Weight-loss medication program and prior authorization requirements
Describes HealthPartners' requirements for Minnesota Medical Assistance (Medicaid) members to access weight-loss medications and an associated coaching program; covers prior authorization, documentation expectations, and the coaching program structure. Affects clinicians prescribing weight-loss medications and members enrolled in Medicaid plans served by HealthPartners in Minnesota.
No material clinical or coverage changes in this revision.
Prior Authorization and Coaching Program Requirements
Prior Authorization and Ongoing Documentation Requirements
Coverage for weight-loss medication requires prior authorization and ongoing clinician documentation. Coverage is conditional and requires meeting all of the following expectations:
- Prior authorization (approval ahead of time) is required for weight-loss medication for Medical Assistance (Medicaid) members.
- Clinician must document why the member needs the medication.
- Clinician must document the lifestyle changes the member is making (diet, exercise, other behavioral changes).
- Clinician must document how the member is doing while taking the medication (ongoing monitoring/progress).
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