Network Alert: Prescribing Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

Anthem Blue Cross and Blue Shield (Anthem) wants to help ensure that members have access to medications with evidence to improve health, and promote evidence-based, clinically appropriate use and that align with FDA prescribing guidelines.

While Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (such as Ozempic®, Mounjaro™, Trulicity®, Victoza®, Rybelsus®) have gained popularity because of their weight loss effects, they are FDA-approved for diabetes only. We will continue to require medical documentation that:

1. Individual is diagnosed with type 2 diabetes;
   AND
2. Individual has had a trial and inadequate response or intolerance to metformin (AACE/ACE 2020)
   OR
   Individual has a contraindication to metformin therapy;
   OR
   Individual has a history of atherosclerotic cardiovascular disease (ASCVD) including one or more of the following (AHA/ACC 2018):
   • Acute coronary syndrome;
   • Coronary artery disease (CAD);
   • History of myocardial infarction (MI);
   • Stable or unstable angina;
   • Coronary or other arterial revascularization;
   • Stroke;
   • Transient ischemic attack (TIA);
   • Peripheral arterial disease (PAD).

Wegovy® and Saxenda® are FDA-approved for weight loss only and not for treatment of diabetes. For the most part, our member benefits specifically exclude weight loss drugs, yet GLP-1Receptor Agonists approved only for diabetes are being used off-label for weight loss and contributing to clinically inappropriate use.

Compliance with prescribing guidelines is a requirement of Anthem network participation.

You can access our drug lists and formulary policies by visiting the Pharmacy webpage on our website at anthem.com/provider/pharmacy.

• Scroll down to Drug List Management and click on Review our Commercial Drug Lists. Here you will be able to search for the policies based on the member’s health plan.
• Be sure you click on the drug lists for Kentucky when performing your search.

If you have questions, please contact Provider Services.