Customer Service Documentation Specialty Pharmacies 
The Checkup by Singlecare
JUNE 5, 2025
When Zepbound is covered, prior authorization is usually required, and the patient may need to meet clinical requirements such as a BMI of 30 or more or a BMI of 27 or more with a comorbid condition like hypertension or Type 2 diabetes, and documented weight management efforts like a low-calorie diet and increased physical activity.
The Checkup by Singlecare
JUNE 5, 2025
Some specialty pharmacies will create their own version of Mounjaro, known as compounded tirzepatide. You can also log in to your health insurance portal to access policy documents. The two you want to look for are the drug list (also called a formulary, pharmacy benefits document, or PDL) and the summary of benefits.
The Checkup by Singlecare
OCTOBER 15, 2024
In some cases, however, it might mean your healthcare provider needs to submit documentation of symptoms, specialist visits, or other information to BCBS. You can also call your BCBS company directly to get the information from a customer service representative. However, they only apply for drugs you get from the pharmacy.
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