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Commercial GLP-1 Coverage Updates for Expanded FDA-Approved Indications

Sep. 10, 2026 

As of Aug. 1, 2026, BlueCross BlueShield of South Carolina updated coverage policies for certain GLP-1 medications following recent FDA approvals that expand their use beyond chronic weight management. These updates are intended to align coverage policies with evolving clinical evidence, FDA-approved indications, and member benefit designs.

Newly Approved GLP-1 Indications

The FDA has approved additional indications for the following GLP-1 medications:

Zepbound® (tirzepatide)

Approved for:

  • Treatment of obstructive sleep apnea (OSA) in adults with obesity

Wegovy® (semaglutide)

Approved for:

  • Reduction of major adverse cardiovascular events (MACE) in adults with overweight or obesity and established cardiovascular disease 
    • Applies to injectable and oral formulations
  • Treatment of metabolic dysfunction-associated steatohepatitis (MASH) in adults with moderate-to-advanced liver fibrosis 
    • Applies to injectable formulations only

Why Did This Change?

BlueCross BlueShield of South Carolina regularly reviews pharmacy coverage policies to ensure alignment with:

  • FDA-approved indications
  • Current clinical evidence
  • Member benefit designs
  • Formulary management strategies

As GLP-1 therapies continue to gain FDA approval for conditions beyond weight management, coverage policies are being updated to reflect these expanded uses while maintaining applicable benefit exclusions, prior authorization requirements, and medical necessity standards.

Providers should always verify member-specific benefits and authorization requirements prior to prescribing GLP-1 therapies, as coverage may differ based on indication and plan design.

Coverage Determinations

As of Aug. 1, 2026, for Commercial plans that have not elected coverage for weight-loss medications:

  • Wegovy (semaglutide) injectable or oral formulations may be eligible for coverage when prescribed for the FDA-approved indication of major adverse cardiovascular event (MACE) risk reduction, provided all applicable prior authorization requirements are met.
  • Wegovy (semaglutide) injectable formulations only may be eligible for coverage when prescribed for the FDA-approved indication of metabolic dysfunction-associated steatohepatitis (MASH), provided all applicable prior authorization requirements are met.
  • Zepbound (tirzepatide) prescribed for the treatment of obstructive sleep apnea (OSA) will not be reviewed for medical necessity for plans that exclude coverage of weight-loss GLP-1 medications.

Important Reminder

Coverage determinations remain subject to:

  • Member eligibility and benefit design
  • Applicable prior authorization requirements
  • Medical necessity criteria
  • Formulary coverage rules and exclusions

Please note: Prior authorization approval does not guarantee payment if a member's benefit plan excludes coverage for the requested medication or indication.

Provider Action Needed

Before prescribing GLP-1 therapies:

  • Verify member eligibility and benefits
  • Confirm formulary coverage status
  • Review prior authorization requirements
  • Ensure documentation supports medical necessity for the requested FDA-approved indication

For questions regarding coverage or authorization requirements, please refer to the provider portal or contact Provider Services.