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Common Prior Authorization Criteria BMI documentation: Most states require a documented BMI of 30 or greater, or 27 or greater with at least one weight-related comorbidity (hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea) Failed lifestyle modification: Typically 3 to 6 months of documented dietary counseling and physical activity recommendations that did not produce adequate weight loss Step therapy: Some states require patients to try and fail less expensive medications (phentermine, orlistat) before approving GLP-1 coverage Provider qualification: Some Medicaid plans require the prescriber to have completed training in obesity medicine
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