CurrentCignaPolicy N/A

Weight Loss - Glucagon-Like Peptide-1 Agonists Prior Authorization Policy

Prior authorization criteria and coverage policy for liraglutide (Saxenda, generic), semaglutide (Wegovy), and tirzepatide (Zepbound) for weight-loss indications (adults and pediatrics) and related FDA-approved uses (including MASH, OSA, and CV risk reduction as referenced). Applies to Cigna-administered health benefit plans; targets these specific agents for the prescription benefit.

Policy Summary

PayerCigna

PolicyWeight Loss - Glucagon-Like Peptide-1 Agonists Prior Authorization Policy

Policy CodePolicy N/A

Change TypeMaterial revisions and additions (indications, dosing/continuation criteria, documentation)

Effective Date

Next Review Date

Key ActionPrior authorization is recommended for liraglutide (Saxenda, generic), Wegovy, and Zepbound; submit required documentation (baseline BMI prior to any GLP-1/GLP-1-GIP, behavioral trial, sleep study or liver biopsy/imaging as applicable) to support approvals.

POLICY UPDATE CHANGES

Policy targets liraglutide (Saxenda, generic), Wegovy, and Zepbound for prior authorization; other GLP-1 agents without FDA weight-loss indication are not targeted.

Baseline BMI criteria were modified across Saxenda, Wegovy, and Zepbound to clarify that 'baseline' refers to baseline prior to any GLP-1 or GLP-1/GIP agonist.

Zepbound was added to the policy with new criteria.

Wegovy continuation and initial dosing-related criteria were removed; continuation approval duration standardized to 1 year.

Wegovy Major Adverse Cardiovascular Event(s) risk reduction indication was added.

Conditions Not Covered updated to prohibit concomitant use of GLP-1 and GLP-1/GIP agonists.

For Wegovy MACE indication, prior stroke does not include transient ischemic attack (TIA).

Zepbound OSA sleep study timeframe removed; a sleep study is still required.

BMI requirement clarified to specify 'current BMI ≥ 27 kg/m2'.

Requirement that continuing Wegovy patients tolerate maintenance dose of 1.7 mg or 2.4 mg once weekly was removed.

Dosing/tolerability/titration requirements for continuing Zepbound patients were removed.

Zepbound: New FDA-approved indication for moderate to severe obstructive sleep apnea in a patient with obesity (initial therapy).

For Wegovy MACE risk reduction indication, prior stroke specification clarified to exclude TIA.

Wegovy: New FDA-approved indication for metabolic dysfunction-associated steatohepatitis (MASH)/NASH.

Concomitant use with other medications FDA-approved for weight loss is not recommended.

Prior Authorization recommended for liraglutide (Saxenda, generic), Wegovy, and Zepbound.

Inclusion of liraglutide (generic) to the Saxenda policy and updates to baseline definition notes.

3Targeted agents

3Products covered

3Minimum behavioral trial (months)

variedInitial vs continuation durations

2New FDA indications added

Concomitant use prohibitedKey exclusion

Coverage Summary

This policy targets glucagon-like peptide-1 (GLP-1) and GLP-1/GIP receptor agonists specifically for weight-management and related FDA-approved indications: liraglutide (Saxenda, and generic liraglutide), semaglutide (Wegovy), and tirzepatide (Zepbound). Covered indications include adult and pediatric weight loss (per product labeling and age/BMI thresholds), Wegovy’s FDA-approved indications for MACE risk reduction in adults with established cardiovascular disease and overweight/obesity, Wegovy’s indication for MASH/NASH (non-cirrhotic, F2–F3 fibrosis), and Zepbound’s indication for moderate to severe obstructive sleep apnea (OSA) in adults with obesity. (Policy applies to Cigna-administered plans.)

Medical-Necessity Criteria (by product and indication)

Saxenda (liraglutide) — Adult Weight-Loss: Initial Therapy

ALL of the following

Patient is an adult (≥ 18 years of age).
- ANY of the following
  - BMI ≥ 30 kg/m2
  - BMI ≥ 27 kg/m2 with at least one weight-related comorbidity (e.g., hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea)
Documentation of a comprehensive lifestyle program (reduced-calorie diet and increased physical activity) attempted or concurrently prescribed.
Treating clinician attests that other causes of weight gain have been evaluated and addressed (e.g., medication review, endocrine causes).
Prescribed by or in consultation with a clinician experienced in management of obesity (e.g., primary care, endocrinology, obesity medicine).

