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CVS CAREMARK. CVS Caremark is the pharmacy benefit manager (PBM) for the Plans prescription drug program.
A prior authorization ensures a drug is being prescribed safely and is of medical necessity. In most cases, your healthcare provider will initiate the prior authorization for Wegovy and will work with your BCBS plan to complete the request. If the prior authorization is approved, the medication will be covered.
If you are interested in our Blue Cross Blue Shield of Mississippi Clearinghouse services, please contact our Provider eSupport Services team at 601-664-4357.
Mounjaro (tirzepatide) may be prescribed if you have type 2 diabetes. Form Health physicians may choose to prescribe Mounjaro if you have a BMI of 30 or higher or 27 or higher with weight-related conditions, and you have not been successful in losing weight or maintaining weight loss with lifestyle changes alone.
BCBS may cover Mounjaro, but it all depends on the specific plan. Some plans may list it as a preferred drug, while others list it as nonpreferred. Some might also have prior authorization requirements before theyll cover it. Without insurance or discounts, Mounjaro costs around $1,474 per month on average.
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How to Get Tirzepatide (Mounjaro) Coverage with Blue Cross Blue Shield Verify Prescription Eligibility. Review Your Blue Cross Blue Shield Plan. Contact Blue Cross Blue Shield Customer Service. Initiate Prior Authorization. Submit an Exception Request if Needed. Follow Up on Decision. Explore Additional Support Options.
Work with your healthcare provider to submit a prior authorization request if required. This usually involves filling out specific forms and providing medical documentation. Ensure that your provider includes all necessary information, such as your diagnosis, treatment history, and any other medications tried.

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