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BMI above 30 PPO Requirements: Pre-authorization Higher need for the medication Medical necessity (Labs, Clinical History, Medical Records) BMI of 27 or more with a cardiovascular risk BMI of 30 or more without cardiovascular risk Documentation of participation in lifestyle intervention consisting of reduced calorie diet, increased physical activity and behavioral modification for 6 months within the last year Some insurances might need BMI above 40 HMO Requirements: May use health carrier plan or pharmacy insurance May require prior authorization Medical necessity (Labs, Clinical History, Medical Records) Insurance Disclaimer (California) GLP-1 medications may not be covered by all California insurance plans
