October 2023

We’ll require prior authorization for some diabetes drugs prescribed to Medicare Advantage members, starting Jan. 1

We continually review prescription drugs to provide the best value for our members, control costs and make sure members are using the right drug for the right situation.

As part of our process, certain diabetes medications will require prior authorization if they’re prescribed for Medicare Plus Blue℠ and BCN Advantage℠ members who don’t have a supporting prescription or medical record with a diabetes diagnosis, beginning Jan. 1, 2024. Original Medicare prohibits Part D plans from covering drugs used for weight loss.

The drugs that will require prior authorization are listed below:

Brand-name medication	FDA-approved indication	Plan payment requirement
Bydureon^® Byetta^® Mounjaro^® Ozempic^® Rybelsus^® Trulicity^® Victoza^®	Type 2 diabetes	Payment will only be approved if using for Type 2 diabetes Excluded if used for weight loss

Health care providers prescribing any of the medications listed above for our Medicare Plus Blue and BCN Advantage members will need to request a prior authorization for the medication to be covered for their patients. For information on how to submit the request electronically, click here.

We’ll let your affected patients know about this change and encourage them to speak with you about any concerns.

For a complete list of drugs and associated requirements, go to 2023 Drug Lists.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2022 American Medical Association. All rights reserved.