Some are rigorous
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For example, Kaiser Northwest members may have Zepbound coverage for weight loss if they: Have a diagnosis for chronic weight management Are 18 years or older Have a body mass index (BMI) greater than or equal to 30 kg/m2 (classified as obesity) or 27 kg/m2 (classified as overweight) and have a diagnosis of high blood pressure, diabetes, or high cholesterol Are following a diet and exercise program Have previously tried at least two drugs such as phentermine, diethylpropion, Qsymia (phentermine/topiramate), or Contrave (naltrexone/bupropion) without success (or cannot take or tolerate other drugs) Tried semaglutide (Wegovy or Ozempic) and it didnt work, or they cant take semaglutide due to an allergy, serious side effects, or contraindication The same Kaiser plan may cover Zepbound for OSA for members who are 18 or older who have obesity and meet all of the following criteria: Have no personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 Have been diagnosed with severe sleep apnea, but does notinclude central or complex apnea Have had a sleep study within the three past years Are following a diet and exercise program Have tried other preferred medications or have allergies to them Some Kaiser plans may also require your healthcare provider to submit prior authorization before the drug is covered
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Neuromodulatory control of energy reserves in dopaminergic neurons
