Reminder: Glucagon-like Peptide-1 (GLP-1) Antagonists Pharmacy Prior Authorization

This impacts our Commercial line of business only

Blue Cross Blue Shield of North Dakota (BCBSND) is seeing an increase of appeals related to GLP-1 antagonists. As of September 2024, the GLP-1 antagonists prior authorization program summary criteria includes the requirement of lab test results that confirms the patient’s type 2 diabetes diagnosis (e.g., A1C greater than or equal to 6.5%).

Please note, the lab value required is what prompted the type 2 diabetes diagnosis, not the most recent values. Providers must submit the required lab test results for patients to be considered for approval of coverage of diabetic GLP-1 agonists.

Questions?
Contact our Provider Service Center at 800-368-2312.