HealthRX.com · Printable coverage checklist
BCBSM Wegovy pathway, documents and renewal log
Confirm whether your Michigan Blue group benefit covers weight-loss GLP-1 drugs at all, find out which of BCBSM's criteria sets it uses, gather that set's documents, and track weight and refills toward the renewal test.
Your Michigan Blue coverage
Plan and group typefully insured large group, self-funded, small group, individual, or BCN HMO
Does the group benefit include weight-loss GLP-1 drugs? Who confirmed it, and when?
Criteria set the plan appliesstandard adult, BMI 35 set, or ages 12 to 17
From BCBSM's own documents
- BCBSM does not cover weight-loss GLP-1 drugs, including Wegovy, for commercial members of fully insured large groups and some self-funded groups.[1]
- The coverage criteria for Wegovy are determined by the group benefit.[2]
- The BMI 35 set asks for weight within 30 days and at least 6 months of documented lifestyle program participation, with Teladoc Health coaching on record.[2]
- Lifestyle evidence can include food diaries or activity records showing at least 10,000 steps a day or 150 minutes of moderate activity a week.[2]
- First approval lasts 1 year on the standard adult set and 6 months on the BMI 35 set; BMI 35 renewal also asks for at least 80% of days covered.[2]
- BCBSM says it continues to cover GLP-1 drugs prescribed for type 2 diabetes, including Ozempic.[3]
Documents for the BMI 35 set
- Weight measured within the last 30 days
- Six months of food diaries, step-counter reports, gym logs or app records
- Teladoc Health weight coach visit and a written plan of action
- In-person visit with your primary care provider
- Note that you do not have type 2 diabetes
Weight and refill log for renewal
| Date | Weight | Change from baseline (%) | Refill picked up on time? | Teladoc contact |
|---|---|---|---|---|
Questions for BCBSM customer service
- Is my group fully insured or self-funded, and does its benefit cover Wegovy for weight loss?
- Which Wegovy criteria set does my group use?
- Is Wegovy covered under my plan if it is prescribed to reduce cardiovascular risk?
- What do I pay for Wegovy on my plan, and is there a deductible first?
- How do I file an appeal, and where does an external review go for my plan type?
Sources for the facts on this sheet
- Blue Cross Blue Shield of Michigan. Blue Cross Blue Shield of Michigan Clinical Drug List (October 2026). Accessed 2026-10-18. https://www.bcbsm.com/amslibs/content/dam/public/consumer/forms-documents/pharmacy/clinical-drug-list-formulary.pdf
- Blue Cross Blue Shield of Michigan and Blue Care Network. Blue Cross Blue Shield of Michigan and Blue Care Network: Prior authorization and step therapy coverage criteria (October 2026). Accessed 2026-10-18. https://www.bcbsm.com/amslibs/content/dam/public/consumer/forms-documents/pharmacy/prior-authorization-and-step-therapy-guidelines.pdf
- Blue Cross Blue Shield of Michigan, MI Blue Daily. Why We Are Changing Coverage of GLP-1 Drugs for Weight Loss. Accessed 2026-10-18. https://bcbsm.mibluedaily.com/stories/coverage/why-we-are-changing-coverage-of-glp-1-drugs-for-weight-loss
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.