Commercial coverage
Does Blue Cross Blue Shield of Texas cover Wegovy?
Wegovy (semaglutide) for weight loss / obesity — the Blue Cross Blue Shield of Texas prior-authorization rule, source-cited.
Blue Cross Blue Shield of Texas Wegovy PA criteria
Anti-obesity GLP-1 coverage is an optional, employer-group-elected pharmacy benefit (BCBSTX 'GLP-1 New to Therapy' optional program for ASO groups); some groups exclude it entirely.
Covers Wegovy, Zepbound, Saxenda, Foundayo.
Adult (17+) initial: obesity by BMI >=30, OR BMI >=25 if South/Southeast/East Asian descent, OR BMI >=27 with >=1 weight-related comorbidity (T2DM, dyslipidemia, hypertension, OSA, CVD/CAD).
Lifestyle: on low-calorie diet + increased activity + behavioral modification for a MINIMUM of 6 MONTHS prior with inadequate response (did not lose >=1 lb/week), continued on the drug.
No step through other weight-loss drugs; not combined with another GLP-1.
Pediatric (12-16, NOT 12-17): BMI >=95th pctl, OR >=30, OR >=85th pctl + >=1 severe comorbidity, plus the 6-month lifestyle requirement.
Initial: Wegovy/Zepbound/Foundayo 12mo; adult Saxenda 4mo; peds Saxenda 5mo; BCBSIL 12mo.
Renewal: continued lifestyle + maintained >=5% weight loss (Wegovy/Zepbound); adult Saxenda >=4%; peds Saxenda >=1% BMI reduction.
Source: HCSC/Prime Commercial GLP-1 Agonists PAQL Program Summary (eff. 05-11-2026) & Weight Management PAQL Program Summary (eff. 05-18-2026). View cited GLP-1 policy reference →
Note: semaglutide is also sold as Ozempic for type 2 diabetes, which Blue Cross Blue Shield of Texas evaluates under a separate type 2 diabetes policy (not this one) — see does Blue Cross Blue Shield of Texas cover Ozempic?. Coverage follows the brand's FDA indication, not the molecule.
Frequently asked
- Does Blue Cross Blue Shield of Texas cover Wegovy for weight loss / obesity?
- Varies by plan — PA required where covered. Anti-obesity GLP-1 coverage is an optional, employer-group-elected pharmacy benefit (BCBSTX 'GLP-1 New to Therapy' optional program for ASO groups); some groups exclude it entirely. See the full source-cited criteria above. Per HCSC/Prime Commercial GLP-1 Agonists PAQL Program Summary (eff. 05-11-2026) & Weight Management PAQL Program Summary (eff. 05-18-2026), as of 2026 (diabetes eff. 05-11-2026; weight management eff. 05-18-2026) — confirm the member's current plan policy.
d3rx does not hold plan-specific pharmacy formularies or PBM prior-auth grids, so it cannot confirm a particular plan's GLP-1 coverage, tier, or PA criteria. The guidance below is the general, source-cited rule; confirm the specific plan's pharmacy formulary / PA policy for a binding answer.
Check Wegovy for another payer — or draft the PA
Run Wegovy + any payer in the GLP-1 PA lookup, or have Ask D3 draft a Blue Cross Blue Shield of Texas-ready prior-authorization request with the right criteria and codes — free, no signup.