Antidiabetics - GLP-1 Agonists
Customize your policy alerts
Sign up for Washington State Health Care Authority Policy 27.17.00-5 alerts
Get alerted when Policy 27.17.00-5 changes without checking for updates manually.
Monitor payer policy activity
This policy governs prior authorization and medical-necessity coverage for GLP-1 agonists used primarily to treat type 2 diabetes, including specified criteria for tirzepatide in adults with obesity and moderate-to-severe obstructive sleep apnea. It applies to providers requesting coverage through Washington State Health Care Authority Apple Health.
The required trial for non-preferred GLP-1 products was changed to two preferred products.
Initial and reauthorization criteria for semaglutide for MACE, MASH, and ESRD were removed.
The dosage and quantity limits chart was updated.
Bydureon Bcise and Byetta were removed from the policy.
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.