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Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan (with Blue Care Network) · Drug benefit: Not named in the documents read · 2 documents cited · Read September 2026

Doesn't cover GLP-1s for weight loss for fully insured large groups and some self-funded groups; where a group covers them, renewal needs 5% weight loss.

American GLP, Publisher · Who writes this site

Blue Cross Blue Shield of Michigan says it on page one of its 2026 drug lists: it doesn't cover GLP-1 drugs for weight loss, including Saxenda, Wegovy and Zepbound, for commercial members of fully insured large groups and some self-funded groups.

For groups that do cover them, its criteria start with the same sentence for Wegovy, Zepbound and Foundayo: coverage is determined by group benefit. There are two paths. One asks for a BMI of 30, or 27 with a weight-related condition, and an approval of 1 year. The other asks for a BMI of 35, 6 months in a lifestyle program and enrollment in Teladoc's weight management program, with a 6-month approval.

Either way, you need to keep off 5% of your starting weight to renew.

Which forms are on the drug list?

The 2026 Clinical Drug List marks Wegovy injection, Wegovy HD, Foundayo and the Zepbound auto-injector as preferred brands with prior authorization. The Wegovy tablet, the Zepbound KwikPen and generic liraglutide for weight management are listed as not covered.

What does the stricter path require?

A BMI of 35 or more, 6 months of documented diet or exercise, current participation in the Teladoc Health Weight Management Program, and a prescriber who has seen you in person. Members with type 2 diabetes aren't covered on this path.

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.

The "Your 2026 Blue Cross Blue Shield of Michigan Clinical Drug List" says Blue Cross doesn't cover "glucagon-like peptide-agonist drugs used for weight loss, including Saxenda®, Wegovy®, and Zepbound® for commercial members of fully insured large groups and some self-funded groups."

Blue Cross Blue Shield of Michigan, 2026 Clinical Drug List · source

The list shows "WEGOVY SUBCUTANEOUS Preferred brand PA; QL", "FOUNDAYO Preferred brand PA; QL", "WEGOVY ORAL Not covered QL" and "ZEPBOUND KWIKPEN Not covered QL"; the Zepbound auto-injector is a preferred brand with PA and QL.

Blue Cross Blue Shield of Michigan, 2026 Clinical Drug List · source

For Wegovy, Zepbound and Foundayo: "Coverage criteria is determined by group benefit and requires one of the following:" The first path asks for an attestation that the member's "body mass index (BMI) is 30 kg/m2 or greater (obese), or 27 kg/m2 or greater (overweight)" with a weight-related condition, and gives "Initial approval: 1 year".

Blue Cross Blue Shield of Michigan and Blue Care Network, Prior authorization and step therapy coverage criteria (September 2026), effective September 2026 · source

"Continued coverage requires physician attestation that the member maintains a 5% weight loss from baseline".

Blue Cross Blue Shield of Michigan and Blue Care Network, Prior authorization and step therapy coverage criteria (September 2026), effective September 2026 · source

The second path requires "Body mass index (BMI) ≥ 35 kg/m2", "Documentation of active participation for a minimum of 6 months in a lifestyle modification program", participation in the "Teladoc Health Weight Management Program", and "Initial approval: 6 months"; it "Will not be covered for members with Type 2 Diabetes Mellitus".

Blue Cross Blue Shield of Michigan and Blue Care Network, Prior authorization and step therapy coverage criteria (September 2026), effective September 2026 · source

On that path the drug "Must be prescribed by a PCP or provider who has an established relationship with the member, that the member has seen in-person".

Blue Cross Blue Shield of Michigan and Blue Care Network, Prior authorization and step therapy coverage criteria (September 2026), effective September 2026 · source

What these documents cannot tell you

Everything above is what Blue Cross Blue Shield of Michigan 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.

  • Whether your group is one of the self-funded groups that covers these drugs isn't public. Your benefit booklet or HR can tell you.
  • The criteria don't say which groups use the first path and which use the second.
  • Blue Cross Blue Shield of Michigan publishes several drug lists. This page reads the Clinical Drug List and the September 2026 criteria.
  • None of this is legal or medical advice. Your plan documents and your notice govern your case.

Where this comes from

  1. Blue Cross Blue Shield of Michigan, 2026 Clinical Drug List — Open the document
  2. Blue Cross Blue Shield of Michigan and Blue Care Network, Prior authorization and step therapy coverage criteria (September 2026), effective September 2026 — Open the document

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 Blue Cross Blue Shield of Michigan publishes. It is not affiliated with Blue Cross Blue Shield of Michigan (with Blue Care Network), and your own plan documents and your own notice govern your case. Policies carry effective dates and change — read the sources before you act.