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CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. · Drug benefit: CVS Caremark (prior authorization criteria and forms) · 7 documents cited · Read September 2026

Lists Wegovy and Foundayo with prior authorization subject to your plan's benefits, and adds Zepbound to two formularies from October 1, 2026.

American GLP, Publisher · Who writes this site

CareFirst's 2026 drug lists put Wegovy and Foundayo on the list with prior authorization and quantity limits, and every one of those lines ends the same way: coverage is subject to your plan and benefits.

Zepbound is the moving piece. It wasn't on Formulary 3 as of September 1, 2026, and CareFirst's October 1, 2026 update adds it to Formularies 2 and 3. The same update adds Foundayo or moves it to a lower-cost tier.

CVS Caremark writes the prior authorization criteria for CareFirst. For weight loss they ask for a 6-month weight management program first, and renewal depends on keeping at least 5% of your weight off.

What do the Caremark criteria ask for?

For adults: a comprehensive weight management program with follow-up for at least 6 months before the drug, and a BMI in the obesity range, or in the overweight range with a weight-related condition. For Zepbound, the first approval runs 8 months and renewals 12.

To renew, you need to have lost at least 5% of your starting weight, or kept that first 5% off.

What happened to Saxenda?

CareFirst moved Saxenda to a higher-cost tier from April 1, 2026, and named generic liraglutide and Wegovy as the alternatives.

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.

Formulary 3 ("Last updated 09/01/2026") lists "WEGOVY INJ 2.4MG 2 PA, QL (1 package every 28 days); Coverage is subject to your plan/benefits" and "FOUNDAYO TAB 9MG 3 PA, QL (30 tablets every 25 days); Coverage is subject to your plan/benefits". It is "for members of an employer group with 51 or more employees."

CareFirst BlueCross BlueShield, CareFirst Formulary 3 (2026), effective September 2026 · source

Zepbound is not listed on CareFirst Formulary 3 as "Last updated 09/01/2026", which lists Mounjaro.

CareFirst BlueCross BlueShield, CareFirst Formulary 3 (2026), effective September 2026 · source

"This document provides a list of formulary changes effective October 1, 2026." Additions: "ZEPBOUND ADDED F2, F3, F2 CHART , F4 CHART" and "FOUNDAYO ADDED/ POSITIVE TIER CHANGE F1, F2, F3, F2 CHART , F4 CHART".

CareFirst, October 1, 2026 CareFirst Commercial Formulary Updates, effective October 2026 · source

"This document provides a list of formulary changes effective April 1, 2026"; among removals and negative tier changes: "SAXENDA* NEGATIVE TIER CHANGE liraglutide, WEGOVY".

CareFirst, April 1, 2026 CareFirst Formulary Updates, effective April 2026 · source

"To access all medical and pharmacy benefit policies and prior authorization fax forms, please visit the CVS Caremark* Prior Authorization Documents page."

CareFirst, Pharmacy Prior Authorization (provider page) · source

Adults qualify after a comprehensive weight management program with follow-up "for at least 6 months prior to using drug therapy", plus a baseline BMI of 30, or 27 with a weight-related condition.

CVS Caremark for CareFirst, Foundayo Weight Loss Management criteria (7433-C) · source

Renewal requires that "The patient has lost at least 5 percent of baseline body weight OR the patient has continued to maintain their initial 5 percent weight loss."

CVS Caremark for CareFirst, Wegovy Weight Loss Management criteria (4774-C) · source

For Zepbound in weight management: "Initial therapy DOA: 8 months; Continuation of therapy DOA: 12 months" (DOA is duration of approval).

CVS Caremark for CareFirst, Zepbound criteria (6192-C) · source

What these documents cannot tell you

Everything above is what CareFirst BlueCross BlueShield 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 plan covers weight-loss drugs isn't in these documents. The drug list only says coverage is subject to your plan and benefits.
  • CareFirst runs several formularies. Which one applies to you depends on your group; this page reads Formulary 3 and the quarterly change notices.
  • The Caremark criteria documents are marked confidential and proprietary, so they're summarized here, not reproduced.
  • None of this is legal or medical advice. Your plan documents and your notice govern your case.

Where this comes from

  1. CareFirst BlueCross BlueShield, CareFirst Formulary 3 (2026), effective September 2026 — Open the document
  2. CareFirst, October 1, 2026 CareFirst Commercial Formulary Updates, effective October 2026 — Open the document
  3. CareFirst, April 1, 2026 CareFirst Formulary Updates, effective April 2026 — Open the document
  4. CareFirst, Pharmacy Prior Authorization (provider page) — Open the document
  5. CVS Caremark for CareFirst, Foundayo Weight Loss Management criteria (7433-C) — Open the document
  6. CVS Caremark for CareFirst, Wegovy Weight Loss Management criteria (4774-C) — Open the document
  7. CVS Caremark for CareFirst, Zepbound criteria (6192-C) — 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 CareFirst BlueCross BlueShield publishes. It is not affiliated with CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc., and your own plan documents and your own notice govern your case. Policies carry effective dates and change — read the sources before you act.