Important information for MedBen Rx clients using the Ventegra formulary: Effective October 1, an appropriate ICD-10 diagnosis code for type 2 diabetes will be required for certain Ozempic prescriptions and all other GLP-1 class medications.
Ozempic and other GLP-1 drugs are currently FDA-approved only for the treatment of diabetes. If the ICD-10 code isn’t supplied, or if the provided ICD-10 is for an alternative diagnosis such as obesity, the claim will be rejected unless:
- The alternative diagnosis is covered under your plan; or
- Prior authorization has been given.
Pharmacies are used to supplying this information within the Rx submission.
If you have questions about this requirement, please contact your Account Manager.