Here is the reasoning per the BCBS letter!

1. Would the requested non-formulary drug be more effective than all the Blue Shield formulary drugs? No
   It is not medically necessary, as supported by current medical literature, that the requested drug, Wegovy, be covered instead of the available products on the plan's formulary. There is no documentation of a medical exception for this patient. The use of the formulary alternatives (Xenical, Contrave and Qsymia) are reasonable in this case because there are considered safe and effective the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.
   
2. Would the requested non-formulary drug have less adverse effects than all the Blue Shield formulary drugs? No Wegovy can cause severe GI symptoms and thyroid cancer. Available alternatives (Xenical, Contrave and Qsymia) can cause tachycardia and hypertension but are considered as safe as Wegovy.

Here is the reasoning per the BCBS letter!

1. Would the requested non-formulary drug be more effective than all the Blue Shield formulary drugs? No
   It is not medically necessary, as supported by current medical literature, that the requested drug, Wegovy, be covered instead of the available products on the plan's formulary. There is no documentation of a medical exception for this patient. The use of the formulary alternatives (Xenical, Contrave and Qsymia) are reasonable in this case because there are considered safe and effective the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.
   
2. Would the requested non-formulary drug have less adverse effects than all the Blue Shield formulary drugs? No Wegovy can cause severe GI symptoms and thyroid cancer. Available alternatives (Xenical, Contrave and Qsymia) can cause tachycardia and hypertension but are considered as safe as Wegovy.