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Your doctor must submit a prior authorization request attesting that you met one of the following criteria: Pathway 1: BMI of 35 or higher at the time GLP-1 therapy was initiated (no additional conditions required) Pathway 2: BMI of 30 or higher, plus a diagnosis of heart failure with preserved ejection fraction, uncontrolled hypertension (systolic blood pressure above 140 mm Hg), or chronic kidney disease stage 3a or higher Pathway 3: BMI of 27 or higher, plus a diagnosis of pre-diabetes (per American Diabetes Association guidelines), a previous heart attack, a previous stroke, or symptomatic peripheral artery disease The medication must also be prescribed in combination with ongoing lifestyle modification, including structured nutrition and physical activity guidance consistent with the FDA-approved drug label
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