BLUECONNECT

Providers

August 2024

In This Issue

►	August news: Executive summary

►	AZ Blue remits are now available on Availity Essentials

►	Coverage guideline update for GLP-1 drugs

►	Reminder: Quarterly fee updates and code edit changes

Coverage update for GLP-1 drugs

The FDA has approved certain glucagon-like peptide 1 (GLP-1) drugs for clinical use in treating people with type 2 diabetes (including Ozempic^®, Bydureon BCise^®, Byetta^®, Rybelsus^®, Trulicity^®, and Victoza^®). We’ve updated our pharmacy coverage guideline to ensure these GLP-1s are covered only when used for this purpose.

Note: The GLP-1s approved for the treatment of type 2 diabetes are not covered for weight-loss management.

What this means for you and your patients

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We revised our coverage guideline on May 1, 2024, for the impacted types of plans listed below. In keeping with the update, we began denying new prior authorization requests for members who have not been diagnosed with type 2 diabetes.

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On July 1, 2024, we reached out to members who have current authorizations to let them know that we are honoring those requests. However, starting September 1, 2024, authorization renewal requests will be approved only for those with a type 2 diabetes diagnosis.

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Starting September 1, 2024, we will approve new and renewal prior authorization requests for GLP-1s in alignment with the updated guideline. The only exceptions will be for members enrolled in a plan that expressly provides coverage outside of our guideline (see impacted types of plans below).

Applicable benefit plans

Our GLP-1 coverage guideline revision applies to AZ Blue group plans and all of our plans for individuals and families. Federal Employee Program^® (FEP^®) and Medicare Advantage plans also cover certain GLP-1 drugs only for the treatment of type 2 diabetes.

For the following plans, please check with the pharmacy benefit manager (PBM) for GLP-1 coverage guidelines:

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AZ Blue employer group plans that use a different PBM

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BlueCard^® (out-of-area) plans

Continued support for our members

AZ Blue members can continue to take advantage of our many diabetes, prediabetes, and weight loss resources. Most of our plans cover dietitian visits. Many of our members also have access to patient education and resources through the Sharecare app we offer at no cost to the member.

We're here to help

You can find more information about our pharmacy benefits and coverage guidelines at azblue.com/pharmacy. If you have questions about this change, feel free to reach out to the Clinical Therapeutics team at 1-866-325-1794.

In This Issue

►	August news: Executive summary

►	AZ Blue remits are now available on Availity Essentials

►	Coverage guideline update for GLP-1 drugs

►	Reminder: Quarterly fee updates and code edit changes

Ozempic, Rybelsus, and Victoza are registered trademarks of Novo Nordisk A/S.

Bydureon BCise is a registered trademark of AstraZeneca Pharmaceuticals, LP.

Byetta is a registered trademark of Amylin Pharmaceuticals, LLC.

Trulicity is a registered trademark of Eli Lilly and Co.

Blue Cross, Blue Shield, the Cross and Shield Symbols, BlueCard, Federal Employee Program, and FEP are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

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