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Does CareFirst BlueCross BlueShield cover GLP-1s?

What CareFirst BlueCross BlueShield says on its own pages (carefirst.com), sorted by topic. Your own plan documents decide what you get.

Read Sep 28, 2026. Each line names the plan type it applies to.

Does it cover GLP-1s for weight loss?

  • CareFirst provider news (posted June 3, 2025) says that from July 1, 2025 Zepbound is no longer covered on the F2, F3, F3 Choice, F2 CHART and F4 CHART formularies, with Wegovy and Saxenda remaining as alternatives.Employer and commercial plans:Zepbound GLP-1 Removal: The weight management GLP-1/GIP drug Zepbound will no longer be covered on F2, F3, F3 Choice, F2 CHART, and F4 CHART formularies. GLP-1 medications Wegovy and Saxenda will remain as alternative options.provider.carefirst.com, Sep 29, 2026
  • CareFirst BlueChoice’s FEHB page says it expanded weight management benefits to include Noom Med, a medically supervised weight loss program.Federal employees:CareFirst BlueChoice (CareFirst) has expanded your weight management benefits to include Noom Med, a medically supervised weight loss program for members at higher risk of weight-related medical conditions.carefirst.com, Sep 29, 2026
  • CareFirst’s Medicare pharmacy FAQ says weight-loss drugs such as Wegovy and Zepbound are excluded from the RxSavingsPlus for Medicare discount program.Medicare:Please note that some medications used for weight loss, such as Wegovy and Zepbound, are excluded from this program.carefirst.com, Sep 29, 2026

Does it depend on your employer or plan?

  • CareFirst (provider news, July 20, 2023) says that for members whose plan includes weight-loss medications, only GLP-1s FDA-approved for obesity are covered, via specific prior authorization criteria.Employer and commercial plans:For members whose plan includes weight loss medications as a covered benefit, only GLP-1s that are FDA-approved to treat obesity are covered and must be obtained via specific prior authorization criteria that ensures appropriate use of those agents.provider.carefirst.com, Sep 29, 2026

Prior authorization criteria

  • CareFirst’s FEHB Noom Med FAQ says members must be 18 or older and meet one of two BMI conditions to be eligible for Noom Med.Federal employees:To be eligible for Noom Med, members must be 18 years and older and either:carefirst.com, Sep 29, 2026
  • One Noom Med eligibility condition (FEHB): BMI of 30 or higher.Federal employees:Have a Body Mass Index (BMI) of 30 or higher; orcarefirst.com, Sep 29, 2026
  • The other Noom Med eligibility condition (FEHB): BMI of 27 or higher plus one or more comorbidities.Federal employees:Have a BMI of 27 or higher AND one or more comorbiditiescarefirst.com, Sep 29, 2026
  • CareFirst BlueChoice’s FEHB page says that if a member qualifies for a weight-management medication, it is prescribed directly through the Noom Med program.Federal employees:Determine if you qualify for a weight management medication. If you do, your medication will be prescribed directly through the program.carefirst.com, Sep 29, 2026
  • CareFirst’s FEHB Noom Med page says members with a personal or family history of medullary thyroid cancer or MEN2 are ineligible for GLP-1s through Noom Med.Federal employees:If you have a personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia Type 2 (MEN2), you are ineligible for GLP-1s. However, you may still qualify for an oral medication through Noom Med.carefirst.com, Sep 29, 2026

Type 2 diabetes

  • CareFirst (July 20, 2023) reminded prescribers that Ozempic, Trulicity, Rybelsus and Victoza are covered only for type 2 diabetes.Employer and commercial plans:OZEMPIC (semaglutide), TRULICITY (dulaglutide), RYBELSUS (semaglutide), and VICTOZA (liraglutide) are only covered for the treatment of type 2 diabetes mellitus.provider.carefirst.com, Sep 29, 2026
  • CareFirst provider news (page updated 2023-12-13) says CareFirst requires clinical documentation of a type 2 diabetes diagnosis for coverage of Bydureon BCise/Byetta, Mounjaro, Ozempic, Trulicity, Rybelsus and Victoza.Employer and commercial plans:will require submission of clinical documentation supporting a diagnosis of type 2 diabetes mellitus for members to obtain coverage for the following incretin mimetics: BYDUREON BCISE/BYETTA (exenatide), MOUNJARO (tirzepatide), OZEMPIC (semaglutide), TRULICITY (dulaglutide), RYBELSUS (semaglutide) and VICTOZA (liraglutide).provider.carefirst.com, Sep 29, 2026
  • CareFirst’s FEHB Noom Med FAQ says members already taking a GLP-1 for type 2 diabetes are not required to use Noom Med.Federal employees:If you’re taking a GLP-1s for type 2 diabetes, you’re not required to use Noom Med.carefirst.com, Sep 29, 2026

How to check your own plan

  • CareFirst says members find their formulary in My Account under Drug and Pharmacy Resources, or can call the pharmacy number on the back of their ID card.All plans:To locate your formulary, visit My Account, and select Drug and Pharmacy Resources to the right. Your formulary is at the top of the page, i.e., CareFirst Formulary 3. Members may also call the pharmacy telephone number on the back of their member ID card with additional questions.member.carefirst.com, Sep 29, 2026

What we could not confirm

  • No web page from CareFirst BlueCross BlueShield that we could read covers: sleep apnea (zepbound); heart risk (wegovy); recent changes.
  • More detail, such as exact BMI cutoffs, is in 9 PDF documents from CareFirst BlueCross BlueShield, which we have not opened.

Next steps

Other insurers: Aetna, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Illinois, Blue Shield of California, Cigna, Florida Blue, Highmark, Humana, Independence Blue Cross, Kaiser Permanente, Molina Healthcare, Oscar Health, Premera Blue Cross, UnitedHealthcare, Ambetter, Wellcare, TRICARE, FEP Blue (federal employees), BlueCross BlueShield of South Carolina