Saxenda (liraglutide) — Adult Weight-Loss: Continuing Therapy

ALL of the following

Patient is an adult (≥ 18 years of age).
Patient has achieved and documented at least 4% reduction in body weight from baseline after 16 weeks of therapy at the maintenance dose, OR prescriber documents clinical rationale for continued therapy despite not meeting this threshold (e.g., tolerability, dose adjustments).
Per liraglutide prescribing information, discontinue if <4% weight loss at 16 weeks unless clinical justification provided.
Documentation of ongoing participation in a reduced-calorie diet and increased physical activity program.
No contraindications to continued liraglutide therapy and monitoring for adverse effects is in place.
Approval duration: 1 year.

Saxenda (liraglutide) — Pediatric Weight-Loss: Initial Therapy

ALL of the following

Patient is a pediatric patient aged ≥ 12 years and weight ≥ 60 kg.
Baseline BMI ≥ 95th percentile for age and sex (documented).
Baseline BMI percentile must be recorded in the medical record prior to initiation.
Documentation of a comprehensive lifestyle program (reduced-calorie diet and increased physical activity) attempted or concurrently prescribed.
Prescribed by or in consultation with a clinician experienced in pediatric obesity management.
Approval duration: 4 months (initial).

Saxenda (liraglutide) — Pediatric Weight-Loss: Continuing Therapy

ALL of the following

Patient is a pediatric patient aged ≥ 12 years and weight ≥ 60 kg.
Patient has demonstrated a reduction in BMI of ≥ 1% from baseline after 12 weeks on the maintenance dose, OR prescriber documents clinical rationale for continued therapy despite not meeting this threshold.
Documentation of ongoing participation in a reduced-calorie diet and increased physical activity program.
No contraindications to continued liraglutide therapy and monitoring for adverse effects is in place.
Approval duration: 1 year.

Saxenda — FDA-Approved Indications (consolidated)

ALL of the following

Consolidated FDA-approved indications for Saxenda (liraglutide) include adult and pediatric obesity indications as reflected above.
Prescribing information recommends evaluation at 16 weeks (adults) and 12 weeks (pediatrics) for response; relevant discontinuation thresholds are ≥4% weight loss (adults) and ≥1% BMI reduction (pediatrics).
Approval durations referenced in prescribing information: initial trial evaluation periods (adults 4 months equivalent to 16 weeks; pediatrics 4 months initial) and continuing approvals commonly granted for 1 year; some source documents reference 7 months for certain Wegovy indications (see Wegovy group).
Where brief source text omits full duration detail, the policy uses the clinically aligned durations specified in the respective Initial and Continuing Therapy groups above.

Wegovy (semaglutide) — Weight Loss: Initial Therapy (Adult and Pediatric)

ALL of the following

Wegovy (semaglutide) Initial Therapy — Adults:
ALL of the following
- Patient is an adult (≥ 18 years of age).
- - ANY of the following
    BMI ≥ 30 kg/m2
    BMI ≥ 27 kg/m2 with at least one weight-related comorbidity

Wegovy (semaglutide) — Weight Loss: Continuing Therapy (Adult and Pediatric)

ALL of the following

Wegovy (semaglutide) Continuing Therapy — Adults:
ALL of the following
- Patient is an adult (≥ 18 years of age).
- Documented weight loss of at least 5% from baseline while on Wegovy maintenance dose, OR prescriber documents clinical rationale for continued therapy despite not meeting this threshold (e.g., dosing/tolerability adjustments, gradual response).
  Policy clarifies that a ≥5% weight loss from baseline is the continuation threshold used for many long-term maintenance decisions.
- Documentation of ongoing participation in a reduced-calorie diet and increased physical activity program.

Wegovy — Major Adverse Cardiovascular Event(s) (MACE) Risk Reduction (Adult): Initial and Continuing Therapy

ALL of the following

Wegovy — Major Adverse Cardiovascular Event(s) (MACE) Risk Reduction: Initial Therapy (Adults ≥18):
ALL of the following
- Patient is an adult (≥ 18 years of age).
- Current BMI ≥ 27 kg/m2 documented.
- Established cardiovascular disease documented (one of the following): prior myocardial infarction, prior stroke (excluding transient ischemic attack), or symptomatic peripheral arterial disease (e.g., intermittent claudication with ABI < 0.85, prior peripheral arterial revascularization, or amputation due to atherosclerotic disease).

