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Anthem

Elevance Health · Drug benefit: CarelonRx · 5 documents cited · Read September 2026

Its answer moves several times a year in both directions, and it publishes the news one state at a time.

Denise Ramirez, Coverage Editor · Who writes this

Anthem is the carrier where the useful question is not what the rule says today. It is how long today's answer lasts.

Its own quarterly formulary update is a dated log of these drugs moving between tiers, and over the window that one document covers they move at least nine times — in both directions. Wegovy comes off the formulary and the Wegovy tablet goes on. Saxenda comes off twice while its generic goes on at the cheapest tier. Zepbound is downgraded a tier, then one presentation is added and another is dropped. None of that is a clinical judgment about you; it is a purchasing calendar, and it is published as a table.

The second thing to know is where you will hear about it. Anthem is a federation of state Blue Cross plans, and its provider news is published per state, so the same policy is announced under a Missouri masthead and again under a Kentucky one on a different date. There is no single national feed to watch, which makes a change easy to miss even when Anthem has announced it.

Underneath both of those sits the same fact every carrier page here reaches: Anthem says in its own words that its member benefits mostly exclude weight-loss drugs. Where Cigna publishes a stack of numbered coverage policies and Aetna publishes the sentence where its criteria stop applying, Anthem publishes considerably less. The criteria that decide a retail weight-loss request are not in its public clinical-criteria index at all, and we say so below rather than leaving a gap.

Read the calendar, not just the rule

Anthem's quarterly formulary update is the most useful document it publishes on this subject, and it is not a criteria document at all. It is a table of drugs, the change made to them, and the date the change took effect.

Across that one table these drugs move repeatedly: Zepbound from tier 2 to tier 3, Wegovy from tier 2 to non-formulary, Saxenda from tier 3 to non-formulary and then again months later, Qsymia off the formulary, the Wegovy tablet on to tier 2, generic liraglutide on at tier 1, Foundayo on at tier 2, the Zepbound KwikPen added, and the Zepbound standard pen dropped. Every one of those carries its own effective date.

The reader's takeaway is practical rather than alarming. A tier is not a permanent property of a drug on this plan, an approval you have today was priced against a tier that may move, and the document that tells you is a formulary update rather than a letter.

Why there is no single announcement to watch

Anthem operates as Anthem Blue Cross and Blue Shield across many states, and its provider news site is organized by state. The GLP-1 policy notice we read appears under Missouri with one date and under Kentucky with another, carrying substantially the same message.

That matters if you are trying to work out when something changed for you. The version of a notice that governs your plan is the one published for your state, and a notice you find under another state's masthead may carry a different date or different detail.

It is also why a page like this one dates every document it quotes. A carrier that publishes state by state cannot be summarized by a single national sentence, and any source that does so is smoothing over the thing you actually need.

What Anthem says about the benefit itself

Anthem's network alert on GLP-1 prescribing states the benefit position in one line: for the most part its member benefits specifically exclude weight-loss drugs. It is making that point in the course of explaining why it gates the diabetes GLP-1s, because it says those were being prescribed off-label for weight loss.

The same notice adds something no other carrier on this site does. It ties compliance with prescribing guidelines to network participation, which makes this a question about the prescriber's contract as well as the member's benefit.

Both notices are from 2023 and are dated as such below. They are the standing published position we could find; they are not new, and this page does not present them as new.

What Anthem does not publish, and how we checked

Anthem's public clinical-criteria index does not contain these drugs. We read the index its own provider page uses: 279 entries, and not one of them is a weight-loss agent. That zero is a fact about the index's scope rather than a failed search — it holds no insulin either, while control terms like adalimumab and pegfilgrastim return hits, so the index covers specialty drugs billed under the medical benefit and not the retail pharmacy classes these drugs sit in.

The criteria that actually decide a retail request are administered through CarelonRx's formulary portal, where they open in a pop-up rather than as a document with an address. We could not recover a stable first-party link to them, so this page does not quote them. That is a real limit on what you can learn about Anthem from the open web, and it is the reason this page is shorter than the Cigna one.

If you need the criteria, the route that exists is your own plan's portal or a call to the number on your card, and your prescriber's office can usually see the requirements when they submit.

Every claim above, with the document behind it

These are the policies we opened and the month we opened them. Each one carries its own policy number and effective date on its face, and those are printed here as the document shows them.

Anthem states the benefit position in its own words, while explaining why it gates the diabetes GLP-1s: "For the most part, our member benefits specifically exclude weight loss drugs, yet GLP-1 Receptor Agonists approved only for diabetes are being used off-label for weight loss and contributing to clinically inappropriate use." The same notice adds a lever no other carrier here uses: "Compliance with prescribing guidelines is a requirement of Anthem network participation."

Anthem Blue Cross and Blue Shield, Provider News (Missouri), "Glucagon-Like Peptide-1 prior authorization changes", effective December 2023 · source

The same policy is published state by state, on different dates, which is why there is no one announcement to watch. Anthem's Kentucky provider news carries "Network Alert: Prescribing Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists", making the same point about the diabetes agents — that they "have gained popularity because of their weight loss effects" but "are FDA-approved for diabetes only" — and it is dated seven months before the Missouri notice.

