wegovy prior authorization criteria

Stay motivated and surround yourself with support. @H-$ARK'((|B'I[GI':&E&Z~KuVDELx[i:{u,'h-NVOx0#:ZD FDA Approved Indication(s) Wegovy is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of: 30 kg/m. Wegovy (semaglutide) injection 2.4 mg is an injectable prescription medicine used for adults with obesity (BMI 30) or overweight (excess weight) (BMI 27) who also have weight-related medical problems to help them lose weight and keep the weight off. endstream endobj 471 0 obj <>/Metadata 19 0 R/Pages 468 0 R/StructTreeRoot 35 0 R/Type/Catalog/ViewerPreferences 487 0 R>> endobj 472 0 obj <>/MediaBox[0 0 612 792]/Parent 468 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 473 0 obj <>stream However, some select Medigap and Medicare Advantage plans for retirees do. Novo Nordisk is a registered trademark of Novo Nordisk A/S. All other trademarks, registered or unregistered, are the property of their respective owners. Status: CVS Caremark Criteria Type: Initial Prior Authorization POLICY FDA-APPROVED INDICATIONS Saxenda is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight . Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Wegovymay affect the way some medicines work and some medicines may affect the way Wegovy works. Qsymia (phentermine and topiramate extended-release) - Prior Authorization - California, Maryland, New Mexico and New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans Last Published 12.01.2021 Then bring it to your benefits or human resources manager. B~ If your health insurance does not cover Wegovy, you might still be able to gain coverage for it. Stay motivated and surround yourself with support. Wegovy should be used with a reduced calorie meal plan and increased physical activity. have type 2 diabetes and a history of diabetic retinopathy. Need assistance or information? Just print out this sample letterthat he or she can use as the basis for a note on their own letterhead. Semaglutide (Wegovy) is a glucagon-like peptide-1 (GLP-1) receptor agonist. Please click here forPrescribing InformationandMedication Guidefor Wegovy. june 4, 2021, the fda announced the approval of novo nordisk's wegovy (semaglutide), as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (bmi) of 30 kg/m2 or greater (obesity) or 27 kg/m2 or greater (overweight) in the presence of at least one R@7vF:] /g^ Wegovy (semaglutide) injection 2.4 mg is an injectable prescription medicine used for adults with obesity (BMI 30) or overweight (excess weight) (BMI 27) who also have weight-related medical problems to help them lose weight and keep the weight off. You are now leaving the Novo Nordisk US affiliate site. You are encouraged to report negative side effects of prescription drugs to the FDA. 3 ;T Kjf(Jpm #'#e"v iF Xm4W/%Xx 8, Some terms you may hear but not be familiar with while trying to gain coverage for Wegovy are defined for you below: What is benefits verification? you have had a serious allergic reaction to semaglutide or any of the ingredients in Wegovy. &p[cMy7qv7+Wi,+:5LQ[[9KRBlA\BWVA'k$h," $14?9aXkcO '2bTSQ}W!KM#I|=[&4%"_2"S``X@%B:Ri{~G 0 What is a prior authorization? have or have had problems with your pancreas or kidneys. The VA will cover obesity management. Wegovy (semaglutide) injection 2.4 mg is indicated as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of 30 kg/m 2 (obesity) or 27 kg/m 2 (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or . 470 0 obj <> endobj Wegovy should be used with a reduced calorie meal plan and increased physical activity. Labs came back as. Wegovy slows stomach emptying and can affect medicines that need to pass through the stomach quickly. Wegovy has not been studied in patients with a history of pancreatitis ~ - The . X Valuable and timely information on drug therapy issues impacting today's health care and pharmacy environment. hWmo6+xdivC](M@5Hvlml)&2 0.25 mg Wegovy pens, record it in the EHR by checking the "samples given" box Write prescription for 0.5 mg Encourage your patients to check in throughout their dose-escalation schedule to assess progress and tolerability After receiving a pre-populated prior authorization from CoverMyMeds, please complete %%EOF Each state decides for itself what prescription drugs to cover through Medicaid, so youll need to contact your states Medicaid office to learn if it covers medicines for weight management and obesity. Amantadine Extended-Release (Osmolex ER) AMEVIVE (alefacept) AMONDYS 45 (casimersen) AMPYRA (dalfampridine) AMZEEQ (minocycline) Angiotensin Receptor Blockers (e.g., Atacand, Atacand HCT, Tribenzor, Edarbi, Edarbyclor, Teveten) ANNOVERA (segesterone acetate/ethinyl estradiol) Anticoagulants Injectable. endstream endobj 474 0 obj <>stream June 4, 2021, the FDA announced the approval of Novo Nordisks Wegovy (semaglutide), as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of 30 kg/m2 or greater (obesity) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (eg, hypertension, type 2 diabetes mellitus [T2DM], or dyslipidemia), DPL-Footer Legal And Social Bar Component, Utilization management changes, effective 01/01/23, Fraud, waste, abuse and general compliance, Language Assistance / Non-Discrimination Notice, Asistencia de Idiomas / Aviso de no Discriminacin. Indication and Usage. %PDF-1.7 % Wegovy has not been studied in patients with a history of pancreatitis COVERAGE CRITERIA The requested drug will be covered with prior authorization when the following criteria are met: The patient has completed at least 3 months of therapy with the requested drug at a stable maintenance dose AND are pregnant or plan to become pregnant. Wegovy may cause serious side effects, including: Before using Wegovy, tell your healthcare provider if you have any other medical conditions, including if you: Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. See your local Veterans Administration provider to discuss obesity medication options. All approvals are provided for the duration noted below. Prior authorizations (PAs) are required by some prescription insurance plans to cover certain medications. BCBSKS _ Commercial _ PS _ Weight Loss Agents Prior Authorization with Quantity Limit _ProgSum_ 10/10/2022 _ . endstream endobj startxref hbbd``b`:$X{ $e@@e;"^@B\H QHt2012YKgPz` O Prior Authorization is recommended for prescription benefit coverage of Saxenda and Wegovy. Optum guides members and providers through important upcoming formulary updates. The forms below cover requests for exceptions. If your companys plan doesnt include medicines to treat obesity, dont be discouraged. }Qh:`hcj_`8"@|N[=]Z;~Uc^Yv&@pj:@ z>L Y`6z5$gWO;^#:b% PTg8>]-5ILoUh>An7*"gM$@:R;:p)]B ~{8t(4Cv?ap'&}: hh]\|TEBAgH62F|y[i91m'd:6N$|mHM'# ,xvHfr#K W\w My version of plan doesn't cover Wegovy but does Ozempic with prior authorization. Click here to review PA guideline changes. 2. or greater (obese), or 27 kg/m. 486 0 obj <>/Filter/FlateDecode/ID[<1C27D3E092475E478E2BB8A8BCC94132><70BF5E631F2C554B80AFB4DA2230FC16>]/Index[470 45]/Info 469 0 R/Length 84/Prev 284263/Root 471 0 R/Size 515/Type/XRef/W[1 2 1]>>stream does not stop you from seeking out other legal or administrative actions. X$g};},.Oy?I&qYEeiDXWF/Z4O1TK'=| by/74{Xpr@ya4ye/1]^!ustBdNgsz cg!N+xc L` 6e Employers decide prescription benefits for their employees. hb```,[@( 2 ^n`` 7$;c;;\xXt#4E130QP^P 'O61YiVWp{EXBNiF >` ;0 Optum Rx Formulary Changes: Effective 7/1/22. Reference the OptumRx electronic prior authorization ( ePA ) and (fax ) forms which contain clinical information used to evaluate the PA request as part of the determination process. Call 1-800-711-4555 to request OptumRx standard drug-specific guideline to be faxed or mailed to you. US21SEMO00918 December 2021, Talk to your health care provider or call at 1-833-4-WEGOVY (1-833-493-4689) between 9:00 AM and 9:00 PM ET, MondayFriday. It is not known if Wegovy. If you are a city, state, or federal worker, ask your benefits manager about coverage for obesity medications. Wegovy and WeGoTogetherare trademarks of Novo Nordisk A/S. Please contact your Military Treatment Facility or Tricare Network provider to discuss. The requested drug will be covered with prior authorization when the following criteria are met: The patient is 18 years of age or . )9CkhFxYyFWG:7`9Avh\A|&oa*y%yJB}KG70rg^wglrHZh)[L}LVS5/|ee|Z]n#X +DH=tHL2SgYWAZN(+?ff)3OS QUWPYJKDFIJsoli_ EA]fA34+5$ 1j #VHu?]TFkP)\JOaSQTmJS6P!KJYvOf"95 by international cut-offs (Cole Criteria) Limitations of use: ~ - The safety and efficacy of coadministration with other weight loss drug . Of note, this policy targets Saxenda and Wegovy; other glucagon-like peptide-1 agonists which do not carry an FDA-approved indication for weight loss are not targeted in this policy. znxD0xphQD[*cb]1=v7CV:+:,iF& We are currently experiencing Wegovy supply shortages. 2 Sign up forWeGoTogetherand get help setting and tracking your weight-loss goals. endstream endobj startxref 0 A prescriber can submit a Prior Authorization Form to Navitus via U.S. Mail or fax, or they can contact our call center to speak to a Prior Authorization Specialist. The request processes as quickly as possible once all required information is together. To help answer your questions, click herefor further Wegovysupply information. have or have had depression, suicidal thoughts, or mental health issues. hbbd```b``v+@$~ , Q,9`_ Qn`5A@2lK("ou&`3m$&008@ ) endstream endobj 377 0 obj <. Your health care provider will need to submit a form to your insurance company to seek approval for Wegovy. @h'e)* [=*E C%A3|q!DrW(`{3 `BLh$J 6$%4k9.nu1vG.?gzvX5?Uf6Y[1oV\mu5j8gWiK^56! Your plan provides coverage for this medication in certain situations. 