Beginning Jan. 1, 2024, the presence of prior pharmacy claims for insulin alone will no longer qualify Blue Cross Blue Shield of Michigan commercial and Blue Care Network commercial members for coverage of the medications in the table listed below. We’ll require a prior authorization to confirm that the medications listed below are being used for Type 2 diabetes for members who don’t have a supporting prescription or medical record with a diabetes diagnosis.
The full-coverage requirements are listed in the table below.
| Brand-name medication | FDA-approved indication | Coverage requirements starting Jan. 1 | |
| Bydureon® Byetta® Mounjaro® Ozempic® |
Rybelsus® Trulicity® Victoza® |
Type 2 diabetes | Coverage without prior authorization will require diagnosis of Type 2 diabetes verified by one of the following:
If either coverage criteria outlined above isn’t fulfilled, you must submit a prior authorization to confirm that your patient has a diagnosis of Type 2 diabetes for coverage. |
**Effective Jan. 1, 2024, previous trial of only insulin will no longer qualify members for coverage without prior authorization if they don’t have a medical diagnosis of Type 2 diabetes.
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