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Zepbound is the obesity-indication brand Most BCBS plans cover Mounjaro for T2D after prior authorization Step therapy typically requires failure on metformin plus one additional agent Prior authorization processing takes 2 to 4 weeks on average BCBS coverage for obesity (Zepbound) varies widely by state affiliate and employer plan List price for Mounjaro is approximately $1,023 per month without insurance Eli Lilly offers a savings card that can reduce copays to $25 per month for commercially insured patients Appeals succeed roughly 40% to 60% of the time when supported by clinical documentation Federal Employee Program (FEP) Blue Cross Blue Shield has its own formulary and criteria A1C threshold for BCBS approval is commonly 7.0% or higher after lifestyle modification How BCBS Classifies Tirzepatide on Its Formularies Blue Cross Blue Shield is not a single insurer

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Subtheme 3: Behavioral and lifestyle modification This third subtheme addresses challenges that healthcare providers face when educating on diet and lifestyle modifications for those on GLP-1 therapy