Orlistat (Xenical) clinical coverage
Defines medical necessity criteria, prior authorization requirements, dosing limits, and coverage for orlistat (Xenical) for commercial and HIM lines of business. Applies to providers requesting coverage of orlistat for weight management and other indications per the policy.
Added requirement for documentation of baseline and current height and weight within the last 30 days to initial criteria and for reauthorization current weight within last 30 days.
Added requirement that documentation of participation in an approved weight loss program show active enrollment for at least 6 months prior to use and continuation during therapy.
Specified positive response to therapy for continuation: first reauthorization requires ≥5% baseline body weight loss (adults) or baseline BMI (pediatrics); subsequent reauthorizations require continued loss or maintenance.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.