Noom: Weight Management — Coverage Criteria
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Defines Highmark West Virginia coverage, eligibility, and enrollment for the Noom: Weight Management digital behavioral program (Noom Weight, Noom DPP, Noom Diabetes Lifestyle) for qualifying members.
No material clinical or coverage changes in this revision.
Coverage Criteria — Program Eligibility
Program-specific eligibility
Covered for qualifying adult Highmark members when the following eligibility criteria are met for each program:
Enrollment track is determined by member responses to a pre-enrollment questionnaire
For the Noom Diabetes Prevention Program (DPP), members must screen positive for prediabetes on the CDC questionnaire to meet inclusion for that track. Members who do not screen positive on the CDC questionnaire are excluded from DPP enrollment. This screening requirement is an enrollment caveat specific to the DPP track and must be completed prior to program assignment.
BMI Threshold and Definitions
Provider Actions, Enrollment & Authorization
Prior authorization
No prior authorization is specified in the policy; enrollment and access are determined by each member's plan benefits via the Highmark member app or web portal.
Program assignment (no step therapy)
No step therapy or sequential treatment requirements are specified. Program assignment (Noom Weight, Noom DPP, or Noom Diabetes Lifestyle) is determined by responses to the pre-enrollment questionnaire and member-reported conditions.
Enrollment method
Members must enroll in Noom: Weight Management through the My Highmark app or the Highmark web portal; enrollment and related documentation are managed via the member portal.
Plan-specific coverage may limit access
Coverage for each program component may vary by the member's specific Highmark plan; if a component is not included in a member's plan, access to that component may be denied.
Background on Noom Programs
Noom is a digital behavioral-weight-management platform that offers multiple program tracks to support lifestyle change and chronic disease prevention and management. The platform includes Noom Weight (a behavioral program for weight loss using food logging, coaching, and education), Noom DPP (a CDC-aligned Diabetes Prevention Program focused on healthy eating and physical activity with personalized coaching and social support), and Noom Diabetes Lifestyle (a diabetes-specific program providing coaching, medication tracking, blood glucose logging, and predictive glucose tools for members with type 2 diabetes).
Reported clinical outcomes from Noom include reductions in HbA1c and blood glucose and high user engagement. Enrollment into a specific Noom track is determined by member responses to a pre-enrollment questionnaire and plan eligibility; plan benefit coverage may vary by component and can affect access. Members enroll via the My Highmark app or web portal as part of the enrollment process.
Program Definitions
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