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Based on Kaiser formulary bulletins and member-reported experiences, most regions require the following before approving Wegovy: Clinical eligibility: BMI of 30 kg/m or greater, or BMI of 27 kg/m or greater with at least one weight-related condition (type 2 diabetes, hypertension, dyslipidemia, or obstructive sleep apnea) Documentation that the member has participated in a Kaiser-affiliated lifestyle or behavioral weight-management program for a minimum of 3 to 6 months Lab work within the past 6 months including fasting glucose, HbA1c, lipid panel, and thyroid function Prescriber requirements: The prescribing physician must be a Kaiser-employed or contracted provider A referral to Kaiser's obesity-medicine or endocrinology department is typically required before the PA can be submitted The obesity-medicine specialist's notes must confirm medical necessity The clinical rationale for these layers traces back to the STEP-1 trial (N=1,961), which demonstrated 14.9% mean body-weight loss with semaglutide 2.4 mg at 68 weeks versus 2.4% with placebo
Tips for Kaiser Members Trying to Get GLP-1 Coverage Start the weight management program immediately
Participants who took the stronger dose lost about 19% of their body weight, or about 47 pounds on average
For patients who want the most clinically rigorous approach available through telehealth, IVIM stands out
A 90-degree angle, straight into the skin, is appropriate when you can grasp at least 2 inches of tissue in your skin pinch
And what does your own health situation have to do with the choice
