Carrier
Horizon Blue Cross Blue Shield of New Jersey
Its Classic drug list names anti-obesity drugs like Wegovy and Zepbound as an excluded class, while listing them on tier 3 for plans that include the benefit.
Horizon's Classic drug list, the formulary Prime Therapeutics publishes for it, names anti-obesity drugs such as Wegovy, Saxenda and Zepbound among the drug classes excluded from coverage. It adds that coverage and exclusions vary with your pharmacy plan design.
The same list then carries Wegovy, Wegovy HD, the Wegovy tablet, the Zepbound auto-injector and Saxenda on tier 3, the highest-cost brand tier, marked for prior authorization and quantity limits. Its heading for the class says it plainly: coverage is based on your benefit.
So the answer turns on your plan. If your benefit excludes anti-obesity drugs, the listing doesn't help you. If it includes them, expect prior authorization.
Where does Foundayo stand?
Foundayo isn't listed on the July 2026 Classic Formulary, which does list Ozempic. Horizon's own quarterly change pages for 2026 don't mention it either.
What changed for the Wegovy tablet?
Horizon's first-quarter 2026 formulary changes moved the Wegovy tablet to non-preferred status, with prior authorization, effective February 1, 2026.
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.
"Certain drug classes are excluded from coverage (not covered) including investigational and cosmetic (such as Propecia® for hair growth), anti-obesity (such as Wegovy®, Saxenda®, or Zepbound®) and erectile dysfunction (such as Viagra®) drugs."
Horizon Blue Cross Blue Shield of New Jersey / Prime Therapeutics, Classic Formulary (July 2026), effective July 2026 · source
"Coverage, copayment, and additional restrictions and exclusions may vary depending on your pharmacy plan design."
Horizon Blue Cross Blue Shield of New Jersey / Prime Therapeutics, Classic Formulary (July 2026), effective July 2026 · source
The class heading reads "Anti-Obesity/Anorexiants - coverage of drugs in this class is ... based on your benefit", and under it Wegovy (injection and tablets), Wegovy HD, the Zepbound auto-injector and Saxenda are listed on tier 3, marked in the prior authorization and quantity limit columns. The legend reads "Tier 3 – Highest copayment – Non-Preferred brands."
Horizon Blue Cross Blue Shield of New Jersey / Prime Therapeutics, Classic Formulary (July 2026), effective July 2026 · source
Foundayo is not listed on the "Horizon Blue Cross Blue Shield of New Jersey Classic Formulary July 2026"; Ozempic is.
Horizon Blue Cross Blue Shield of New Jersey / Prime Therapeutics, Classic Formulary (July 2026), effective July 2026 · source
Under "Move to Non-Preferred Status": "Wegovy® oral semaglutide tablets Y 2/1/2026", where Y marks prior authorization.
Horizon Blue Cross Blue Shield of New Jersey, Q1 2026 Classic Formulary Changes, effective February 2026 · source
"Prime Therapeutics LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration of prescription drug benefits."
Horizon Blue Cross Blue Shield of New Jersey / Prime Therapeutics, Classic Formulary (July 2026), effective July 2026 · source
What these documents cannot tell you
Everything above is what Horizon Blue Cross Blue Shield of New Jersey 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 design includes anti-obesity drugs isn't public. Your benefit booklet or HR can tell you.
- Horizon publishes several drug lists (Classic, NetResults, the marketplace list and others). This page reads the Classic list only.
- The clinical criteria behind the prior authorization weren't published where they could be read.
- None of this is legal or medical advice. Your plan documents and your notice govern your case.
Where this comes from
- Horizon Blue Cross Blue Shield of New Jersey / Prime Therapeutics, Classic Formulary (July 2026), effective July 2026 — Open the document
- Horizon Blue Cross Blue Shield of New Jersey, Q1 2026 Classic Formulary Changes, effective February 2026 — Open the document
Where to go next
- New Jersey Medicaid, and the state employee plan
- How employer and commercial plans treat GLP-1s
- When a weight-loss exclusion doesn't block every use
- How to appeal a commercial or employer plan denial
- Every carrier we have read
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 Horizon Blue Cross Blue Shield of New Jersey publishes. It is not affiliated with Horizon Blue Cross Blue Shield of New Jersey, and your own plan documents and your own notice govern your case. Policies carry effective dates and change — read the sources before you act.