Wegovy — MASH/NASH (Initial and Continuing Therapy)

ALL of the following

Wegovy — MASH/NASH: Initial Therapy (Adults ≥18):
ALL of the following
- Patient is an adult (≥ 18 years of age).
- Diagnosis of non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with stage F2 or F3 fibrosis documented.
- Liver biopsy within the prior 3 years showing F2–F3 fibrosis OR non-invasive imaging (e.g., transient elastography, MRI elastography) within 6 months supporting F2–F3 fibrosis with corroborating clinical data.
- Alcohol use within acceptable limits per clinical guidelines documented (exclusion of alcoholic steatohepatitis).

Zepbound — Obstructive Sleep Apnea (OSA), Moderate-to-Severe (Initial and Continuing)

ALL of the following

Zepbound — Obstructive Sleep Apnea (OSA), Moderate-to-Severe: Initial Therapy (Adults ≥18):
ALL of the following
- Patient is an adult (≥ 18 years of age).
- Current BMI ≥ 30 kg/m2 documented.
- Diagnosis of moderate-to-severe obstructive sleep apnea confirmed by a sleep study with apnea-hypopnea index (AHI) ≥ 15 events/hour (or respiratory disturbance index equivalent).
- Exclusion of predominant central sleep apnea (central events ≥ 50% of total) and Cheyne-Stokes respiration documented.

Conditions Not Covered — Concomitant Use with Other FDA-Approved Weight-Loss Medications

ALL of the following

Conditions Not Covered — Concomitant Use:
ANY of the following
- Concomitant use of two or more GLP-1 receptor agonists (e.g., liraglutide, semaglutide) is not covered (coadministration is not recommended).
- Concomitant use of Zepbound (a GLP-1/GIP agonist) with another GLP-1 agonist or GLP-1/GIP agonist is not covered except in rare, documented clinical scenarios reviewed by the medical director.
Rationale: None of the GLP-1 or GLP-1/GIP agonists are recommended for coadministration in prescribing information; concurrent use increases risk without demonstrated incremental benefit.

Concomitant Use — Zepbound with GLP-1 or GLP-1/GIP Agonists

ALL of the following

Concomitant Use — Zepbound with GLP-1 or GLP-1/GIP agonists:
ALL of the following
- Coadministration of Zepbound with another GLP-1 agonist or GLP-1/GIP agonist is generally not permitted.
- If a prescriber proposes switching therapy (e.g., from a GLP-1 to Zepbound), documentation must show an appropriate washout or clinical rationale and an individualized transition plan; overlapping chronic therapy with two agents is not supported.
- Exceptional cases requesting concomitant use must include detailed clinical justification and will be reviewed by medical director; approval, if granted, will be time-limited and require enhanced monitoring documentation.

Not Covered / Concomitant Use Restrictions

The policy states these agents should not be combined with each other: concomitant use of GLP-1 agonists and GLP-1/GIP agonists with one another is considered not medically necessary. The policy also notes concomitant use with other FDA‑approved weight-loss medications is not recommended. It clarifies that other GLP‑1 agents that do not carry an FDA weight‑loss indication (examples given include Ozempic, Rybelsus, Trulicity, exenatide, and Mounjaro) are not targeted by this policy but combining targeted products with such agents (e.g., Saxenda, Wegovy, or Zepbound with Ozempic or Mounjaro) may lead to denial as not medically necessary. Operational examples and denial risk are explicitly noted in the policy.

Provider Actions and Prior Authorization Requirements

Prior Authorization

Prior authorization required

Prior authorization is recommended for liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound). Typical approval durations: initial authorizations are often limited (for example, ~4 months initial approval for assessment of early response), with continuation approvals commonly issued for up to 1 year when continuation criteria are met. Submit requests to the payer's prior authorization portal with drug name, indication, dose, and duration requested.