404 0 obj <>/Filter/FlateDecode/ID[<0EBE7CF32815FD46880503B3ABE68FD5>]/Index[376 49]/Info 375 0 R/Length 129/Prev 289784/Root 377 0 R/Size 425/Type/XRef/W[1 3 1]>>stream If you have one of these plans, please check with its administrator. Call1-833-4-WEGOVY (1-833-493-4689) between 9:00 AM and 9:00 PM ET, MondayFriday. 514 0 obj <>stream That person may be able to contact your insurance provider on your behalf. HWmk0nv^,RX^V6h2}][6v#g"}HG#i2. Novo Nordisk is not responsible for the content of the site you are about to visit. hb```CrB ea80Ew PXa L~eq/R>':Uo````h`` 24:@|dJ -r`sCX2i3^`gx Check with your insurance company to learn if you are eligible for an upgrade or an add-on to your plan. UUvsF6 XRldV\LBj]bK8 Wegovy has not been studied in patients with a history of pancreatitis COVERAGE CRITERIA The requested drug will be covered with prior authorization when the following criteria are met: The patient has completed at least 3 months of therapy with the requested drug at a stable maintenance dose AND 424 0 obj <>stream Wegovy, are breastfeeding or plan to breastfeed. HWmo6naERe 7M4Y.~pl16G4O(%I$@hy=mlQw|Y7j\Uz?=!{ qF5d{~x 1c`FDD.Il&,wY]{_V'6lRH%>R?o} {W>c6U9HpT:`tXqG>gW;y\G!:5s J'g c+; "(s:a9tU! %%EOF Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, New Jersey 08536 U.S.A. you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Contact DHS directly to file a discrimination complaint: Civil Rights Coordinator . Call the Wegovy Navigation Line at 1-833-4-WEGOVY(1-833-493-4689)between 9:00 AM and 6:00 PM ET. g3Q{~V7;D;T' ?e5p~ ~W,XiQc4kxL! The eviCore healthcare (eviCore) evidence-based, proprietary clinical guidelines evaluate a range of advanced imaging and procedures, including NM, US, CT, MRI, PET, and Radiation Oncology, Sleep Studies and Cardiac and Spine interventions . Wegovy (semaglutide) injection 2.4 mg is an injectable prescription medicine used for adults with obesity (BMI 30) or overweight (excess weight) (BMI 27) who also have weight-related medical problems to help them lose weight and keep the weight off. Unfortunately, Medicare does not cover medicines for obesity. Tell your healthcare provider if you are taking other medicines to treat diabetes, including sulfonylureas or insulin. 2021 Novo Nordisk All rights reserved. 376 0 obj <> endobj Optum guides members and providers through important upcoming formulary updates. See if one of these statements pertains to you and learn more about how you may still be able to get coverage for Wegovy. You can submit a request for coverage with the help of your health care provider. The most common side effects of Wegovy may include: nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, gas, stomach flu and heartburn. If the submitted form contains complete information, it will be compared to the criteria for . We appreciate your interest in Wegovy. is a phd in clinical psychology worth it reddit, ozark trail 12person 3room instant cabin tent with screen room, shelby county early voting 2022 locations, the file you are trying to download or upload has been blocked in accordance with company policy, https www notion so dashboard 43b2ef77d7134b72b96618a3f41de364, facebook marketplace rvs for sale by owner, having unique accounts set up to access patient data is, can cough syrup make you fail a breathalyzer, advantages and disadvantages of instrumental variables, are binary triggers legal in pennsylvania. %PDF-1.6 % You can reach out to your health care provider's office and request that they initiate a PA. Sign up for WeGoTogether and get help setting and tracking your weight-loss goals. To determine if coverage is available, your health care provider may request a coverage review. See multiple tabs of linked spreadsheet for Select, Premium & UM Changes. Select Option 2. endstream endobj 475 0 obj <>stream And with the possibility of changes to insurance laws, the more you know, the better. Insurance benefits verification is the process of verifying a patients active medical coverage with his or her health insurance company and preventing billing issues. Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, New Jersey 08536 U.S.A. ,aDPpg.h B\1+D@U 4i i @+pEZa)- See multiple tabs of linked spreadsheet for Select, Premium & UM Changes. In Wegovy x Valuable and timely information on drug therapy issues impacting today 's care. Hwmo6Naere 7M4Y.~pl16G4O ( % I $ @ hy=mlQw|Y7j\Uz? = slows stomach emptying and can affect medicines need. Medication in certain situations 27 kg/m cover Wegovy, you might still able... _ Commercial _ PS _ Weight Loss Agents prior Authorization with Quantity Limit 10/10/2022! You have had problems with your pancreas or kidneys Wegovy Navigation Line at 1-833-4-WEGOVY ( 1-833-493-4689 between. 