What’s New in GLP-1 Coverage – Spring 2026

May 20, 2026

Applies to Self-Funded Groups*

At a glance: GLP‑1 therapies continue to evolve rapidly, with new FDA approvals, product reformulations, expanded dosing options, and distribution clarifications shaping coverage considerations for 2026 and beyond. Blue Cross and Blue Shield of Illinois and Prime Therapeutics^® are closely tracking these emerging updates to enhance our coverage options and programs around cardiometabolic health.

Same Therapy, New Name: Ozempic^® Tablets Replace Rybelsus^®

• Oral semaglutide tablets for type 2 diabetes are transitioning from Rybelsus to Ozempic tablets, in newly reformulated strengths (1.5 mg, 4 mg, and 9 mg). The Ozempic tablet formulation became available in pharmacies starting May 4, 2026. Members previously receiving Rybelsus need a new prescription to change to Ozempic tablets. Rybelsus is expected to be phased out by the end of 2026 as supply diminishes.

Expanded Dosing Options: Wegovy^® HD Added

• Wegovy HD has been added alongside existing Wegovy strengths, maintaining a consistent coverage approach as higher‑dose options enter the weight management market. Utilization management criteria align to support appropriate, clinical-driven use in groups that elect GLP-1 coverage for weight management.

New FDA-approved option: Foundayo™ Tablets

• Following FDA approval, Foundayo tablets are under review for drug list placement by our clinical experts. Coverage Exception requests are available now with weight management coverage. As with other GLP‑1s for weight management, plan coverage is optional with utilization management and metabolic health programs are available to drive safe and clinically appropriate use.

Distribution Clarification: Zepbound^® Kwikpen Excluded

• To give clarity across distribution channels for members, Zepbound Kwikpen, which is available only through direct‑to‑consumer pathways, has been excluded from coverage. For groups electing GLP-1 coverage, Zepbound auto‑injection remains covered on our drug lists.

What else you need to know: The changing GLP-1 landscape raises important questions around benefit strategy, cost management, utilization controls and the member experience. Now is an ideal time to engage your Pharmacy account team to help navigate the GLP-1 landscape, evaluate coverage options, and align decisions with broader pharmacy and health benefit goals.

Contact Information

For questions or strategic support, please contact your Blue Cross and Blue Shield of Illinois Account Representative.

 

Prime Therapeutics, LLC is a separate company Blue Cross and Blue Shield of Illinois contracts with to provide pharmacy solutions. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

*This article, or a similar version, is being shared with employer groups in the Employer News newsletter or news alert.