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BCBS Rhode Island

Does BCBS Rhode Island cover Ozempic for Kidney Disease (CKD)?

Yes. BCBS Rhode Island covers Ozempic for kidney disease (CKD) with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Employer and ACA Marketplace: Covered (preferred drug). See the qualification pathways below.

Earliest policy review June 2, 2026. How we verify · Check your exact plan

Full requirements: Ozempic for Kidney Disease (CKD) (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

CKD risk reduction in T2DM

All of:

  • Diagnosis of type 2 diabetes mellitus
  • A1C ≥ 6.5% confirmed by lab test (lab results or medical records required)
  • Patient has chronic kidney disease (CKD)
  • Requested agent will be used to reduce the risk of sustained eGFR decline, end-stage kidney disease, and cardiovascular death
  • Age within FDA labeling for indication OR support for off-label age use
  • Will NOT use in combination with a DPP-4 containing agent
  • Will NOT use in combination with another GLP-1 receptor agonist
  • No FDA labeled contraindications to requested agent

Documentation to bring

  • Documentation of type 2 diabetes mellitus diagnosis
  • Lab results confirming A1C ≥ 6.5% or medical records confirming diabetes diagnosis
  • Documentation of chronic kidney disease (CKD) diagnosis
  • Statement that agent is being used to reduce risk of sustained eGFR decline, ESKD, and cardiovascular death
  • Confirmation patient will not use concurrently with a DPP-4 agent
  • Confirmation patient will not use concurrently with another GLP-1 receptor agonist
  • Confirmation of no FDA labeled contraindications to requested agent

Quantity limits

  • 2 MG/3ML, 4 MG/3ML, 8 MG/3ML — 1 pen per 28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Patient must have been treated with an eligible continuation agent within the past 90 days (not starting on samples), OR prescriber states patient has been treated within past 90 days and is at risk if therapy is discontinued.

Not covered when

  • Concurrent use with DPP-4 containing agents
  • Concurrent use with another GLP-1 receptor agonist
  • Personal or family history of MTC or MEN 2 (per FDA contraindication)
  • Prior serious hypersensitivity reaction to semaglutide or product components

Policy note: CKD indication for Ozempic (injection) is explicitly listed in the FDA indication table: to reduce the risk of sustained eGFR decline, end-stage kidney disease, and cardiovascular death in adults with T2DM and CKD. The policy clinical criteria include a specific CKD pathway. No specific eGFR or UACR thresholds are specified in the PA criteria beyond CKD diagnosis.

Policy effective May 25, 2026 · verified June 2, 2026 · source: Ri GLP-1 Agonists Paql Prog Sum · View policy document (PDF)

Open on its own page →

Questions people ask
Does BCBS Rhode Island cover Ozempic?
Yes. BCBS Rhode Island covers Ozempic for kidney disease (CKD) with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with BCBS Rhode Island?
Kidney Disease (CKD) — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does BCBS Rhode Island require to renew Ozempic?
Kidney Disease (CKD) — Applies to Employer and ACA Marketplace plans. Patient must have been treated with an eligible continuation agent within the past 90 days (not starting on samples), OR prescriber states patient has been treated within past 90 days and is at risk if therapy is discontinued.
How current is this information?
The oldest review date among the policies on this page is June 2, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under BCBS Rhode Island: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: BCBS Alabama, BCBS Arizona, BCBS Arkansas, BCBS Kansas, BCBS Louisiana, BCBS Massachusetts, BCBS Michigan, BCBS Minnesota

All insurance plans · All medications

Summary of BCBS Rhode Island's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.