Weight Loss Drug Coverage List
Lists weight-loss medications covered under Priority Health employer group and individual plans with a weight loss rider and notes related utilization management (prior authorization, step therapy) and generic-first requirements.
No material clinical or coverage changes in this revision.
Coverage Criteria
The list of covered weight-loss products below is informational and not complete. Coverage can vary by employer group and individual plan; some drugs may be excluded under a member’s specific plan. Members and providers should verify plan-specific coverage, exclusions, and requirements by reviewing the member’s plan documents in their member account or the Priority Health formulary.
Provider Actions and Utilization Management
Prior Authorization May Apply
Prior authorization may be required for some medications. Before prescribing, verify whether the drug needs prior authorization through the member’s plan formulary and the Priority Health prior authorization lists.
- Check the member’s specific plan formulary and prior authorization lists at priorityhealth.com/formulary or the provider portal.
- If prior authorization is required, submit the required clinical information per Priority Health guidelines to avoid claim denial or delay.
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