Drugs affected: liraglutide (Saxenda), Wegovy (semaglutide), Zepbound (tirzepatide)
Typical authorization durations: initial ~4 months; continuation up to 12 months (subject to plan terms and documented response)

Documentation Required

Baseline BMI and weight-change documentation

Documentation must include the patient’s baseline BMI (measured prior to initiation of any GLP-1 or GLP-1/GIP agonist) and the percent weight change from that baseline. For metabolic risk management indications (e.g., MACE risk reduction, MASH/NASH), include prescriber attestation that weight management is being provided in the context of ongoing metabolic risk optimization (for example, diabetes, lipids, blood pressure management) when applicable.

Coding

Products referencedmixedCovered

Saxenda	liraglutide subcutaneous injection - Novo Nordisk (generic)
Wegovy	semaglutide subcutaneous injection - Novo Nordisk
Zepbound	tirzepatide subcutaneous injection - Eli Lilly

No specific billing codes listed in this partmixed

No codes listed

Background, Evidence and Definitions

Background summarizes product roles, dosing, trials, and guideline context: these agents are indicated with diet and increased physical activity to reduce and maintain weight in adults (and select pediatric indications for liraglutide and semaglutide). Wegovy dosing escalates to a 2.4 mg weekly maintenance (or 1.7 mg QW considered for tolerability); liraglutide escalates to 3 mg daily (with pediatric dosing guidance), and Zepbound escalates to maintenance doses of 5, 10, or 15 mg weekly (10 or 15 mg QW for OSA). Key trial evidence supporting expanded indications includes SELECT (Wegovy) showing a HR 0.80 for MACE vs placebo, ESSENCE (Wegovy) demonstrating significant MASH/NASH resolution at Week 72 (62.9% vs 34.1%), and SURMOUNT‑OSA (Zepbound) showing large reductions in AHI at Week 52 (treatment differences ~ -20 to -24 events/hour). Guideline sources support pharmacotherapy as an adjunct to lifestyle intervention for patients with BMI thresholds and comorbidities; these data and guideline recommendations underpin the policy criteria and required documentation (e.g., baseline BMI defined as prior to any GLP‑1 or GLP‑1/GIP agonist, specialist involvement for Wegovy MASH/NASH, and sleep study requirement for Zepbound OSA).

Study / Evidence	Key result
SELECT trial (Wegovy)	Primary endpoint: MACE HR 0.80 (95% CI: 0.72–0.90); P < 0.001 (6.5% vs 8.0% events Wegovy vs placebo)
ESSENCE trial (Wegovy)	At Week 72, resolution of steatohepatitis with no worsening fibrosis: 62.9% vs 34.1% (difference 28.7%; 95% CI: 21.1%–36.2%; P < 0.001)
SURMOUNT-OSA (Zepbound) - Trial 1	Change in AHI at Week 52: -25.3 vs -5.3 events/hour (treatment difference -20.0; P < 0.001)
SURMOUNT-OSA (Zepbound) - Trial 2	Change in AHI at Week 52: -29.3 vs 5.5 events/hour (treatment difference -23.8; P < 0.001)
SURMOUNT program (tirzepatide) - general (phase 3 obesity trials)	Phase 3 tirzepatide trials demonstrate substantial weight loss in obesity (NEJM publications; supporting efficacy for weight and OSA endpoints)
[{"text":"Phase 3 semaglutide (ESSENCE / semaglutide MASH/NASH publications)","status":""},{"text":"Phase 3 semaglutide data (ESSENCE Part 1 and later phase 3 publications) show histologic MASH benefit including fibrosis improvement and steatohepatitis resolution at Week 72 (see ESSENCE results)
status":""}]

Definitions

ref

title

Revision History

09/13/2023added

Zepbound was added to the policy with new initial and continuation criteria for weight loss (initial approval 8 months, continuation 1 year, with up to 4 months if still titrating).

11/15/2023revised

Baseline BMI notes revised across products to clarify that 'baseline' refers to baseline prior to any GLP-1 or GLP-1/GIP agonist; Zepbound and other product criteria updated and list of comorbidities expanded.

01/31/2024added

Wegovy Major Adverse Cardiovascular Event(s) (MACE) risk reduction indication was added as a new condition of coverage.

Policy Summary

PayerCigna

PolicyWeight Loss - Glucagon-Like Peptide-1 Agonists Prior Authorization Policy

Policy CodePolicy N/A

Change TypeMaterial revisions and additions (indications, dosing/continuation criteria, documentation)

Effective Date

Next Review Date

On This Page

Documentation of a comprehensive lifestyle program (reduced-calorie diet and increased physical activity) attempted or concurrently prescribed.

