Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Blue Cross & Blue Shield of MississippiAll Plans · Prior Auth · Medical Policy · Endocrinology, PharmacyHigh impact

GLP-1 Agonist

Effective date
Apr 1, 2026
Identified
Jun 20, 2026

Summary

Effective 04/01/2026, the GLP-1 agonist policy requires pharmacy review for new-start GLP-1 agonist prescriptions, and prior authorization is required for members with type 2 diabetes who are not treated with an oral antidiabetic agent. The criteria no longer require recent or current metformin use, or documented intolerance, FDA labeled contraindication, or hypersensitivity to metformin. Mounjaro, Ozempic, Rybelsus, and Trulicity may be considered medically necessary when a type 2 diabetes diagnosis is confirmed by lab tests such as A1C greater than or equal to 6.5%, while Byetta, Bydureon, and Victoza are considered not medically necessary as other formulary options exist.

Get alerts when payers change rules like this one

We check Blue Cross & Blue Shield of Mississippi and other payers every day and email you when a change matches your specialty and state.

Get Blue Cross & Blue Shield of Mississippi alertsPolicy Monitoring is free. No card required.

What to do

Action · 8 steps
01Already effective 04/01/2026: Billing team, for new-start GLP-1 agonist prescriptions, pharmacy review is required.
02For members with type 2 diabetes not treated with an oral antidiabetic agent, get prior authorization and provide adequate and appropriate documentation that validates the type 2 diabetes diagnosis, such as lab test results showing an A1C greater than or equal to 6.5% or medical records.
03For continuing therapy, documentation must show treatment with the requested medication within the past 90 days, or the prescriber must state the individual has been treated within the past 90 days and is at risk if therapy is discontinued.
04The requested agent cannot be used in combination with a DPP-4 containing agent or with another GLP-1 receptor agonist, and the individual must not have any FDA labeled contraindication.
05Samples used by an individual are not considered current or stable therapy.
06Rankin County Board of Supervisors was removed from the policy exceptions effective 04/01/2026 because prescription drug benefits for that self-insured group are administered by VersusRx.
07For members of the Structural Steel Self-Insured Group, all GLP-1 agonist medications are covered without prior authorization effective 06/16/2025.
08For members of the Glenn Machine Works Self-Insured Group, Wegovy and Zepbound are covered without prior authorization effective 12/01/2025, and Foundayo is covered without prior authorization effective 11/01/2026.

Codes mentioned

E11.9E11.10E11.11E11.00E11.01E11.641E11.65E11.69E11.8E11.649E13.10

Original notice

GLP-1 Agonist
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
DPP-4 Inhibitors and CombinationsMediumEffective May 1, 2025 · Medical PolicyRetinal Telescreening for Diabetic RetinopathyMediumNo effective date · Medical PolicyAutomated Insulin Delivery SystemsMediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesEndocrinologyPharmacyCode E11.9Code E11.10Code E11.11Code E11.00Code E11.01Code E11.641Code E11.65Code E11.69Code E11.8Code E11.649Code E13.10

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account