Does BCBS Wyoming cover Ozempic?

Yes. BCBS Wyoming covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

How long does a Ozempic approval last with BCBS Wyoming?

Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.

What does BCBS Wyoming require to renew Ozempic?

Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Patient has been 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 is discontinued. Initial A1C and step therapy requirements are not re-verified at continuation.

How current is this information?

The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

BCBS Wyoming coverage for Ozempic (Type 2 Diabetes)

Applies to Employer and ACA Marketplace plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Continuation of therapy

All of:

Diagnosis of type 2 diabetes
A1C ≥ 6.5% confirmed by lab test
Requested agent is eligible for continuation of therapy (Ozempic is listed as eligible)
No FDA labeled contraindications to the requested agent
Not using in combination with a DPP-4 containing agent
Not using in combination with another GLP-1 receptor agonist

Plus any one of:

Patient has been treated with a preferred agent within the past 90 days (not starting on samples)
Prescriber states patient has been treated with a preferred agent within the past 90 days and is at risk if therapy is discontinued

New therapy — step therapy failure or exception

All of:

Diagnosis of type 2 diabetes
A1C ≥ 6.5% confirmed by lab test
No FDA labeled contraindications to the requested agent
Not using in combination with a DPP-4 containing agent
Not using in combination with another GLP-1 receptor agonist
Patient age is within FDA labeling for the requested indication OR there is support for use at patient's age

Plus any one of:

Tried and had inadequate response to ONE prerequisite agent containing metformin or insulin
Intolerance or hypersensitivity to metformin or insulin
FDA labeled contraindication to BOTH metformin AND insulin
Patient has established cardiovascular disease (e.g., MI, stroke, revascularization, TIA, unstable angina, amputation, CAD) OR multiple CV risk factors (HTN, dyslipidemia, family history of CVD, smoking) AND requested agent will be used to reduce risk of MACE
Patient has chronic kidney disease (CKD) AND requested agent will be used to reduce risk of sustained eGFR decline, ESKD, and cardiovascular death
Patient has diagnosis of noncirrhotic MASH with moderate to advanced liver fibrosis (F2 to F3)

Documentation to bring

Lab test confirming T2DM diagnosis (e.g., A1C ≥ 6.5%) or medical records
Documentation of type 2 diabetes diagnosis
Documentation of one of: inadequate response to metformin or insulin trial, intolerance/hypersensitivity to metformin or insulin, contraindication to both metformin and insulin, established CV disease or multiple CV risk factors, CKD diagnosis, or noncirrhotic MASH with F2-F3 fibrosis — OR documentation of prior preferred agent use within past 90 days for continuation
Confirmation that patient will not use requested agent in combination with a DPP-4 containing agent
Confirmation that patient will not use requested agent in combination with another GLP-1 receptor agonist

Quantity limits

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

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
Renewal: Patient has been 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 is discontinued. Initial A1C and step therapy requirements are not re-verified at continuation.

Not covered when

Combination use with a DPP-4 containing agent (e.g., Januvia, Onglyza, Tradjenta, etc.) for the requested indication
Combination use with another GLP-1 receptor agonist
Any FDA labeled contraindication to the requested agent

Policy note: Document covers the WY NetR-Commercial Custom formulary administered by Prime Therapeutics. Ozempic is listed as a preferred agent. Fill limit of one GLP-1 agent and one strength per 28 days applies. Quantity limit exceptions may be approved for: switching strengths (inadequate response to higher, or intolerance to lower), switching GLP-1 agents (inadequate response, intolerance/hypersensitivity, or contraindication to prior agent). One-time approval for titration dose extension requests and for replacement of another GLP-1 agent/strength if within QL but over fill limit. Non-preferred agents (Byetta, Exenatide, Victoza) require trial/failure of preferred agents per step-therapy structure implied by the non-preferred tier designation. Rybelsus (oral semaglutide) shares the same clinical criteria and is listed co-branded with Ozempic for the semaglutide tablet formulation.

Policy effective May 11, 2026 · verified June 4, 2026 · source: Wy GLP-1 Agonists Paql Prog Sum · View policy document (PDF)

Does BCBS Wyoming cover Ozempic for Type 2 Diabetes?

Policy document