Nov. 14, 2025

As of Oct. 1, 2025, prescriptions for GLP-1 agents used in treatment of Type 2 diabetes must be issued by an authorized provider whose scope of practice includes the diagnosis, monitoring, and management of diabetes.

This change was designed to ensure that the use of GLP-1 medications is aligned with the appropriate clinical expertise and oversight.

What this means

At the point of sale or pharmacy counter, all claims for diabetes-indicated GLP-1 medications are reviewed to confirm that the prescribing provider has an eligible practice taxonomy code.

If the provider’s taxonomy code does not reflect a scope of practice that includes diabetes management, the claim will reject.

Affected Plans and Medications

This edit only applies to our commercial and Exchange health plans. It does not include Healthy Blue (Medicaid) or Medicare products.

The impacted GLP-1 medications include:

• Trulicity^® (dulaglutide)
• Byetta^® (exenatide)
• Victoza^® (liraglutide)
• Ozempic^® and Rybelsus^® (semaglutide)
• Mounjaro^® (tirzepatide)

Provider Taxonomy Updates

Providers may add, remove or change taxonomy codes at any time through standard processes. Optum Rx loads updates from the National Council for Prescription Drug Programs (NCPDP) on a weekly basis. Any provider making a change, eligible or ineligible, will be reflected in these weekly updates.

Action Needed

Review the current list of eligible taxonomy codes. If your taxonomy code is not on the list and you need to update your information, be sure to make the update promptly to avoid claim rejections at the pharmacy.

If you have any questions, please contact your Provider Relations Consultant.