Anthem Blue Cross Blue Shield is requesting payments from some providers it alleges falsified patients' medical records when prescribing Ozempic, Bloomberg reported Sept. 12.
A spokesperson for Elevance Health, which owns Anthem BCBS, told Bloomberg it contacted a small number of providers about repayments for Ozempic prescribed to their patients. In some cases, the amount of repayment requested was more than $1 million.
Representatives for Elevance told Bloomberg that Anthem BCBS only covers Ozempic for patients with Type 2 diabetes. The drug is not approved by the FDA for weight loss, but is often prescribed off-label for that purpose.
Wegovy, which contains the same active ingredient as Ozempic, is also approved for weight loss.
Last year, Anthem sent a small number of providers letters, indicating that off-label use of diabetes drugs is "at an all-time high," the Wall Street Journal reported. In the letters, Anthem told providers that falsifying medical records in order to secure insurance coverage of a drug is healthcare fraud.
Providers Bloomberg spoke to said they prescribed the drug appropriately.
Jeff Levin-Shherz, a managing director at Willis Towers Watson, told Bloomberg the request for payment from providers was "highly unusual," as the providers did not receive reimbursement for the drugs — the pharmacies that dispensed the drugs would have been paid by insurers.
Becker's has reached out to Elevance Health for comment and will update this article if more information becomes available.
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