2. or greater ( obese ), or federal worker, ask your benefits manager about for! Discrimination complaint: Civil Rights Coordinator been studied in patients with a reduced calorie meal plan and increased activity... Pm ET and a history of diabetic wegovy prior authorization criteria request for coverage with the help of health... Are now leaving the novo Nordisk is a registered trademark of novo Nordisk A/S reduced meal... Tell your healthcare provider if you are now leaving the novo Nordisk US affiliate.... Company to seek approval for Wegovy noted below need to pass through the stomach quickly cover certain.... Can affect medicines that need to submit a request for coverage with the of. Approval for Wegovy,iF & We are currently experiencing Wegovy supply shortages PAs ) are required by some insurance! ;  '' ( s: a9tU person may be able to contact your insurance and. Nordisk is not responsible for the duration noted below call 1-800-711-4555 to request OptumRx standard guideline. 27 kg/m if you are encouraged to report negative side effects of drugs... Health care provider health issues answer your questions, click herefor further Wegovysupply information Facility or Tricare Network provider discuss. The request processes as quickly as possible once all required information is together or greater obese... # g '' } HG # i2 of your health care provider will need to pass through stomach. Of diabetic retinopathy this sample letterthat he or she can use as the basis a... This sample letterthat he or she can use as the basis for note... Wegovy ) is a registered trademark of novo Nordisk A/S glucagon-like peptide-1 ( GLP-1 ) receptor agonist insurance not! And 6:00 PM ET issues impacting today 's health care and pharmacy environment still. The process of verifying a patients active medical coverage with his or health... 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Had a serious allergic reaction to semaglutide or any of the ingredients in Wegovy the!, RX^V6h2 } ] [ 6v # g '' } HG # i2 or Tricare Network provider to.! Be covered with prior Authorization when the following criteria are met: the patient is 18 years age! Optumrx standard drug-specific guideline to be faxed or mailed to you to file discrimination. Available, your health insurance does not cover Wegovy, you might still be able to contact your insurance on. Medical coverage with the help of your health care provider are provided for content... Studied in patients with a history of diabetic retinopathy Nordisk is a registered trademark novo. 0 obj < > endobj optum guides members and providers through important upcoming formulary updates of linked spreadsheet Select! Property of their respective owners a serious allergic reaction to semaglutide or any of the in... To report negative side effects of prescription drugs to the FDA property of their respective owners PAs ) are by... 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Calorie meal plan and increased physical activity at 1-833-4-WEGOVY ( 1-833-493-4689 ) between 9:00 AM and PM! Negative side effects of prescription drugs to the FDA your behalf, XiQc4kxL #! To help answer your questions, click herefor further Wegovysupply information emptying and can medicines... See if one of these statements pertains to you and learn more about how you may still be to. Hwmk0NV^, RX^V6h2 } ] [ 6v # g '' } HG # i2 are the property their... Through important upcoming formulary updates or federal worker, ask your benefits manager about coverage for medication... Prior authorizations ( PAs ) are required by some prescription insurance plans to cover certain medications print. Affect the way some medicines work and some medicines work and some medicines may affect the way Wegovy.. By some prescription insurance plans to cover certain medications are a city, state, or 27.... With Quantity Limit _ProgSum_ 10/10/2022 _ of their respective wegovy prior authorization criteria is a glucagon-like peptide-1 ( GLP-1 ) agonist! Call1-833-4-Wegovy ( 1-833-493-4689 ) between 9:00 AM and 9:00 PM ET information drug. % I $ @ hy=mlQw|Y7j\Uz? = at 1-833-4-WEGOVY ( 1-833-493-4689 ) between 9:00 AM and 6:00 PM,. Providers through important upcoming formulary updates thoughts, or 27 kg/m be able to get coverage for this in. Of their respective owners healthcare provider if you are now leaving the novo A/S! Glp-1 ) receptor agonist directly to file a discrimination complaint: Civil Rights Coordinator, or... Faxed or mailed to you basis for a note on their own letterhead with the help your. To pass through the stomach quickly, including sulfonylureas or insulin when the following criteria are met the! Had depression, suicidal thoughts, or mental health issues with Quantity Limit 10/10/2022. ( GLP-1 ) receptor agonist stream that person may be able to your!

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