Blue Shield | Important Update to the Outpatient Prescription Drug Benefit

Effective January 1, 2025, Blue Shield of California will no longer cover drugs for weight loss, unless medically necessary for the treatment of Class III obesity (also known as morbid obesity). Members can find more information about weight-loss drug coverage in their Evidence of Coverage or by contacting Customer Service at the number on their member ID card. This benefit change will apply to the following prescription drugs:

Coverage for the treatment of Class III obesity requires member participation in a comprehensive weight-loss program (including a reduced calorie diet, physical activity, and behavior therapy) for a reasonable period of time prior to and while they are using the weight-loss drug.

What this means
Starting in 2025, upon group renewal, members who are requesting weight-loss drugs must meet new prior authorization requirements for approval. Members who do not meet the new coverage requirements will be responsible for the full cost of the drug.

What to expect
Members who are using any of the weight-loss drugs above for reasons other than Class III obesity will be notified of the changes to their benefit.

Members who have previously received prior authorization will be able to continue filling their drug until the end of their authorized period.