BlueCross BlueShield of South Carolina · Heart Disease Risk Reduction
BlueCross BlueShield of South Carolina coverage for Wegovy (Heart Disease Risk Reduction)
Employer / Commercial Insurance
Not covered
Despite FDA approval for MACE reduction in adults with overweight or obesity and established cardiovascular disease, Wegovy remains classified as an anti-obesity agent. For members whose benefit plans exclude weight loss medications, Wegovy is not covered even when prescribed for cardiovascular risk reduction. Coverage determinations are based on drug classification, not specific indication.
Policy note: This exclusion applies only to commercial and Marketplace (Exchange/ACA) plans. It does NOT apply to Medicare or Medicaid. The document explicitly addresses the MACE/cardiovascular risk reduction indication by name.
Policy effective May 9, 2025 · verified June 4, 2026 · source: policy-395.html
ACA Marketplace
Not covered
Despite FDA approval for MACE reduction in adults with overweight or obesity and established cardiovascular disease, Wegovy remains classified as an anti-obesity agent. For members whose benefit plans exclude weight loss medications, Wegovy is not covered even when prescribed for cardiovascular risk reduction. Coverage determinations are based on drug classification, not specific indication.
Policy note: This exclusion applies only to commercial and Marketplace (Exchange/ACA) plans. It does NOT apply to Medicare or Medicaid. The document explicitly addresses the MACE/cardiovascular risk reduction indication by name.
Policy effective May 9, 2025 · verified June 4, 2026 · source: policy-395.html