Prescribed by or in consultation with a clinician experienced in obesity management.

Approval duration: 7 months (initial titration/response assessment period).

Per dosing guidance and policy notes, the 7-month initial period reflects titration to maintenance and early response evaluation (week 16 titration to 2.4 mg reached at Week 17 in PI; policy aligns initial approval to allow assessment).

Wegovy (semaglutide) Initial Therapy — Pediatrics (≥12 years):

ALL of the following

Patient is a pediatric patient ≥ 12 years of age.
Baseline BMI ≥ 95th percentile for age and sex documented.
Documentation of a comprehensive lifestyle program attempted or concurrently prescribed.
Approval duration: 7 months (initial).

Approval duration: 1 year.

Wegovy (semaglutide) Continuing Therapy — Pediatrics:

ALL of the following

Patient is a pediatric patient ≥ 12 years of age.
Documented clinical response per pediatric metrics and ongoing lifestyle program; prescriber documents benefit of continued therapy.
Approval duration: 1 year.

Patient is on optimized guideline-directed medical therapy for secondary prevention (e.g., statin unless contraindicated, antiplatelet therapy as indicated, blood pressure management) with documentation of ongoing cardiovascular risk management.

Concurrent reduced-calorie diet and increased physical activity prescribed or ongoing.

Exclusion of recent use of another GLP-1 or GLP-1/GIP agonist within 90 days prior to initiation (per trial design) should be noted if applicable.

Approval duration: initial period aligned with titration and assessment (unspecified in some source briefs; see continuing therapy for standard 1-year duration).

Wegovy — MACE Risk Reduction: Continuing Therapy (Adults):

ALL of the following

Patient is an adult (≥ 18 years of age).
Documentation of clinical benefit for continued therapy (per prescriber) and ongoing optimized cardiovascular pharmacotherapy and lifestyle program.
Approval duration: 1 year.

Prescribed by or in consultation with a specialist experienced in liver disease (e.g., hepatology, gastroenterology).

Concurrent optimization of treatment for type 2 diabetes, dyslipidemia, and CV risk management is documented.

Approval duration: initial period aligned with titration (policy allows evaluation during initial 7 months); continuing approval considerations below.

Wegovy — MASH/NASH: Continuing Therapy (Adults):

ALL of the following

Documentation of clinical benefit on Wegovy for MASH (per prescriber and relevant objective measures where available) and continued specialist follow-up.
Approval duration: 1 year.

Documentation that conventional OSA therapies (e.g., positive airway pressure) have been considered and are being used as appropriate or documented reasons why they are not tolerated/appropriate.

Prescribed by or in consultation with a clinician experienced in OSA management (e.g., sleep medicine specialist) and obesity management.

Approval duration: initial period consistent with dose escalation to maintenance (per Zepbound dosing); policy supports initial approval to allow titration to maintenance doses (10 mg or 15 mg QW).

Zepbound — Obstructive Sleep Apnea: Continuing Therapy (Adults):

ALL of the following

Patient is an adult (≥ 18 years of age).
Documentation of sustained weight loss of ≥ 10% from baseline OR clinical documentation demonstrating meaningful improvement/stability of OSA (per sleep specialist assessment), and that OSA remains appropriately managed on current therapy.
No clinical evidence of worsening central sleep apnea; ongoing monitoring in place.
Approval duration: 1 year.

Baseline BMI documented prior to any GLP-1 or GLP-1/GIP agonist use
Record percent weight change from baseline at required evaluation timepoints
Include prescriber attestation re: metabolic risk management when indication requires it

Documentation Required

Behavioral modification trial documentation

Prior to initiation of therapy, document a trial of behavioral modification and dietary restriction of at least 3 months duration. The documentation should describe the program or interventions attempted (dietary counseling, exercise program, behavioral therapy), dates of participation, and the patient’s response to these interventions.

≥3 months documented behavioral modification and dietary restriction prior to initiating therapy
Describe interventions, participation dates, and patient response

Documentation Required

Sleep study requirement for OSA indication (Zepbound)

For Zepbound when prescribed for obstructive sleep apnea (OSA), providers must include documentation of a diagnostic sleep study confirming moderate-to-severe OSA. The study must report an apnea-hypopnea index (AHI) ≥ 15. A specific timeframe for when the sleep study was performed has been removed; however, a diagnostic study result demonstrating AHI ≥ 15 is still required.

