction)

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Age 18 and older
  • BMI of 30 or higher
  • BMI of 27 or higher with a weight-related condition
  • Established cardiovascular disease (CV death, nonfatal MI, and nonfatal stroke)

Qualification pathways

You can qualify through any one of these.

CV risk reduction in adults with established CV disease and obesity or overweight

All of:

  • Adult patient (age >= 18)
  • Established cardiovascular disease
  • Obesity (BMI >= 30) or overweight (BMI >= 27)

Documentation to bring

  • Documentation of established cardiovascular disease
  • Documentation of BMI >= 27 kg/m2 (overweight or obese)

Not covered when

  • Coadministration with other semaglutide-containing products is not recommended
  • Coadministration with any other GLP-1 receptor agonist is not recommended

Policy note: FDA indication listed in document for CV risk reduction: to reduce the risk of major adverse CV events (CV death, non-fatal MI, or non-fatal stroke) in adults with established CV disease and either obesity or overweight. Available as both tablet and subcutaneous injection formulations. Full PA criteria beyond FDA indication summary not enumerated in provided document text.

Policy effective April 20, 2026 · verified June 2, 2026 · source: ND_Weight_Management_PAQL_ProgSum.pdf

ACA Marketplace

Covered with requirements

What you need to qualify

  • Age 18 and older
  • BMI of 30 or higher
  • BMI of 27 or higher with a weight-related condition
  • Established cardiovascular disease (CV death, nonfatal MI, and nonfatal stroke)

Qualification pathways

You can qualify through any one of these.

CV risk reduction in adults with established CV disease and obesity or overweight

All of:

  • Adult patient (age >= 18)
  • Established cardiovascular disease
  • Obesity (BMI >= 30) or overweight (BMI >= 27)

Documentation to bring

  • Documentation of established cardiovascular disease
  • Documentation of BMI >= 27 kg/m2 (overweight or obese)

Not covered when

  • Coadministration with other semaglutide-containing products is not recommended
  • Coadministration with any other GLP-1 receptor agonist is not recommended

Policy note: FDA indication listed in document for CV risk reduction: to reduce the risk of major adverse CV events (CV death, non-fatal MI, or non-fatal stroke) in adults with established CV disease and either obesity or overweight. Available as both tablet and subcutaneous injection formulations. Full PA criteria beyond FDA indication summary not enumerated in provided document text.

Policy effective April 20, 2026 · verified June 2, 2026 · source: ND_Weight_Management_PAQL_ProgSum.pdf

All Wegovy policies under BCBS North Dakota · Check your card