Anthem Blue Cross and Blue Shield, Provider News (Kentucky), "Network Alert: Prescribing Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists", effective May 2023 · source

Anthem's own formulary update records these drugs changing tier at least nine times, in both directions, each with its own effective date: Zepbound from Tier 2 to Tier 3 (7/1/2025); Wegovy from Tier 2 to non-formulary (7/1/2025); Saxenda from Tier 3 to non-formulary (7/1/2025, and again 4/1/2026); Qsymia from Tier 3 to non-formulary (7/10/2025); the Wegovy tablet from non-formulary to Tier 2 (12/23/2025); liraglutide, listed as generic Saxenda, from non-formulary to Tier 1 (1/1/2026); Foundayo from non-formulary to Tier 2 (5/15/2026); the Zepbound KwikPen from not-covered to Tier 2 (8/1/2026); and the Zepbound standard pen from Tier 3 to non-formulary (10/1/2026).

Anthem, Formulary Update (unbranded, quarterly rolling) · source

The same table shows the answer is not uniform across Anthem's plans. Each drug's row runs across a separate column for each of Anthem's differently named drug lists — a national list, national direct and direct plus lists, a preferred list, a traditional open list, essential and essential direct lists, and California CDI and DMHC variants of several of them — and a single drug's row can carry a change in some columns and "No Change" in others on the same date. We do not print which list is which here: the columns wrap across lines in the published PDF and cannot be attributed cell by cell without guessing.

Anthem, Formulary Update (unbranded, quarterly rolling) · source

Anthem also offers a non-drug route and states what it is aiming at. Its provider news describes "The CarelonRx, Inc. and Lark Weight Management Program" as a digital coaching program with an app, a fitness tracker and a connected scale, "designed to help them achieve a projected weight loss of 5% to 10%". Whether it is available to you is a plan question, and the notice is addressed to prescribers rather than to members.

Anthem Blue Cross and Blue Shield, Provider News (Missouri), "Weight management support for your patients", effective March 2026 · source

Anthem's public clinical-criteria index does not cover these drugs, and we checked rather than assuming. The index behind its own provider clinical-criteria page returns 279 entries, and a search of every drug name and associated-medication field found zero occurrences of Wegovy, Zepbound, Saxenda, semaglutide, tirzepatide, "weight" or "obes". It returns zero for insulin as well, while control terms adalimumab and pegfilgrastim both hit — so the index covers specialty drugs under the medical benefit, not the retail pharmacy classes these drugs sit in.

Anthem, Clinical Criteria (pharmacy information for providers) · source

What these documents cannot tell you

Everything above is what Anthem publishes. None of it establishes what your own plan does, and the gap between those two things is wider than a carrier policy makes it look.

  • Anthem's current weight-loss criteria are not quoted here because we could not find a first-party address for them. They are administered through CarelonRx's formulary portal and open in a pop-up rather than as a document with a stable link, and this site does not cite a mirror or an opaque download token for a publisher's own document.
  • The tier changes above are read from a national formulary update. It carries a separate column for each of Anthem's drug lists, and this page deliberately does not say which list each change applies to, because the columns cannot be attributed reliably from the published PDF.
  • Two of the notices quoted here are from 2023. They are dated in place. They are the standing published position we could locate, not a new announcement.
  • Anthem operates as a group of state plans, and the notice that governs you is the one published for your state. A notice found under another state's masthead may carry a different date or different detail.
  • A self-funded employer plan may adopt different rules, and nothing published maps a member to one of Anthem's drug lists. None of this is legal or medical advice, and this page does not predict how an appeal will come out.

Where this comes from

  1. Anthem Blue Cross and Blue Shield, Provider News (Missouri), "Glucagon-Like Peptide-1 prior authorization changes", effective December 2023 — providernews.anthem.com/missouri/articles/glucagon-like-peptide-1-prior-
  2. Anthem Blue Cross and Blue Shield, Provider News (Kentucky), "Network Alert: Prescribing Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists", effective May 2023 — providernews.anthem.com/kentucky/articles/network-alert-prescribing-gluc
  3. Anthem, Formulary Update (unbranded, quarterly rolling) — www.anthem.com/content/dam/digital/docs/pharmacy-information/unbranded-f
  4. Anthem Blue Cross and Blue Shield, Provider News (Missouri), "Weight management support for your patients", effective March 2026 — providernews.anthem.com/missouri/articles/weight-management-support-for-
  5. Anthem, Clinical Criteria (pharmacy information for providers) — www.anthem.com/pharmacy-information/for-providers/clinical-criteria

Where to go next

American GLP is not a law firm, an insurer, a government office or a clinician, and nothing here is legal or medical advice. This page describes what Anthem publishes. It is not affiliated with Elevance Health, and your own plan documents and your own notice govern your case. Policies carry effective dates and change — read the sources before you act.