Applies to Employer plans.
Covered with requirementsQualification pathways
You can qualify through any one of these.
Type 2 Diabetes Approval
All of:
- Diagnosis of type 2 diabetes
- Diagnosis confirmed by medical records OR chart notes
Documentation to bring
- Medical records or chart notes confirming type 2 diabetes diagnosis
Policy note: Policy applies to the GLP-1 Agonist class as a group. The named guideline covers Bydureon BCise, Byetta (exenatide), Mounjaro, Ozempic, Rybelsus, Trulicity, and Victoza (liraglutide) under a single shared rule requiring T2DM diagnosis confirmed by medical records or chart notes. No additional step therapy, BMI, A1C, or lifestyle requirements are specified. Wegovy and Zepbound are not listed in the policy; no criteria for weight loss or cv risk reduction indications are established.
Policy effective April 27, 2026 · verified June 5, 2026 · source: Standard Commercial Guidelines 6 1 26 Excerpted · View policy document (PDF)