HealthRX.com · Printable appeal checklist

BCBSMN Wegovy coverage and appeal record

First establish whether your plan excludes anti-obesity drugs or simply has criteria you have not met, because the next step is different. Then gather the records BCBSMN's criteria ask for, and use the Minnesota deadlines for a step therapy override and an external review to keep the request moving.

Companion to “Does Blue Cross Blue Shield of Minnesota Cover Semaglutide (Wegovy)?” · healthrx.com/glp-1-questions/does-blue-cross-blue-shield-of-minnesota-cover-semaglutide-wegovy · Facts checked 2026-10-18

Your BCBSMN plan

Plan name and group number

Fully insured or self-funded?ask member services or your employer

Does the pharmacy benefit include anti-obesity drugs?who told you, and the date

Formulary name and Wegovy's status on it

Which kind of denial is it?

Benefit exclusion: the letter says the drug or obesity treatment is excluded under your plan
Criteria not met: the letter names a missing record or step
Step therapy: the letter says a formulary alternative must be tried first
Unclear: ask for the clinical review criteria used, in writing

Records BCBSMN's criteria ask for

BMI with date, and any weight-related conditions
Diet, activity and behavior program: start date and weekly weight change
Formulary alternatives tried, with dates and results, or why each is unsuitable
For heart risk reduction: records of the heart attack, stroke or artery disease, and current blood pressure and lipid medicines
List of other weight-loss medicines, to show none will be taken with Wegovy

Rules to hold the plan to

BCBSMN's criteria start by checking that the drug is not excluded under your benefit plan.[1]
They ask for at least three formulary alternatives tried and failed, or a documented reason they are unsuitable; approval lasts 12 months.[1]
On written request, a Minnesota-regulated plan must give you the clinical review criteria for a specific drug.[2]
A step therapy override request or appeal must be answered within five days of a complete request; with no answer in time, it is granted.[2]
External review must be requested within six months of the adverse determination and is decided within 45 days.[3]

Requests, denials and reviews

Date	What was sent or received	Reference number	Answer due by	Result

Questions for BCBSMN member services

Is my plan fully insured or self-funded, and does Minnesota's external review process apply?
Does my pharmacy benefit include anti-obesity medications at all?
Which version of the Wegovy criteria applies to my plan this year?
How do I submit a step therapy override request, and is it electronic?
If my employer excludes the benefit, who decides at the next renewal?

Sources for the facts on this sheet

Blue Cross and Blue Shield of Minnesota and Blue Plus. Commercial Pharmacy Program Policy Activity, effective July 1, 2024 (Program Summary: Anti-Obesity GLP-1 Agents). Accessed 2026-10-18. https://bluecrossmn.com/sites/default/files/DAM/2024-05/bc-com-pharmprogpolicynotifctn-eff-7-1-24.pdf
Minnesota Office of the Revisor of Statutes. Minnesota Statutes 62Q.184 Step Therapy Override. Accessed 2026-10-18. https://www.revisor.mn.gov/statutes/cite/62Q.184
Minnesota Office of the Revisor of Statutes. Minnesota Statutes 62Q.73 External Review of Adverse Determinations. Accessed 2026-10-18. https://www.revisor.mn.gov/statutes/cite/62Q.73

This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.