wegovy prior authorization criteria

You are encouraged to report negative side effects of prescription drugs to the FDA. 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. @H-$ARK'((|B'I[GI':&E&Z~KuVDELx[i:{u,'h-NVOx0#:ZD Novo Nordisk is not responsible for the content of the site you are about to visit. Semaglutide (Wegovy) is a glucagon-like peptide-1 (GLP-1) receptor agonist. X$g};},.Oy?I&qYEeiDXWF/Z4O1TK'=| by/74{Xpr@ya4ye/1]^!ustBdNgsz cg!N+xc L` 6e Contact DHS directly to file a discrimination complaint: Civil Rights Coordinator . hbbd```b``v+@$~ , Q,9`_ Qn`5A@2lK("ou&`3m$&008@ ) hb```,[@( 2 ^n`` 7$;c;;\xXt#4E130QP^P 'O61YiVWp{EXBNiF >` ;0 And with the possibility of changes to insurance laws, the more you know, the better. UUvsF6 XRldV\LBj]bK8 Amantadine Extended-Release (Osmolex ER) AMEVIVE (alefacept) AMONDYS 45 (casimersen) AMPYRA (dalfampridine) AMZEEQ (minocycline) Angiotensin Receptor Blockers (e.g., Atacand, Atacand HCT, Tribenzor, Edarbi, Edarbyclor, Teveten) ANNOVERA (segesterone acetate/ethinyl estradiol) Anticoagulants Injectable. Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, New Jersey 08536 U.S.A. %%EOF Some terms you may hear but not be familiar with while trying to gain coverage for Wegovy are defined for you below: What is benefits verification? Labs came back as. %PDF-1.6 % HWmk0nv^,RX^V6h2}][6v#g"}HG#i2. hb```CrB ea80Ew PXa L~eq/R>':Uo````h`` 24:@|dJ -r`sCX2i3^`gx does not stop you from seeking out other legal or administrative actions. Novo Nordisk is a registered trademark of Novo Nordisk A/S. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. endstream endobj startxref @h'e)* [=*E C%A3|q!DrW(`{3 `BLh$J 6$%4k9.nu1vG.?gzvX5?Uf6Y[1oV\mu5j8gWiK^56! My version of plan doesn't cover Wegovy but does Ozempic with prior authorization. Unfortunately, Medicare does not cover medicines for obesity. Then bring it to your benefits or human resources manager. }Qh:`hcj_`8"@|N[=]Z;~Uc^Yv&@pj:@ z>L Y`6z5$gWO;^#:b% PTg8>]-5ILoUh>An7*"gM$@:R;:p)]B ~{8t(4Cv?ap'&}: hh]\|TEBAgH62F|y[i91m'd:6N$|mHM'# ,xvHfr#K W\w have type 2 diabetes and a history of diabetic retinopathy. 2 376 0 obj <> endobj 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. Call1-833-4-WEGOVY (1-833-493-4689) between 9:00 AM and 9:00 PM ET, MondayFriday. Optum guides members and providers through important upcoming formulary updates. Optum Rx Formulary Changes: Effective 7/1/22. To help answer your questions, click herefor further Wegovysupply information. 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 Wegovymay affect the way some medicines work and some medicines may affect the way Wegovy works. 3 ;T Kjf(Jpm #'#e"v iF Xm4W/%Xx 8, We are currently experiencing Wegovy supply shortages. X Indication and Usage. 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 g3Q{~V7;D;T' ?e5p~ ~W,XiQc4kxL! Sign up forWeGoTogetherand get help setting and tracking your weight-loss goals. Just print out this sample letterthat he or she can use as the basis for a note on their own letterhead. 470 0 obj <> endobj 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 hWmo6+xdivC](M@5Hvlml)&2 The requested drug will be covered with prior authorization when the following criteria are met: The patient is 18 years of age or . Check with your insurance company to learn if you are eligible for an upgrade or an add-on to your plan. 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. Stay motivated and surround yourself with support. BCBSKS _ Commercial _ PS _ Weight Loss Agents Prior Authorization with Quantity Limit _ProgSum_ 10/10/2022 _ . Your plan provides coverage for this medication in certain situations. Wegovy should be used with a reduced calorie meal plan and increased physical activity. &p[cMy7qv7+Wi,+:5LQ[[9KRBlA\BWVA'k$h," $14?9aXkcO '2bTSQ}W!KM#I|=[&4%"_2"S``X@%B:Ri{~G 424 0 obj <>stream 514 0 obj <>stream Each state decides for itself what prescription drugs to cover through Medicaid, so youll need to contact your states Medicaid office to learn if it covers medicines for weight management and obesity. have or have had problems with your pancreas or kidneys. If you have one of these plans, please check with its administrator. ,aDPpg.h B\1+D@U 4i i @+pEZa)- )9CkhFxYyFWG:7`9Avh\A|&oa*y%yJB}KG70rg^wglrHZh)[L}LVS5/|ee|Z]n#X +DH=tHL2SgYWAZN(+?ff)3OS QUWPYJKDFIJsoli_ EA]fA34+5$ 1j #VHu?]TFkP)\JOaSQTmJS6P!KJYvOf"95 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. 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). However, some select Medigap and Medicare Advantage plans for retirees do. hbbd``b`:$X{ $e@@e;"^@B\H QHt2012YKgPz` O 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. Prior Authorization is recommended for prescription benefit coverage of Saxenda and Wegovy. 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 . That person may be able to contact your insurance provider on your behalf. Please contact your Military Treatment Facility or Tricare Network provider to discuss. See multiple tabs of linked spreadsheet for Select, Premium & UM Changes. Select Option 2. %%EOF 2021 Novo Nordisk All rights reserved. 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. Stay motivated and surround yourself with support. by international cut-offs (Cole Criteria) Limitations of use: ~ - The safety and efficacy of coadministration with other weight loss drug . All approvals are provided for the duration noted below. Your health care provider will need to submit a form to your insurance company to seek approval for Wegovy. What is a prior authorization? 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See if one of these statements pertains to you and learn more about how you may still be able to get coverage for Wegovy. endstream endobj 475 0 obj <>stream We appreciate your interest in Wegovy. endstream endobj startxref 2. or greater (obese), or 27 kg/m. znxD0xphQD[*cb]1=v7CV:+:,iF& If your health insurance does not cover Wegovy, you might still be able to gain coverage for it. Please click here forPrescribing InformationandMedication Guidefor Wegovy. See your local Veterans Administration provider to discuss obesity medication options. 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. 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. To determine if coverage is available, your health care provider may request a coverage review. The VA will cover obesity management. Prior authorizations (PAs) are required by some prescription insurance plans to cover certain medications. 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 474 0 obj <>stream If your companys plan doesnt include medicines to treat obesity, dont be discouraged. You can submit a request for coverage with the help of your health care provider. All other trademarks, registered or unregistered, are the property of their respective owners. R@7vF:] /g^ B~ The request processes as quickly as possible once all required information is together. Insurance benefits verification is the process of verifying a patients active medical coverage with his or her health insurance company and preventing billing issues. you have had a serious allergic reaction to semaglutide or any of the ingredients in Wegovy.

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wegovy prior authorization criteria