BCBS Rhode Island · Heart Disease Risk Reduction

BCBS Rhode Island coverage for Wegovy (Heart Disease Risk Reduction)

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

Age 45 and older
BMI of 27 or higher
Established cardiovascular disease (CV death, non-fatal MI, and non-fatal stroke)
Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

CV risk reduction in adults with established CVD and overweight/obesity without diabetes

All of:

Age >= 45 years
BMI >= 27 kg/m2
Established cardiovascular disease
Without diabetes (SELECT trial enrolled patients without diabetes)

Documentation to bring

Documentation of established cardiovascular disease
Baseline BMI >= 27 kg/m2
Confirmation that patient does not have diabetes (SELECT trial basis)

Not covered when

Concomitant use with other semaglutide-containing products not recommended
Concomitant use with any other GLP-1 receptor agonist not recommended
SELECT trial excluded patients with diabetes; document notes CV indication is independent of diabetes status per FDA label but trial population was without diabetes

Policy note: The SELECT trial (NCT03574597) enrolled adults >= 45 years with BMI >= 27 kg/m2, established CVD, and without diabetes. The document references this trial as supporting CV risk reduction. The FDA indication covers adults with established CV disease and either obesity or overweight. The clinical rationale notes the CV benefit is 'independent of diabetes status' but the trial itself excluded patients with diabetes, hence excludes_diabetes set to true based on trial population.

Policy effective May 4, 2026 · verified June 2, 2026 · source: RI_Weight_Management_ProgSum.pdf

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