How long does a Ozempic approval last with Horizon BCBS?

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

What does Horizon BCBS require to renew Ozempic?

Type 2 Diabetes — Applies to Employer plans. Continuation eligible if patient has been treated with a preferred agent within the past 90 days (samples not approvable), or prescriber attests patient has been treated with a preferred agent 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 5, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Does Horizon BCBS cover Ozempic?

Applies to Employer plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

New Start — Preferred Agent (Ozempic)

All of:

Diagnosis of type 2 diabetes
A1C ≥ 6.5% confirmed by lab test
Patient will NOT use the requested agent in combination with a DPP-4 containing agent
Patient will NOT use the requested agent in combination with another GLP-1 receptor agonist
Patient will NOT use the requested agent in combination with OTC weight management products or supplements that may increase GLP hormone
Patient does NOT have any FDA labeled contraindications to the requested agent
Patient age is within FDA labeling for the requested indication

Plus any one of:

Medication history of use in the past 90 days to an agent containing metformin or insulin
FDA labeled contraindication to BOTH metformin AND insulin
Diagnosis of type 2 diabetes with or at high risk for atherosclerotic cardiovascular disease, heart failure, and/or chronic kidney disease

Continuation of Therapy — Preferred Agent (Ozempic)

All of:

Diagnosis of type 2 diabetes
A1C ≥ 6.5% confirmed by lab test
Patient will NOT use the requested agent in combination with a DPP-4 containing agent
Patient will NOT use the requested agent in combination with another GLP-1 receptor agonist
Patient will NOT use the requested agent in combination with OTC weight management products or supplements that may increase GLP hormone
Patient does NOT have any FDA labeled contraindications to the requested agent
Patient age is within FDA labeling for the requested indication

Plus any one of:

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

Documentation to bring

Documentation of type 2 diabetes diagnosis
Lab result confirming A1C ≥ 6.5%
Documentation of prior metformin or insulin use within past 90 days, OR documentation of FDA labeled contraindication to both metformin AND insulin, OR documentation of T2DM with/at high risk for ASCVD, heart failure, and/or CKD
Attestation that patient will not use requested agent in combination with a DPP-4 inhibitor
Attestation that patient will not use requested agent in combination with another GLP-1 receptor agonist
Attestation that patient will not use requested agent in combination with OTC weight management products or GLP-hormone-increasing supplements
Confirmation patient has no FDA labeled contraindications to the requested agent

Quantity limits

2 MG/3ML, 4 MG/3ML, 8 MG/3ML — 1 pen per 28 days
1.5 MG tablet, 4 MG tablet, 9 MG tablet — 30 tablets per 30 days

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
Renewal: Continuation eligible if patient has been treated with a preferred agent within the past 90 days (samples not approvable), or prescriber attests patient has been treated with a preferred agent 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
Concurrent use with OTC weight management products (e.g., orlistat/Alli) or supplements that may increase GLP hormone (e.g., berberine, curcumin, taurine, ginseng, wild bitter gourd)
FDA labeled contraindications to the requested agent (personal or family history of MTC or MEN 2; prior serious hypersensitivity reaction)

Policy note: Fill limit of one GLP-1 agent and one strength per 28 days. Ozempic injection is a preferred agent; Ozempic tablets (Rybelsus) share semaglutide tablet quantity limits. The policy covers Ozempic for its FDA-labeled T2DM indication including glycemic control, CV risk reduction in T2DM with established CVD, and CKD risk reduction in T2DM — all under the same PA criteria for type 2 diabetes. The CV and CKD indications listed in the FDA label table are subsumed within T2DM criteria here; no separate CV/CKD pathway with distinct criteria is established in this document. QL approval is up to 12 months; one-time approval for titration dose extensions or when replacing another GLP-1 agent/strength within QL but over fill limit.

Policy effective May 11, 2026 · verified June 5, 2026 · source: Nj GLP-1 Agonists Paql Prog Sum · View policy document (PDF)