Is Qsymia Covered By Blue Cross Blue Shield?
Coverage is limited.
Some BCBS plans may cover Qsymia for weight management if strict clinical criteria are met.
Qsymia is FDA-approved for chronic weight management in adults with obesity or overweight with weight-related conditions. Blue Cross Blue Shield plans vary, and coverage is typically limited to plans that offer weight-loss drug benefits.
Does Qsymia Require Prior Authorization?
Yes.
Prior authorization is commonly required and includes:
- Documentation of BMI ≥30 or ≥27 with comorbidities
- Evidence of a structured lifestyle program (including diet, exercise, and behavioral changes)
- History of failed weight-loss attempts with lifestyle changes alone
Are There Coverage Restrictions?
Yes.
Coverage may include:
- Step therapy (other medications or programs must be attempted first)
- A 12-week trial period requiring ≥3% weight loss to continue
- Age limitation (typically 18+)
Can Qsymia Be Covered for Adolescents?
Rarely.
While research is expanding in adolescent obesity, Qsymia is not typically covered for patients under 18.
What Documentation Is Needed?
When requesting prior authorization:
- Diagnosis including BMI and relevant comorbidities
- Weight-loss treatment history
- Structured program participation evidence
- A treatment plan and rationale for prescribing Qsymia
What If Coverage Is Denied?
If denied, you can appeal by submitting:
- A detailed medical necessity letter
- Supporting clinical records and data
- Progress or failure with other treatments
Where to Get More Info
- Qsymia Coverage Info
- FDA Qsymia Prescribing Info
- Your local BCBS plan’s member portal or customer support
FAQ: BCBS and Qsymia Coverage
Does BCBS cover Qsymia for weight loss?
Sometimes. Usually only if criteria like BMI and comorbidities are met.
Do I need prior authorization?
Yes, with proof of weight-loss program participation and failed lifestyle efforts.
Is it covered for teenagers?
Rarely. Most plans restrict Qsymia to adults 18 and older.
What if I don’t lose enough weight?
You may be denied continued access beyond the trial period.
Are there alternative weight-loss meds more likely to be covered?
Yes. Wegovy and Saxenda may have broader coverage under BCBS.
Related pages: Ozempic, Zepbound, Mounjaro, Saxenda, Contrave
Medical Disclaimer
This page is intended for educational purposes only and is not medical advice. Coverage varies by BCBS region and plan. Always verify with your provider and insurance representative.