Diagnostic sleep study required with AHI ≥ 15 for OSA indication (Zepbound)
No strict timeframe required for when study was performed, but a diagnostic result must be provided

Prior Authorization

Wegovy for MASH/NASH — specialist requirement and documentation

Wegovy use for MASH/NASH requires prior authorization and additional documentation. A specialist prescriber (or documented specialist consultation) is required: prescriber must be an endocrinologist, gastroenterologist, or hepatologist. Required documentation for MASH/NASH includes liver biopsy results or appropriate liver imaging demonstrating non-cirrhotic MASH with fibrosis stage consistent with moderate-to-advanced fibrosis (typically F2–F3). Document alcohol intake to confirm it is within policy limits for non-alcoholic disease, and include patient-identifying information (name, DOB, medical record number) on submitted documentation.

Specialist prescriber required: endocrinologist, gastroenterologist, or hepatologist — OR documented specialist consultation
Required diagnostic documentation: liver biopsy OR appropriate imaging documenting MASH with fibrosis stage F2–F3 (non-cirrhotic)
Document alcohol intake and confirm it is within allowable limits for non-alcoholic etiology
All submitted documentation must include patient-identifying information (name, DOB, MRN)

Documentation Required

Documentation required for Wegovy use in MASH/NASH

When requesting Wegovy for MASH/NASH, include full supporting documentation: specialist prescriber or consultation note, liver biopsy or imaging reports documenting MASH with fibrosis stage F2–F3 (non-cirrhotic), clinical history, and alcohol use assessment. Documentation must clearly identify the patient (name, DOB, MRN) and show that standard-of-care optimization for metabolic comorbidities has been addressed or is being managed.

Specialist prescriber or consultation note (endocrinology, gastroenterology, or hepatology)
Liver biopsy report OR imaging report showing MASH with fibrosis stage F2–F3
Alcohol consumption assessment documented to exclude alcoholic liver disease
Patient-identifying information on all documents

Denial Risk

Concomitant GLP-1/GLP-1-GIP use prohibited

Concomitant use of more than one GLP-1 or GLP-1/GIP agonist (for example, liraglutide + semaglutide, semaglutide + tirzepatide, or liraglutide + tirzepatide) is prohibited and may result in claim denial. Concurrent use of a GLP-1 or GLP-1/GIP agonist with another FDA-approved weight-loss medication is not recommended and also may lead to denial; examples include combination therapy with phentermine/topiramate, bupropion/naltrexone, or orlistat. Verify prior therapy and current medications when submitting claims to avoid denial.

Claims may be denied for concomitant GLP-1 + GLP-1/GIP agonist use (e.g., liraglutide + semaglutide; semaglutide + tirzepatide)
Concomitant use with other FDA-approved weight-loss drugs (e.g., phentermine/topiramate, bupropion/naltrexone, orlistat) is not recommended and may be denied
Ensure current medication list and recent prescriptions are provided with authorization requests

ref_value_correction_required

05/08/2024added

Wegovy MASH/NASH indication added; Wegovy for MASH/NASH required specialist prescribing/consultation and documentation (e.g., liver biopsy or imaging) and defined fibrosis/NAS thresholds.

07/12/2023revised

Wegovy continuation criteria were modified to reflect approved maintenance doses (1.7 mg or 2.4 mg QW) and continuation approval tied to tolerability or titration status (later removed in 2025).

01/08/2025revised

Dosing/tolerability requirements requiring patients to tolerate Wegovy maintenance doses (1.7 mg or 2.4 mg QW) were removed and continuation approval duration standardized to 1 year.

01/08/2025revised

Zepbound continuation dosing/tolerability/titration requirements were removed and approval duration for continuing Zepbound changed to 1 year (previously up to 4 months if titrating).

04/03/2024clarified

For Wegovy MACE indication, prior stroke definition clarified to exclude transient ischemic attack (TIA).

05/28/2025clarified

Policy clarified that concomitant use with other medications FDA-approved for weight loss is not recommended; examples updated to reflect availability.

07/09/2025addedLatest

Policy statement updated to include liraglutide generic to Saxenda in the targeted agents list and to define specified gender asterisk; prior authorization recommended for liraglutide (Saxenda, generic), Wegovy, and Zepbound. Last review date recorded.